Press Release WHO/23 13 February 1998     DRAMATIC UPSURGE IN VISCERAL LEISHMANIASIS CASES IN THE HORN OF AFRICA    There has been a dramatic upsurge in cases of visceral leishmaniasis (VL) in Ethiopia, Eritrea and Sudan in the last months of 1997 and the beginning of 1998. In Sudan, over 2 500 confirmed cases were registered in one treatment centre in Gedaref State (eastern Sudan) from October to December 1997, out of a total of 4 400 cases registered for the whole of 1997 in the same treatment centre which is run by Médecins sans Frontières (MSF) Holland. This represents an increase of 439% compared to the same period in 1996. Eritrea and Ethiopia have also reported a sharp increase in cases during 1997, and the Tigray health bureau (in Ethiopia) has issued an urgent request to the World Health Organization (WHO) for serological facilities and drugs. "Visceral leishmaniasis has become an emergency health problem in Eritrea, Ethiopia and Sudan, where it has been endemic for years. The high mortality rate in this outbreak is mainly due to the absence of diagnostic facilities and the non-availability of first-line drugs at local level," said Dr Ralph Henderson, Assistant Director-General of WHO. In the absence of treatment, the mortality rate is close to 100% from the disease in these areas, while, with treatment, it is normally under 10% (with deaths mainly due to associated diseases). The current outbreak is also being exacerbated by the massive population migration among these three countries (due to the traditional seasonal migration of workers and the resettlement of returnees and refugees in highly endemic areas). Although a simple diagnostic test and an effective first-line, specific treatment exist, these are not available for the majority of people suffering from the disease. In this area of Africa, approximately 65% of VL cases are found in children less than 15 years old. Malnourished children, who often suffer simultaneously from associated diseases such as tuberculosis, respiratory and/or intestinal infections, are particularly vulnerable. The Ministry of Health of Sudan has requested the urgent assistance of WHO in combatting this disease. Although MSF Holland have been active in addressing the outbreak in Sudan, stocks of the first-line drugs (Pentavalent antimonials) risk being exhausted soon. WHO's Divisions of Control of Tropical Diseases (CTD), Emergency and Humanitarian Assistance (EHA), and Emerging and other Communicable Diseases Surveillance and Control (EMC), in coordination with the corresponding WHO Regional and Country Offices, and MSF Holland, are working together to launch an immediate response to this multi-country epidemic emergency. The response will include the establishment of diagnostic facilities in decentralized laboratories and remote areas, the provision of first-line drugs, and distribution of insecticide-impregnated bednets. The leishmaniases are a widespread group of parasitic diseases, transmitted by the female phlebotomine sandfly, and have a broad range of clinical manifestations. VL, also known as kala azar, is the most severe form of the disease, with an almost 100% mortality rate if left untreated. It is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia. Leishmaniases are now endemic in 88 countries on five continents - Africa, Asia, Europe, North America and South America - with a total of 350 million people at risk. Five-hundred thousand new cases of VL occur every year. Currently, it is believed that 12 million cases of all forms of the disease exist worldwide. Only approximately one-third of new cases are ever officially declared. For further information please contact Gregory Hartl, Health Communications and Public Relations, WHO, Geneva. Telephone (+41 22) 791 4458. Fax (+41 22) 791 4858. Email hartlg@who.ch .; or Dr Philippe Desjeux, WHO/CTD, Genève. Tel: (41 22) 791 3870, fax (41 22) 791 4777. E-mail: desjeuxp@who.ch All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.ch