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-
1.
World Health Organization , 2023. Leishmaniasis. Available at: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis. Accessed November 4, 2022.
-
2.
Maroli M , Feliciangeli MD , Bichaud L , Charrel RN , Gradoni L , 2013. Phlebotomine sandflies and the spreading of leishmaniases and other diseases of public health concern. Med Vet Entomol 27: 123–147.
-
3.
World Health Organization , 2022. Regional Strategic Framework for Elimination of Kala-azar from the South-East Asia Region, 2022–2026. New Delhi, India: WHO.
-
4.
Rijal S , Sundar S , Mondal D , Das P , Alvar J , Boelaert M , 2019. Eliminating visceral leishmaniasis in South Asia: The road ahead. BMJ 364: k5224.
-
5.
World Health Organization , 2019. Independent Assessment of Kala-azar Elimination Programme India. Geneva, Switzerland: WHO.
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6.
Ministry of Health and Population , 2019. National Guideline on Kala-azar Elimination Program 2019. Kathmandu, Nepal: Ministry of Health and Population, Government of Nepal.
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7.
Ministry of Health , 2023. National Guideline for the Prevention, Diagnosis and Management of Leishmaniasis in Bhutan, 2023. 2nd ed. Gelephu, Bhutan: Ministry of Health, Royal Government of Bhutan.
-
8.
Yangzom T , Cruz I , Bern C , Argaw D , den Boer M , Vélez ID , Bhattacharya SK , Molina R , Alvar J , 2012. Endemic transmission of visceral leishmaniasis in Bhutan. Am J Trop Med Hyg 87: 1028–1037.
-
9.
Tharakan SJ , Cv DP , Karthik R , Rupa V , Rose W , Thomas M , Manuel M , Rupali P , Pulimood S , Rao Ajjampur SS , 2021. Case report: A single-center case series on skin manifestations of leishmaniasis from a non-endemic state in southern India. Am J Trop Med Hyg 104: 928–933.
-
10.
Bhattacharya SK , Rinzin N , Chusak P , Dash AP , Chowdhury R , Tobgay T , Narain JP , 2010. Occurrence & significance of kala-azar in Bhutan. Indian J Med Res 132: 337–338.
-
11.
Wangdi T, Sananayake S, Dorjee S, Tobgay T, Zhou G, Piyasiri SB, Weerasinghe L, Karunaweera N, 2024. Distribution and seasonal variation of Phlebotomus and Sergentomyia sand fly populations in Bhutan. Am J Trop Med Hgy (in press).
-
12.
World Health Organization , 2022. Operational Manual on Leishmaniasis Vector Control, Surveillance, Monitoring and Evaluation. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/i/item/9789240060340. Accessed February 8, 2024.
-
13.
Galluzzi L , Ceccarelli M , Diotallevi A , Menotta M , Magnani M , 2018. Real-time PCR applications for diagnosis of leishmaniasis. Parasit Vectors 11: 273.
-
14.
Bajgai GP , Tshering S , Pradhan B , Pradhan AR , Yangzom P , 2023. Oral mucosal leishmaniasis presenting as a nonhealing chronic oral growth: A case report. Clin Case Rep 11: e7234.
-
15.
Ministry of Health , 2023. National Essential Medicines List 2023. Thimphu, Bhutan: Ministry of Health, Royal Government of Bhutan.
-
16.
Silva H , Liyanage A , Deerasinghe T , Chandrasekara V , Chellappan K , Karunaweera ND , 2021. Treatment failure to sodium stibogluconate in cutaneous leishmaniasis: A challenge to infection control and disease elimination. PLoS One 16: 1–16.
-
17.
World Health Organization , 2022. WHO Guideline for the Treatment of Visceral Leishmaniasis in HIV Co-infected Patients in East Africa and South-East Asia. Geneva, Switzerland: WHO.
-
18.
Gedda MR , Singh B , Kumar D , Singh AK , Madhukar P , Upadhyay S , Singh OP , Sundar S , 2020. Post kala-azar dermal leishmaniasis: A threat to elimination program. PLoS Negl Trop Dis 14: e0008221.
-
19.
World Health Organization , 2020. Ending the Neglect to Attain the Sustainable Development Goals: A road Map for Neglected Tropical Diseases 2021–2030. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/i/item/9789240010352. Accessed February 8, 2024.
-
20.
National Statistics Bureau , 2022. Bhutan Poverty Analysis Report 2022. Thimphu, Bhutan: National Statistics Bureau.
-
21.
