Guidelines for prevention of leishmaniasis in dogs

Human infections with Leishmania protozoan
\nparasites, transmitted by the bite of phlebotomine
\nsand flies, cause visceral, cutaneous, or mucocutaneous
\nleishmaniasis. Eighty-eight countries are
\naffected, with > 2 million new infections worldwide
\neach year.1 The most severe disease forms are anthroponotic
\nVL due to Leishmania donovani in the Indian
\nsubcontinent and parts of central Asia and Africa and
\nzoonotic VL due to Leishmania infantum (Leishmania
\nchagasi) in the Mediterranean, parts of Asia, and
\nLatin America.
\nDomestic dogs are the only confirmed domestic
\nreservoir of zoonotic VL.2 Reports3–5 from various areas
\nsuggest that the geographic range of leishmaniasis
\nin dogs is changing, including detection of new foci
\nin northern Italy and an extension of disease distribution
\nin Israel and France. Moreover, there is some
\nevidence that leishmaniasis in dogs could be enzootic
\nin the United States. Sporadic autochthonous cases
\nof disease have been reported in North America since
\nearly 1980.6 Of particular importance is the outbreak
\nof leishmaniasis in Foxhounds at a New York kennel,
\nwhich was first detected in 1999. A subsequent survey
\ninvolving Foxhounds, other breeds of dogs, and wild
\ncanids revealed that leishmaniasis in dogs is enzootic
\nin 18 states and 2 Canadian provinces. The lack of
\nspread from Foxhounds to the wider dog population
\nor local wild canid population suggests that sand fly
\ntransmission could not be involved, and thus infection
\nin these dogs must be maintained by non–sand fly
\ntransmission routes. Neglected by researchers and funding agencies,
\nleishmaniasis control strategies have varied little for
\ndecades, but in recent years, there have been advances
\nin diagnosis, treatment, and prevention of the disease.
\nAdvances in prevention include evidence that the incidence
\nof zoonotic VL, both in humans and dogs, can
\nbe reduced by treating dogs with dermal application of
\nsynthetic pyrethroids.7
\nIn a broad sense, the term prevention includes the
\napplication of measures intended to avoid instances of
\ninfection by a pathogen or the pathological outcome of
\nsuch instances. Vaccination against pathogens is regarded
\nas a milestone in the field of infectious disease prevention;
\nhowever, this important tool is not yet available
\nworldwide for prevention of leishmaniasis in dogs.
\nGuidelines developed by the Canine Leishmaniasis
\nWorking Group for diagnosis, clinical classification, and
\ntreatment of leishmaniasis in dogs have been published.8,9
\nHere, we review preventive strategies by updating guidelines
\npreviously published in Italian in Veterinaria, the
\nofficial journal of the Italian Society of Veterinarians of
\nCompanion Animals.10 The guidelines reported here are
\na result of a thorough review of international literature
\nand, where inadequate or incomplete information existed,
\nthe experience of working group members. For completeness,
\nwe include a summary of research conducted
\nto produce safe Leishmania vaccines for dogs. Therefore,
\nthe guidelines concern available preventive measures
\nagainst phlebotomine sand flies, the only established
\nLeishmania vector. It should be pointed out, however,
\nthat non–sand fly transmission routes have long been
\nsuspected and some have been confirmed experimentally,
\nsuch as transplacental11 and sexual12 routes as well as
\nvia blood transfusion,13 although no evidence exists for
\ntransmission via saliva or conjunctiva fluids. All these
\ntransmission routes could be particularly important in
\nareas in which autochthonous leishmaniasis in dogs has
\nbeen reported in the absence of sand flies (eg, northern
\nEurope)14 or in which local sand fly species have not yet
\nbeen implicated in enzootic transmission of leishmaniasis
\n(eg, North America). In such circumstances, our
\nguidelines may not be effective or relevant.

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