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<p>Kala-azar, or visceral leishmaniasis, has long posed a formidable public health challenge in India, with its historical roots tracing back to devastating epidemics in the 19<sup>th</sup> and 20<sup>th</sup> centuries. Caused by <i>Leishmania donovani</i> and transmitted by the sand fly <i>Phlebotomus argentipes</i>, the disease primarily afflicted the Indian states of Bihar, Jharkhand, West Bengal, and Uttar Pradesh. This paper offers a comprehensive historical narrative, from early misidentifications and colonial-era outbreaks to groundbreaking discoveries that identified the parasite and its vector. Key milestones included the discovery of <i>L. donovani</i> by William Boog Leishman (1865–1926) and Charles Donovan (1863–1951), the development of the breakthrough drug urea stibamine by Upendranath Brahmachari (1873–1946) in 1920, and the conclusive identification of the sand fly vector in 1942. Following a dramatic decline during the DDT campaigns of the 1950s under the National Malaria Eradication Programme, kala-azar resurged due to the discontinuation of vector control and the presence of untreated post-kala-azar dermal leishmaniasis (PKDL) cases. The establishment of the National Kala-azar Elimination Program in the 1990s, supported by WHO and the World Bank, led to a sharp decline in disease incidence through improved diagnostics (rK39), treatment (Miltefosine, liposomal amphotericin B), vector control (IRS, synthetic pyrethroids), and digital surveillance (KAMIS). By 2023, India met the WHO elimination target of less than one case per 10,000 people in all endemic blocks. Despite this progress, "last mile challenges" such as hotspot persistence, treatment delays, co-infections, operational fatigue, and socio-economic inequities remain. This review underscores the importance of sustained surveillance, targeted outreach, policy coordination, and community engagement to prevent resurgence and ensure sustained elimination. India’s journey from kala-azar being a colonial epidemic to its elimination exemplifies the convergence of scientific innovation, political will, and inclusive public health strategies in combating neglected tropical diseases.</p>

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The historical fight against visceral leishmaniasis (kala-azar) in India: From epidemic to elimination

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Yash Paul Sharma,
  • Ankita Sindhania,
  • Cornelius Murmu,
  • Kareena Roy,
  • Rohan Ranjan Waliya,
  • Sanjay Kumar Chaturvedi

摘要

Kala-azar, or visceral leishmaniasis, has long posed a formidable public health challenge in India, with its historical roots tracing back to devastating epidemics in the 19th and 20th centuries. Caused by Leishmania donovani and transmitted by the sand fly Phlebotomus argentipes, the disease primarily afflicted the Indian states of Bihar, Jharkhand, West Bengal, and Uttar Pradesh. This paper offers a comprehensive historical narrative, from early misidentifications and colonial-era outbreaks to groundbreaking discoveries that identified the parasite and its vector. Key milestones included the discovery of L. donovani by William Boog Leishman (1865–1926) and Charles Donovan (1863–1951), the development of the breakthrough drug urea stibamine by Upendranath Brahmachari (1873–1946) in 1920, and the conclusive identification of the sand fly vector in 1942. Following a dramatic decline during the DDT campaigns of the 1950s under the National Malaria Eradication Programme, kala-azar resurged due to the discontinuation of vector control and the presence of untreated post-kala-azar dermal leishmaniasis (PKDL) cases. The establishment of the National Kala-azar Elimination Program in the 1990s, supported by WHO and the World Bank, led to a sharp decline in disease incidence through improved diagnostics (rK39), treatment (Miltefosine, liposomal amphotericin B), vector control (IRS, synthetic pyrethroids), and digital surveillance (KAMIS). By 2023, India met the WHO elimination target of less than one case per 10,000 people in all endemic blocks. Despite this progress, "last mile challenges" such as hotspot persistence, treatment delays, co-infections, operational fatigue, and socio-economic inequities remain. This review underscores the importance of sustained surveillance, targeted outreach, policy coordination, and community engagement to prevent resurgence and ensure sustained elimination. India’s journey from kala-azar being a colonial epidemic to its elimination exemplifies the convergence of scientific innovation, political will, and inclusive public health strategies in combating neglected tropical diseases.