Natural history of a visceral leishmaniasis outbreak in highland Ethiopia
Lima, M A
Palma, P P
AffiliationDisease Prevention and Control Programmes, World Health Organization, Addis Ababa, Ethiopia; Médecins Sans Frontières-Ethiopia, Operational Centre Barcelona-Athens, Addis Zemen, Ethiopia; Department for the Control of Neglected Tropical Diseases, Leishmaniasis Control Program, World Health Organization, Geneva, Switzerland; National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain; Médecins Sans Frontières, Medical Department, Operational Centre Barcelona-Athens (OCBA), Barcelona, Spain; Malaria and Other Vector Borne Diseases, Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia; Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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AbstractIn May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemken, Ethiopia, a highland region where only few cases had been reported before. We analyzed records of VL patients treated from May 25, 2005 to December 13, 2007 by the only VL treatment center in the area, maintained by Médecins Sans Frontières-Ethiopia, Operational Center Barcelona-Athens. The median age was 18 years; 77.6% were male. The overall case fatality rate was 4%, but adults 45 years or older were five times as likely to die as 5-29 year olds. Other factors associated with increased mortality included HIV infection, edema, severe malnutrition, pneumonia, tuberculosis, and vomiting. The VL epidemic expanded rapidly over a several-year period, culminating in an epidemic peak in the last third of 2005, spread over two districts, and transformed into a sustained endemic situation by 2007.
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