Title : Elimination of visceral leishmaniasis from India – The story

Abstract:

The current epidemic of visceral leishmaniasis (VL, kala-azar) in India started in early 1970s and in the late 1990s, it became apparent that there is widespread Sb^V resistance with its cure rate nose-diving to 35%. There was an urgent need for alternative treatments. In 2002, miltefosine the first oral antileishmanial drug was approved in India and became available for the treatment of VL. This drug along with early and rapid diagnosis with rk39 antigen-based Rapid Diagnosis Strip Test, became the backbone of the Kala-azar Elimination Programme (KAEP) jointly launched in 2005 in India, Nepal and Bangladesh. In 2010 a landmark paper was published which demonstrated 95.6% efficacy of single-dose liposomal amphotericin B (LAmB)with a dose of 10 mg/kg without any safety concerns. This proved to be a true game changer in the management of VL in India, the American manufacturer of this highly expensive LAmB announced a free donation of the drug to India, Nepal and Bangladesh. In 2014 miltefosine was replaced by the single dose LAmB treatment. There was a dramatic fall in the incidence of kala-azar in all three countries, and in 2023 India achieved the target of KAEP in all affected 633 blocks. The Elimination Target has been maintained in the year 2024, and the Country need to hold this in 2025 also to obtain the World Health Organization certification.

Biography:

Dr. Shyam Sundar is presently working as a Professor of Medicine Head, Department of Medicine at Institute of Medical Sciences Banaras Hindu University (BHU), Varanasi, India. Dr. Shyam Sundar first to successfully conduct multidrug therapy of VL, and these regimens are also approved by WHO as the second most preferred regimen. Combination of paromomycin and miltefosine is also being used at primary health centers by the National Control Programme. He has also done excellent work on lipid associated amphotericin B. His work with single dose liposomal amphotericin B is considered as a major breakthrough and has earned worldwide acclaim. This single dose regimen is now the most preferred according to WHO recommendations, and it is being used in the control programme in India. He led the pivotal paromomycin trial, based on which the drug was approval by the Government of India.