RATIONALE FOR SURVEILLANCE
Leishmania/HIV co-infections have already been reported from 30 countries. The overlap of visceral leishmaniasis (VL) and AIDS is on the increase because the AIDS pandemic is spreading in rural areas and visceral leishmaniasis in suburban areas. In southern Europe, 25% to 70 % of adult cases of visceral leishmaniasis are related to HIV infection and 1.5% to 9% of AIDS cases suffer from newly acquired or reactivated visceral leishmaniasis.
RECOMMENDED CASE DEFINITION
WHO operational definition:
A case of co-infection is a HIV positive person showing clinical signs of leishmaniasis (visceral or cutaneous) with parasitological confirmation of the diagnosis.
RECOMMENDED TYPES OF SURVEILLANCE
Sentinel surveillance: This can be hospital-based and/or based on laboratories.
At peripheral level, hospitals and laboratories, members of the network of surveillance (28 institutions from 13 countries at the time of writing) maintain individual patient records. They use guidelines for diagnosis; a standardized case report form has recently been computerized.
Routine aggregated or case-based data of all cases reported every six months from peripheral level or central level to WHO.
Worldwide information collected, processed and rediffused (twice per year) by the central registry set up at WHO.
RECOMMENDED MINIMUM DATA ELEMENTS
Case-based data (individual patient record at peripheral level, and reporting)
Identification data: Unique identifier, age, sex, geographical information, travel history, duration of stay at current residence.
Leishmaniasis data: Date of diagnosis, serological and parasitological diagnosis, Leishmania species, clinical features.
HIV data (as available): Date of diagnosis, serology, CD4/mm3, risk groups, AIDS-defining diseases, viral load; treatment outcome.
Number of cases by age, sex, type of diagnosis, risk group.
RECOMMENDED DATA ANALYSIS, PRESENTATION, REPORTS
Geographic distribution, sex distribution, age distribution, risk groups, main risk groups by country, date of HIV diagnosis, date of leishmaniasis diagnosis, correlation between leishmaniasis and HIV diagnosis, immunological parameters, parasitological diagnosis, clinical diagnosis stage, clinical features and AIDS-defining diseases.
PRINCIPAL USES OF DATA FOR DECISION-MAKING
• Evaluate the real extent of the problem and the main population at risk
• Improve the management and follow-up of co-infected patients (guidelines)
• Identify technical and operational difficulties faced by the network of institutions
• Evaluate the impact of intervention
A network helps improve:
• the reliability of data collection by the use of the standardized case report form
• coordination between the institutions
• the active medical surveillance of the main population at risk
See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".
Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Department of Communicable Disease Surveillance and Response (CSR)
E-mail: firstname.lastname@example.org / Surveillancekit@who.ch
Tel: (41 22) 791 38 70
Fax: (41 22) 791 4898 attn CSR