Selective primary health care: strategies for control of disease in the developing world. XIV. Leishmaniasis.

The epidemiology of human leishmaniasis is most complex. Not only are there many species of the parasite in the tropics and subtropics, but each has different sand fly vectors and animal reservoirs and exhibits different behavior in humans. Where epidemiologic information is sufficient, one or more of four methods of control has been effectively used. These are spraying of houses with DDT to control domiciliated phlebotomines (southern Europe, India, Brazil), destruction of animal reservoirs (Brazil, USSR), mass treatment of patients (India, China), and vaccination (USSR, Israel). A drug replacing the pentavalent antimonials as the first-line treatment is a priority, since human infections resistant to currently available drugs occur in many countries and antimonials are difficult to give to outpatients. More research is needed on forest leishmaniasis in the tropical Americas; however, sand fly vectors and animal reservoirs seem inaccessible to control measures. If a vaccine can be developed, it might have great utility. There is an urgent need to map the distribution of predominant species infecting humans in Latin America, since treatment schedules differ for the various cutaneous infections.