title: Complexities of assessing the disease burden attributable to leishmaniasis.
abstract: Among parasitic diseases, morbidity and mortality caused by leishmaniasis are surpassed only by malaria and lymphatic filariasis. However, estimation of the leishmaniasis disease burden is challenging, due to clinical and epidemiological diversity, marked geographic clustering, and lack of reliable data on incidence, duration, and impact of the various disease syndromes. Non-health effects such as impoverishment, disfigurement, and stigma add to the burden, and introduce further complexities. Leishmaniasis occurs globally, but has disproportionate impact in the Horn of Africa, South Asia and Brazil (for visceral leishmaniasis), and Latin America, Central Asia, and southwestern Asia (for cutaneous leishmaniasis). Disease characteristics and challenges for control are reviewed for each of these foci. We recommend review of reliable secondary data sources and collection of baseline active survey data to improve current disease burden estimates, plus the improvement or establishment of effective surveillance systems to monitor the impact of control efforts.
authors.affiliation: Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. CBern@cdc.gov
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
authors.forename: Jorge
authors.initials: J
authors.lastname: Alvar
mesh_terms: D000818:Animals; D003140:Communicable Disease Control; D014943:Global Health; D006801:Humans; D007891:Leishmania / Q000502:physiology; D007896:Leishmaniasis / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control