Spatial analysis ofLeishmania donovaniexposure in humans and domestic animals in a recent kala azar focus in Nepal

Abstract

SUMMARYVisceral leishmaniasis (VL) is a major public health problem in the Indian subcontinent where theLeishmania donovanitransmission 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 toL. donovanion 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 toL. 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 ofL. donovani, in particular in this new VL focus.