Pradhan A , Tobgay T , Dorjee S , Wangdi T , Zhou G , Karunaweera ND , 2020. Atypical presentation of post-kala-azar dermal leishmaniasis in Bhutan. Case Rep Dermatol Med 2020: 8899586.
-
22.
Uranw S , Hasker E , Roy L , Meheus F , Das ML , Bhattarai NR , Rijal S , Boelaert M , 2013. An outbreak investigation of visceral leishmaniasis among residents of Dharan town, eastern Nepal, evidence for urban transmission of Leishmania donovani. BMC Infect Dis 13: 21.
-
23.
Tsheten T , Mclure A , Clements ACA , Gray DJ , Wangdi T , Wangchuk S , Wangdi K , 2021. Epidemiological analysis of the 2019 dengue epidemic in Bhutan. Int J Environ Res Public Health 18: 354.
-
24.
Pandey K , Dumre SP , Shah Y , Acharya BK , Khanal L , Pyakurel UR , Kaneko O , Pandey BD , 2023. Forty years (1980–2019) of visceral leishmaniasis in Nepal: Trends and elimination challenges. Trans R Soc Trop Med Hyg 117: 460–469.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1475 | 1475 | 145 |
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Efforts toward the Elimination of Visceral Leishmaniasis in South Asia: A Review of Progress in Bhutan
Thinley Dorji
Thinley Dorji
Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan;
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Sithar Dorjee
Sithar Dorjee
Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;
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Tenzin Wangdi
Tenzin Wangdi
Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;
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Tshokey Tshokey
Tshokey Tshokey
Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;
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Ambika Rani Pradhan
Ambika Rani Pradhan
Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;
Department of Dermatology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;
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Department of Dermatology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;
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Kinley Penjor
Kinley Penjor
Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;
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Rinzin Namgay
Rinzin Namgay
Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;
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Togbye Togbye
Togbye Togbye
Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;
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Nadira Karunaweera
Nadira Karunaweera
Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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ABSTRACT.
Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of Phlebotomus and three species of Sergentomyia sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence <1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country’s medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.
Author Notes
Financial support: A part of the data presented here was gathered through the leishmaniasis project that was jointly implemented by the Khesar Gyalpo University of Medical Sciences of Bhutan and the Vector-Borne Disease Control Program, Ministry of Health, under the funding of the
Authors’ contributions: All authors were involved in the conception of this manuscript. T. Dorji wrote the manuscript. All authors were involved in critical review, editing, and final approval of the manuscript for publication.
Authors’ addresses: Thinley Dorji, Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan, E-mail: dorji.thinleydr@gmail.com. Sithar Dorjee, Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan, E-mail: s.dorjee@kgumsb.edu.bt. Tenzin Wangdi, Rinzin Namgay, and Togbye, Vector-Borne Disease Control Program, Ministry of Health, Gelephu, Bhutan, E-mails: karbay2014@gmail.com, rinzin69@yahoo.com, and tobgye@health.gov.bt. Tshokey, Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, E-mail: doc_tshokey@yahoo.com. Ambika Rani Pradhan, Department of Dermatology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan, E-mail: arpradhan@jdwnrh.gov.bt. Kinley Penjor, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan, E-mail: kinleypal@gmail.com. Nadira Karunaweera, Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, E-mail: nadira@parasit.cmb.ac.lk.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2023. Leishmaniasis. Available at: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis. Accessed November 4, 2022.
-
2.
Maroli M , Feliciangeli MD , Bichaud L , Charrel RN , Gradoni L , 2013. Phlebotomine sandflies and the spreading of leishmaniases and other diseases of public health concern. Med Vet Entomol 27: 123–147.
-
3.
World Health Organization , 2022. Regional Strategic Framework for Elimination of Kala-azar from the South-East Asia Region, 2022–2026. New Delhi, India: WHO.
-
4.
Rijal S , Sundar S , Mondal D , Das P , Alvar J , Boelaert M , 2019. Eliminating visceral leishmaniasis in South Asia: The road ahead. BMJ 364: k5224.
-
5.
World Health Organization , 2019. Independent Assessment of Kala-azar Elimination Programme India. Geneva, Switzerland: WHO.
-
6.
Ministry of Health and Population , 2019. National Guideline on Kala-azar Elimination Program 2019. Kathmandu, Nepal: Ministry of Health and Population, Government of Nepal.
-
7.
Ministry of Health , 2023. National Guideline for the Prevention, Diagnosis and Management of Leishmaniasis in Bhutan, 2023. 2nd ed. Gelephu, Bhutan: Ministry of Health, Royal Government of Bhutan.
