**7.6 Immunization/vaccination**

**7.1 Mass treatment**

*Parasitology and Microbiology Research*

**7.2 Vector control strategies**

on VL and other vector-borne diseases [47].

knowledge of disease biology and its transmission.

**7.3 Reservoir eradication/control**

**7.4 Minimizing outdoor exposure**

standard mosquito nets.

**7.5 Transmission via blood**

transmitted through blood.

**314**

The VL elimination initiative in the Indian subcontinent in collaboration with the WHO was based on diagnosis and treatment of VL patients using mass treatment to reach the target of reducing the annual VL incidence to below 1/10,000. This plan was dependent on actively looking for and diagnosing *Leishmania* patients. However, the target date was missed because of several factors including limitations of diagnostic tools to diagnose patients actively, lack of health-care coverage in certain areas in developing countries in particular rural regions, lack of proper vector control, and high cost and limited availability of treatment [46–48].

Including insecticide-treated nets and indoor insecticide sprays are used for areas where sandflies bite indoor. Recently resistance to dichlorodiphenyltrichloroethane (DDT) is reported to emerge, and therefore other synthetic products such as pyrethroids started to be used [50]. In areas like Africa where the vector mainly bites outdoor, selective outdoor spraying might be effective in reducing vector density. In addition alternative vector control measures have been proposed and used such as plastering of walls and floors using mud and lime. However these environmental management methods need further evaluation and validation. The KALANET project was the only trial that evaluated the impact of "long-lasting insecticidal nets" on *L. donovani* and concluded that these nets have beneficial effects against *L. donovani* as they provide some degree of personal protection against infection as compared to those using untreated nets or no nets. Further prospective studies are needed to evaluate integrated vector management measures

In areas of zoonotic transmission should be effectively targeted to reduce the human infection rate from infected animal reservoir. Several reservoir control measures have been used including animal elimination in certain areas, canine vaccines, and insecticides used on dogs such as spot-on insecticide which are drops applied on skin under the hair in the neck region, insecticide-impregnated dog collars, and whole body insecticide use. Studies on efficacy of animal reservoir intervention programs are limited and show lack of generalizability of intervention measures as well as mixed results [17]. In addition there are also conflicting results on the impact of dogs in transmission of leishmaniasis since not all infected dogs become infectious. All the above factors point towards a fundamental gap in our

At dawn to dusk which are the peak bite times and use of insecticide-treated nets

and/or fine-mesh nets since the sandflies are small in size and can pass through

Infected patients should not donate blood or organs since the parasite can be

Several candidate vaccines are in preclinical development, and at least three are currently in clinical studies; however, no effective vaccine has been identified to date to effectively prevent human leishmaniasis [51]. Some studies show vaccination by killed *Leishmania* promastigotes, and live BCG can develop protection against CL, but no protection is seen against VL. Approximately 90–98% of leishmaniasis patients recover after disease and develop natural acquired immunity mainly due to Th1 lymphocyte activation and its reaction towards the infecting parasite. This strongly supports the ongoing vaccination development efforts, hopefully looking forward for a clinically efficient vaccine to be available in the near future.

All the above measures have shown some success; however, they are costly and require extensive coordination efforts globally. Early diagnosis and treatment remain the main control strategy since untreated patients serve as reservoirs of parasites. In most countries majority of patients present themselves to the health care, suggesting that many cases will remain in the community for long periods before seeking health care due to reduced awareness. Strategy for eradication would require surveillance with early detection and prompt treatment measures applied globally, mostly in heavily infested areas.
