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2015 ; 2015
(8
): CD008736
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Vector and reservoir control for preventing leishmaniasis
#MMPMID26246011
González U
; Pinart M
; Sinclair D
; Firooz A
; Enk C
; Vélez ID
; Esterhuizen TM
; Tristan M
; Alvar J
Cochrane Database Syst Rev
2015[Aug]; 2015
(8
): CD008736
PMID26246011
show ga
BACKGROUND: Leishmaniasis is caused by the Leishmania parasite, and transmitted
by infected phlebotomine sandflies. Of the two distinct clinical syndromes,
cutaneous leishmaniasis (CL) affects the skin and mucous membranes, and visceral
leishmaniasis (VL) affects internal organs. Approaches to prevent transmission
include vector control by reducing human contact with infected sandflies, and
reservoir control, by reducing the number of infected animals. OBJECTIVES: To
assess the effects of vector and reservoir control interventions for cutaneous
and for visceral leishmaniasis. SEARCH METHODS: We searched the following
databases to 13 January 2015: Cochrane Infectious Diseases Group Specialized
Register, CENTRAL, MEDLINE, EMBASE, LILACS and WHOLIS, Web of Science, and
RePORTER. We also searched trials registers for ongoing trials. SELECTION
CRITERIA: Randomized controlled trials (RCTs) evaluating the effects of vector
and reservoir control interventions in leishmaniasis-endemic regions. DATA
COLLECTION AND ANALYSIS: Two review authors independently searched for trials and
extracted data from included RCTs. We resolved any disagreements by discussion
with a third review author. We assessed the quality of the evidence using the
GRADE approach. MAIN RESULTS: We included 14 RCTs that evaluated a range of
interventions across different settings. The study methods were generally poorly
described, and consequently all included trials were judged to be at high or
unclear risk of selection and reporting bias. Only seven trials reported clinical
outcome data which limits our ability to make broad generalizations to different
epidemiological settings and cultures. Cutaneous leishmaniasisOne four-arm RCT
from Afghanistan compared indoor residual spraying (IRS), insecticide-treated
bednets (ITNs), and insecticide-treated bedsheets, with no intervention. Over 15
months follow-up, all three insecticide-based interventions had a lower incidence
of CL than the control area (IRS: risk ratio (RR) 0.61, 95% confidence interval
(CI) 0.38 to 0.97, 2892 participants, moderate quality evidence; ITNs: RR 0.32,
95% CI 0.18 to 0.56, 2954 participants, low quality evidence; ITS: RR 0.34, 95%
CI 0.20 to 0.57, 2784 participants, low quality evidence). No difference was
detected between the three interventions (low quality evidence). One additional
trial of ITNs from Iran was underpowered to show a difference.Insecticide treated
curtains were compared with no intervention in one RCT from Venezuela, where
there were no CL episodes in the intervention areas over 12 months follow-up
compared to 142 in control areas (RR 0.00, 95% CI 0.00 to 0.49, one trial, 2938
participants, low quality evidence).Personal protection using insecticide treated
clothing was evaluated by two RCTs in soldiers, but the trials were underpowered
to reliably detect effects on the incidence of CL (RR 0.40, 95% CI 0.13 to 1.20,
two trials, 558 participants, low quality evidence). Visceral leishmaniasisIn a
single RCT of ITNs versus no intervention from India and Nepal, the incidence of
VL was low in both groups and no difference was detected (RR 0.99, 95% CI 0.46 to
2.15, one trial, 19,810 participants, moderate quality evidence).Two trials from
Brazil evaluated the effects of culling infected dogs compared to no intervention
or IRS. Although they report a reduction in seroconversion over 18 months
follow-up, they did not measure or report effects on clinical disease. AUTHORS'
CONCLUSIONS: Using insecticides to reduce phlebotomine sandfly numbers may be
effective at reducing the incidence of CL, but there is insufficient evidence
from trials to know whether it is better to spray the internal walls of houses or
to treat bednets, curtains, bedsheets or clothing.
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