-
8.
Yangzom T , Cruz I , Bern C , Argaw D , den Boer M , Vélez ID , Bhattacharya SK , Molina R , Alvar J , 2012. Endemic transmission of visceral leishmaniasis in Bhutan. Am J Trop Med Hyg 87: 1028–1037.
-
9.
Tharakan SJ , Cv DP , Karthik R , Rupa V , Rose W , Thomas M , Manuel M , Rupali P , Pulimood S , Rao Ajjampur SS , 2021. Case report: A single-center case series on skin manifestations of leishmaniasis from a non-endemic state in southern India. Am J Trop Med Hyg 104: 928–933.
-
10.
Bhattacharya SK , Rinzin N , Chusak P , Dash AP , Chowdhury R , Tobgay T , Narain JP , 2010. Occurrence & significance of kala-azar in Bhutan. Indian J Med Res 132: 337–338.
-
11.
Wangdi T, Sananayake S, Dorjee S, Tobgay T, Zhou G, Piyasiri SB, Weerasinghe L, Karunaweera N, 2024. Distribution and seasonal variation of Phlebotomus and Sergentomyia sand fly populations in Bhutan. Am J Trop Med Hgy (in press).
-
12.
World Health Organization , 2022. Operational Manual on Leishmaniasis Vector Control, Surveillance, Monitoring and Evaluation. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/i/item/9789240060340. Accessed February 8, 2024.
-
13.
Galluzzi L , Ceccarelli M , Diotallevi A , Menotta M , Magnani M , 2018. Real-time PCR applications for diagnosis of leishmaniasis. Parasit Vectors 11: 273.
-
14.
Bajgai GP , Tshering S , Pradhan B , Pradhan AR , Yangzom P , 2023. Oral mucosal leishmaniasis presenting as a nonhealing chronic oral growth: A case report. Clin Case Rep 11: e7234.
-
15.
Ministry of Health , 2023. National Essential Medicines List 2023. Thimphu, Bhutan: Ministry of Health, Royal Government of Bhutan.
-
16.
Silva H , Liyanage A , Deerasinghe T , Chandrasekara V , Chellappan K , Karunaweera ND , 2021. Treatment failure to sodium stibogluconate in cutaneous leishmaniasis: A challenge to infection control and disease elimination. PLoS One 16: 1–16.
-
17.
World Health Organization , 2022. WHO Guideline for the Treatment of Visceral Leishmaniasis in HIV Co-infected Patients in East Africa and South-East Asia. Geneva, Switzerland: WHO.
-
18.
Gedda MR , Singh B , Kumar D , Singh AK , Madhukar P , Upadhyay S , Singh OP , Sundar S , 2020. Post kala-azar dermal leishmaniasis: A threat to elimination program. PLoS Negl Trop Dis 14: e0008221.
-
19.
World Health Organization , 2020. Ending the Neglect to Attain the Sustainable Development Goals: A road Map for Neglected Tropical Diseases 2021–2030. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/i/item/9789240010352. Accessed February 8, 2024.
-
20.
National Statistics Bureau , 2022. Bhutan Poverty Analysis Report 2022. Thimphu, Bhutan: National Statistics Bureau.
-
21.
Pradhan A , Tobgay T , Dorjee S , Wangdi T , Zhou G , Karunaweera ND , 2020. Atypical presentation of post-kala-azar dermal leishmaniasis in Bhutan. Case Rep Dermatol Med 2020: 8899586.
-
22.
Uranw S , Hasker E , Roy L , Meheus F , Das ML , Bhattarai NR , Rijal S , Boelaert M , 2013. An outbreak investigation of visceral leishmaniasis among residents of Dharan town, eastern Nepal, evidence for urban transmission of Leishmania donovani. BMC Infect Dis 13: 21.
-
23.
Tsheten T , Mclure A , Clements ACA , Gray DJ , Wangdi T , Wangchuk S , Wangdi K , 2021. Epidemiological analysis of the 2019 dengue epidemic in Bhutan. Int J Environ Res Public Health 18: 354.
-
24.
Pandey K , Dumre SP , Shah Y , Acharya BK , Khanal L , Pyakurel UR , Kaneko O , Pandey BD , 2023. Forty years (1980–2019) of visceral leishmaniasis in Nepal: Trends and elimination challenges. Trans R Soc Trop Med Hyg 117: 460–469.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1475 | 1475 | 145 |
| Full Text Views | 61 | 61 | 6 |
| PDF Downloads | 82 | 82 | 5 |