Project Component 3:

Development of VL outbreak management strategy in relation to national kala-azar elimination programme

The national VL elimination program has achieved 96% of its target in 2014. The VL burden has come down dramatically as a result of both program interventions and natural trend of the disease. Since VL case load is decreasing and the disease is clustered, the program is focussing their control interventions on 25 sub-districts. However, VL cases are re-emerging from sub-districts where cases with PKDL are left unidentified and untreated and where program activities have stopped. In 2015, there were 420 new cases of VL reported in the country; this gradual decline means that the programme needs to be alert and responsive to a spike in new cases in previously highly endemic areas where there have been a gradual and consistent fall, and also to new cases emerging in areas that were previously considered non-endemic. As time progresses, the geographical spread will further evolve, and strategies to define and deal with these ‘outbreaks’ need to identified. For example, to understand if a new case in a previously non-endemic area is a result of local transmission or indeed simply an imported case from an endemic area, and react appropriately to ensure that the ‘outbreak’ does not progress and the area become a new ‘hotspot’ for disease.

Till now there is no proper strategy particularly for VL outbreak management in the national VL elimination guideline. The national program is about to introduce an activity known as “No Kala-azar transmission activity (NKTA)”  in VL endemic communities of the country. The NKTA includes house to house search for VL and PKDL suspects with or without indoor residual spraying and deploying larvicide in about 60-100 households around the house of a recently reported VL case (known as the “index case”). This could be an effective platform for VL outbreak management. Considering the objective of consolidation phase of elimination programme, it is also important to generate a definition of VL outbreak in Bangladesh and develop an outbreak management strategy accordingly. The objective of this component of the project is to generate VL specific outbreak management plan, composition of outbreak management team under NKEP and capacity build up of the team on outbreak investigation. We hope that the activity will have significant contribution to sustain the VL elimination target for long run in Bangladesh.

Central level training on VL outbreak management in BangladeshTraining on VL outbreak management in Bangladesh at Upazila level