The 2017 budget set out by Finance Minister Arun Jaitley has established a number of diseases set to be eliminated. Among these is kala-azar. However, previous governments have often said before that India was on the verge of elimination and all have been proved wrong.
Of the disease targeted in the budget such as TB and leprosy, kala-azar, or visceral leishmaniasis (VL), also known as black fever, stands out as the most likely to be eliminated. Perhaps one of the most important factors to its elimination is the fact that cases are currently geographically isolated. Bihar currently houses 90% of all VL patients, with three other states – Jharkhand, West Bengal and Uttar Pradesh – also known to have VL cases.
Despite being the most likely to be eliminated, this target has been set and was not attained in previous announcements by the Indian government. In 2014 the then Health Minister Harsh Vardhan claimed the disease would be eliminated by 2015. Previous deadlines had been set for 2010. Issues arise if the disease is not treated quickly, as with any untreated infectious conditions, if left unchecked the patient increases the potential for further infection of others.
VL is caused by an infection from protozoan parasites of any of more than twenty leishmania species. The protozoan parasites are spread by bites from infected female phlebotomine sandflies. The parasitic infection primarily affects the liver and spleen, causing swelling, fever, weight loss, fatigue and anaemia. There is the potential for the disease to become fatal if left untreated.
Symptoms can subside following treatment though a number of patients may eventually develop Post Kala-azar Dermal Leishmaniasis (PKDL) in which the parasite migrates to skin cells. Though not fatal, this form of the disease can inhibit any attempts to eliminate the disease by acting as a reservoir for the parasite. Sandfly bites of a PKDL infected person may then infect more sandflies and again spread the parasites to other human hosts.
The announcement to eradicate VL in India by 2015 was based on the rollout of free injections of amphotericin B to those infected with the disease. Though the goal of 2015 was not achieved, this is likely due to the either poor management of the scheme or lack of funding rather than the effectiveness of the medication.
Clinical trials of amphotericin B have shown an efficacy of around 99%, the implication of this is that, had the infected patients all been treated the disease would be all but eliminated. Since this is not the case the assumption can be made that the free injections were not available in most cases.
A more optimistic view is that India clearly has the medicinal means to treat the disease. Add to this the fact that the disease is not national, but limited to a small number of states makes it far simpler to address. Should an effective campaign of diagnosis and immediate administration of amphotericin B take place it is well within the grasp of the Indian government to have VL eradicated in potentially just a few years.