Leishmaniasis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Primary prevention of leishmanial infection relies on reservoir host control in areas with zoonotic transmission; vector control activities, such as indoor residual spraying and/or insecticide-treated nets; and measures to decrease transmission of infectious agents in IDUs, such as NEPs. For North American residents, these measures are only relevant during travel. The best way for travelers to prevent leishmaniasis is by protecting themselves from sand fly bites. Vaccines and drugs for preventing infection are not yet available. There is no vaccine or prophylactic medication to prevent the infection from Leishmania spp.
Primary Prevention
- Personal protective measures include minimizing nocturnal outdoor activities, wearing protective clothing, and applying insect repellent to exposed skin: [1]
- Avoid outdoor activities, especially from dusk to dawn, when sand flies generally are the most active.
- Wear protective clothing and apply insect repellent to exposed skin and under the edges of clothing, such as sleeves and pant legs, according to the manufacturer’s instructions.
- Sleep in air-conditioned or well-screened areas. Spraying the quarters with insecticide might provide some protection. Fans or ventilators might inhibit the movement of sand flies, which are weak fliers.
- In general, prevention and control measures must be tailored to the local setting and typically are difficult to sustain.
- Control measures against sand fly vectors or animal reservoir hosts might be effective in some settings.
- In many geographic areas where leishmaniasis is found in people, infected people are not needed to maintain the transmission cycle of the parasite in nature; animal reservoir hosts (such as rodents or dogs), along with sand flies, maintain the cycle. For example, in L. infantum/L. chagasi-endemic regions, dogs serve as the main reservoir hosts; control strategies for such areas are being evaluated.
- In some parts of the world, infected people are needed to maintain the cycle; this type of transmission (human—sand fly—human) is called anthroponotic.
- In such areas, early detection and effective treatment of patients can serve as a control measure; suboptimal treatment can lead to development and spread of drug resistance.
- Because the transmission is intra- and peridomiciliary (rather than sylvatic), spraying dwellings with residual-action insecticides and using bed nets treated with long-lasting insecticides may be protective.