title: Spatial analysis of Leishmania donovani exposure in humans and domestic animals in a recent kala azar focus in Nepal.
abstract: Visceral leishmaniasis (VL) is a major public health problem in the Indian subcontinent where the Leishmania donovani transmission cycle is described as anthroponotic. However, the role of animals (in particular domestic animals) in the persistence and expansion of VL is still a matter of debate. We combined Direct Agglutination Test (DAT) results in humans and domestic animals with Geographic Information System technology (i.e. extraction maps and scan statistic) to evaluate the exposure to L. donovani on these 2 populations in a recent VL focus in Nepal. A Poisson regression model was used to assess the risk of infection in humans associated with, among other factors, the proportion of DAT-positive animals in the proximities of the household. The serological results showed that both humans and domestic animals were exposed to L. donovani. DAT-positive animals and humans were spatially clustered. The presence of serologically positive goats (IRR=9.71), past VL cases (IRR=2.62) and the proximity to a forest island dividing the study area (IRR=3.67) increased the risk of being DAT-positive in humans. Even if they are not a reservoir, domestic animals, and specially goats, may play a role in the distribution of L. donovani, in particular in this new VL focus.
authors.affiliation: BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Basudha
authors.initials: B
authors.lastname: Khanal
authors.forename: Albert
authors.initials: A
authors.lastname: Picado
authors.forename: Narayan Raj
authors.initials: NR
authors.lastname: Bhattarai
authors.forename: Gert
authors.initials: G
authors.lastname: Van Der Auwera
authors.forename: Murari Lal
authors.initials: ML
authors.lastname: Das
authors.forename: Bart
authors.initials: B
authors.lastname: Ostyn
authors.forename: Clive Richard
authors.initials: CR
authors.lastname: Davies
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dujardin
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000372:Agglutination Tests / Q000379:methods; D000818:Animals; D000829:Animals, Domestic / Q000469:parasitology*; D000913:Antibodies, Protozoan / Q000097:blood; D000953:Antigens, Protozoan / Q000276:immunology; D002020:Buffaloes / Q000469:parasitology; D002417:Cattle / Q000469:parasitology; D002418:Cattle Diseases / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D040362:Geographic Information Systems; D015511:Goat Diseases / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D006041:Goats / Q000469:parasitology; D006801:Humans; D007893:Leishmania donovani / Q000276:immunology*; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission / Q000662:veterinary; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan