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Sandfly collection and cone bio-assay was done as part of entomological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A spatially and temporally clustered kala-azar outbreak was found at Kosra village in Sheikhpura district with 70 cases reported till December 2018. Delay of more than a year was found between diagnosis and treatment of the index case. The southern hamlet with socio-economically disadvantaged migrant population was several times more affected than rest of the village (attack rate of 19.0% vs 0.5% respectively, OR\n                      <jats:sub>MH<\/jats:sub>\n                      \u00a0=\u200939.2, 95% CI 18.2\u201384.4). The\u00a0median durations between onset of fever to first contact with any health services, onset to kala-azar diagnosis, diagnosis to treatment were 10\u2009days (IQR 4\u201318), 30\u00a0days (IQR 17\u201373) and 1\u2009day (IQR 0.5 to 3), respectively, for 50 kala-azar cases assessed till June 2017. Three-fourths of these kala-azar cases had out-of-pocket medical expenditure for their condition. Known risk factors for kala-azar such as illiteracy, poverty, belonging to socially disadvantaged community, migration, residing in\n                      <jats:italic>kutcha<\/jats:italic>\n                      houses, sleeping in rooms with unplastered walls and non-use of mosquito nets were present in majority of these cases. Only half the dwellings of the kala-azar cases were fully sprayed. Fully gravid female\n                      <jats:italic>P. argentipes<\/jats:italic>\n                      collected post indoor residual spraying (IRS) and low sandfly mortality on cone-bioassay indicated poor effectiveness of vector control.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is need to focus on low-endemic areas of kala-azar. The elimination programme should implement a routine framework for kala-azar outbreak response. Complete case-finding, use of quality-compliant insecticide and coverage of all sprayable surfaces in IRS could help interrupt transmission during outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-019-4719-3","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T12:02:55Z","timestamp":1578312175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Intensely clustered outbreak of visceral leishmaniasis (kala-azar) in a setting of seasonal migration in a village of Bihar, India"],"prefix":"10.1186","volume":"20","author":[{"given":"Arvind","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2281-6783","authenticated-orcid":false,"given":"Suman","family":"Saurabh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarosh","family":"Jamil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"key":"4719_CR1","unstructured":"Farrar J, Hotez P, Jughanss T, Kang G, Lalloo D, White NJ. 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Therefore, it was considered exempt from review by institutional ethics committee as guided by the ICMR National Ethical Guidelines for Biomedical and Health Research involving Human Participants 2017. The study was conducted in accordance with the national ethical guidelines and a certificate to this effect was provided by chief medical officer of Sheikhpura district. Verbal informed consent was taken from all participants of the study including the index case, in the presence of two witnesses. Informed consent was obtained from a parent or guardian for those participants less than 16\u2009years of age. Verbal informed consent method was adopted due to overwhelming majority of study participants not being literate. Due to the urgent nature of the outbreak investigation, approval of this verbal informed consent procedure could not be sought from ethics committee.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no competing interest for publication of this article. The views expressed in this article are those of the authors alone and do not necessarily represent the views of their respective organizations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10"}}