**7. Epidemiological surveillance, preventive, and control measures**

Visceral leishmaniasis control activities focus on reducing morbidity and mortality through early diagnosis and treatment of human cases, monitoring and euthanasia of seropositive dogs and sand fly population control via entomological surveillance such as chemical control. Additionally, they include education and health activities that involve joint actions aiming to improve population's quality of life, such as provision of basic sanitation and proper trash disposal [143].

In Brazil, the Visceral Leishmaniasis Control Program (VLCP) recommends surveillance, preventive and control measures of human and canine visceral leishmaniasis [11]. Epidemiological surveillance aims to reduce mortality and morbidity rates through early diagnosis and treatment of human cases and to reduce the risk of transmission by controlling reservoirs and vector populations. Surveillance comprises entomological surveillance of human and canine cases. What is set at national level for epidemiological surveillance of VL, emphasizing canine population, is described in the following paragraphs.

Through epidemiological analysis of VL in the state or municipality, transmission areas are classified in areas with VL cases or silent areas (without cases). Areas with cases are those with record of a first confirmed case, those with sporadic, moderate, and intense transmission and those undergoing outbreaks. Silent areas or areas without cases are classified as vulnerable (receptive and unreceptive) or not vulnerable.

Entomological surveillance aims to gather quantitative and qualitative information about *L. longipalpis* and/or *L. cruzi* vectors. This is a task for the state and/or municipal health departments, which must work integratedly in order to optimize resources and effectiveness of sand fly control activities.

In regard to dogs, surveillance focuses on suspect canine cases (symptomatic animals in endemic or outbreak areas) and on those confirmed by (a) laboratory criteria, symptomatic and positive in serological and/or parasitological test; (b) clinical and epidemiological criteria, symptomatic from endemic or outbreak areas without diagnostic confirmation; and (c) infected dogs, asymptomatic and positive in serological and/or parasitological test. When a canine case is identified, delimitation of the area to be investigated is among the surveillance actions to be taken. In those areas, active search for symptomatic dogs must be carried out for parasitological examination, and if the agent is found, serological survey of all animals in the area must be done in order to evaluate local prevalence and to implement appropriate measurements.

vaccinated dogs. Other serological assays, e.g., the direct agglutination (DAT), are not easily available in Brazil and were never adopted in private or public labs. Although new antigens have been described in the last years (e.g., [142]), their commercial use in serodiagnosis is still uncertain. Although available as commercial kits (http://www.genesig.com/products/ 9332?gclid=CNXfgtXc\_c4CFcoHkQodMm4Ctw), PCR assays are seldom used and have lim-

As the existing recombinant ELISA assays have high sensitivity and specificity even in the serodiagnosis of CVL in asymptomatic dogs, one could argue against the need of new laboratory tests. However, claims of cross reactions with babesiosis and other common canine

In conclusion, no diagnostic breakthroughs have been described and no innovative technology was introduced in the market in the last years, and there are no evidences that this scenario

Visceral leishmaniasis control activities focus on reducing morbidity and mortality through early diagnosis and treatment of human cases, monitoring and euthanasia of seropositive dogs and sand fly population control via entomological surveillance such as chemical control. Additionally, they include education and health activities that involve joint actions aiming to improve population's quality of life, such as provision of basic sanitation and proper trash

In Brazil, the Visceral Leishmaniasis Control Program (VLCP) recommends surveillance, preventive and control measures of human and canine visceral leishmaniasis [11]. Epidemiological surveillance aims to reduce mortality and morbidity rates through early diagnosis and treatment of human cases and to reduce the risk of transmission by controlling reservoirs and vector populations. Surveillance comprises entomological surveillance of human and canine cases. What is set at national level for epidemiological surveillance of VL, emphasizing canine

Through epidemiological analysis of VL in the state or municipality, transmission areas are classified in areas with VL cases or silent areas (without cases). Areas with cases are those with record of a first confirmed case, those with sporadic, moderate, and intense transmission and those undergoing outbreaks. Silent areas or areas without cases are classified as vulnerable

Entomological surveillance aims to gather quantitative and qualitative information about *L. longipalpis* and/or *L. cruzi* vectors. This is a task for the state and/or municipal health departments, which must work integratedly in order to optimize resources and effectiveness of sand

In regard to dogs, surveillance focuses on suspect canine cases (symptomatic animals in endemic or outbreak areas) and on those confirmed by (a) laboratory criteria, symptomatic

**7. Epidemiological surveillance, preventive, and control measures**

ited application for the routine diagnosis.

38 Canine Medicine - Recent Topics and Advanced Research

will be changed in the near future.

disposal [143].

fly control activities.

infectious diseases [138] continue to stir dissatisfaction.

population, is described in the following paragraphs.

(receptive and unreceptive) or not vulnerable.

Sample and census serosurveys must be performed as monitoring activity. The sample serological survey must be carried out in silent and receptive municipalities with *L. Longipalpis* and in those with moderate and intense transmission. The census serological survey must be performed in urban areas of silent and receptive municipalities with canine population smaller than 500 animals, in urban areas of moderate or intense transmission and rural areas in any transmission situation. The aim of a census survey is to control disease by identification of infected dogs in order to perform euthanasia and assess prevalence. It must be performed annually for at least three consecutive years, even without notification of new confirmed human cases.

Preventive measures regarding canine population are (a) control of errant canine population, (b) donation of dogs after performing negative serological tests, (c) vaccination against CVL, (d) the use of fine mesh screen at individual or collective kennels, and (e) the use of collars impregnated with deltamethrin 4%.

Canine reservoir control measures consist in euthanasia of seropositive dogs and/or positive in parasitological tests, besides disposal of the bodies in accordance with the provisions of RDC Resolution No. 33, of February 25, 2003, from the National Agency for Health Surveillance.

In Brazil, since 2000, as part of the decentralization process undergone by the National Health Foundation (FUNASA), the states' federal district and municipalities became responsible for operating assistance, epidemiology, and disease control activities. They now receive almost all movable property, allocated in all federal units and more than 26,000 servers, and resources for maintenance of the transferred responsibilities [144]. However, despite the decentralization and recommendations by VLCP, the action taken toward canine reservoirs have been mainly restricted to areas of human case occurrences, that is, after a human case confirmation, canine serological survey follows in the surrounding area, and later, euthanasia of animals found seropositive in screening (DPP®) and confirmatory (EIE-Biomanguinhos) tests. Individual preventive measures such as vaccination, coverage of kennel doors and windows with mesh screen, and collars impregnated with deltamethrin 4% are restricted to animals whose owners have relatively high economic standard.

Several factors hinder the fulfillment of activities imposed by VLCP. Some of them are the lack of federal funding; insufficient staff to perform activities related to VL and other endemic diseases; prioritization for control of other endemic diseases such as dengue, Zika, and chikungunya; expansion of transmission areas; and interference of veterinarians, animal owners; and nongovernmental organizations (NGOs) regarding euthanasia of reservoirs, as such procedure generates controversy regarding its control efficacy, although recommended in Brazil [145].
