{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:23:59Z","timestamp":1790011439673,"version":"4.0.1"},"reference-count":24,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of <jats:italic>Phlebotomus<\/jats:italic> and three species of <jats:italic>Sergentomyia<\/jats:italic> sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence &lt;1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country\u2019s medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0642","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T16:30:59Z","timestamp":1710261059000},"page":"633-638","source":"Crossref","is-referenced-by-count":4,"title":["Efforts toward the Elimination of Visceral Leishmaniasis in South Asia: A Review of Progress in Bhutan"],"prefix":"10.4269","volume":"110","author":[{"given":"Thinley","family":"Dorji","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sithar","family":"Dorjee","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tenzin","family":"Wangdi","sequence":"additional","affiliation":[{"name":"Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tshokey","family":"Tshokey","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambika Rani","family":"Pradhan","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;"},{"name":"Department of Dermatology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinley","family":"Penjor","sequence":"additional","affiliation":[{"name":"Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinzin","family":"Namgay","sequence":"additional","affiliation":[{"name":"Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Togbye","family":"Togbye","sequence":"additional","affiliation":[{"name":"Vector-Borne Disease Control Programme, Ministry of Health, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadira","family":"Karunaweera","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Leishmaniasis.","year":"2023"},{"key":"b2","series-title":"Med Vet Entomol","first-page":"123","article-title":"Phlebotomine sandflies and the spreading of leishmaniases and other diseases of public health concern","volume":"27","author":"Maroli","year":"2013"},{"key":"b3","series-title":"Regional Strategic Framework for Elimination of Kala-azar from the South-East Asia Region, 2022\u20132026","year":"2022"},{"key":"b4","series-title":"BMJ","first-page":"k5224","article-title":"Eliminating visceral leishmaniasis in South Asia: The road ahead","volume":"364","author":"Rijal","year":"2019"},{"key":"b5","series-title":"Independent Assessment of Kala-azar Elimination Programme India","year":"2019"},{"key":"b6","series-title":"National Guideline on Kala-azar Elimination Program 2019","year":"2019"},{"key":"b7","series-title":"National Guideline for the Prevention, Diagnosis and Management of Leishmaniasis in Bhutan, 2023","year":"2023"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"1028","article-title":"Endemic transmission of visceral leishmaniasis in Bhutan","volume":"87","author":"Yangzom","year":"2012"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"928","article-title":"Case report: A single-center case series on skin manifestations of leishmaniasis from a non-endemic state in southern India","volume":"104","author":"Tharakan","year":"2021"},{"key":"b10","series-title":"Indian J Med Res","first-page":"337","article-title":"Occurrence & significance of kala-azar in Bhutan","volume":"132","author":"Bhattacharya","year":"2010"},{"key":"b11"},{"key":"b12","series-title":"Operational Manual on Leishmaniasis Vector Control, Surveillance, Monitoring and Evaluation","year":"2022"},{"key":"b13","series-title":"Parasit Vectors","first-page":"273","article-title":"Real-time PCR applications for diagnosis of leishmaniasis","volume":"11","author":"Galluzzi","year":"2018"},{"key":"b14","series-title":"Clin Case Rep","first-page":"e7234","article-title":"Oral mucosal leishmaniasis presenting as a nonhealing chronic oral growth: A case report","volume":"11","author":"Bajgai","year":"2023"},{"key":"b15","series-title":"National Essential Medicines List 2023","year":"2023"},{"key":"b16","series-title":"PLoS One","first-page":"1","article-title":"Treatment failure to sodium stibogluconate in cutaneous leishmaniasis: A challenge to infection control and disease elimination","volume":"16","author":"Silva","year":"2021"},{"key":"b17","series-title":"WHO Guideline for the Treatment of Visceral Leishmaniasis in HIV Co-infected Patients in East Africa and South-East Asia","year":"2022"},{"key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e0008221","article-title":"Post kala-azar dermal leishmaniasis: A threat to elimination program","volume":"14","author":"Gedda","year":"2020"},{"key":"b19","series-title":"Ending the Neglect to Attain the Sustainable Development Goals: A road Map for Neglected Tropical Diseases 2021\u20132030.","year":"2020"},{"key":"b20","series-title":"Bhutan Poverty Analysis Report 2022","year":"2022"},{"key":"b21","series-title":"Case Rep Dermatol Med","first-page":"8899586","article-title":"Atypical presentation of post-kala-azar dermal leishmaniasis in Bhutan","volume":"2020","author":"Pradhan","year":"2020"},{"key":"b22","series-title":"BMC Infect Dis","first-page":"21","article-title":"An outbreak investigation of visceral leishmaniasis among residents of Dharan town, eastern Nepal, evidence for urban transmission of Leishmania donovani","volume":"13","author":"Uranw","year":"2013"},{"key":"b23","series-title":"Int J Environ Res Public Health","first-page":"354","article-title":"Epidemiological analysis of the 2019 dengue epidemic in Bhutan","volume":"18","author":"Tsheten","year":"2021"},{"key":"b24","series-title":"Trans R Soc Trop Med Hyg","first-page":"460","article-title":"Forty years (1980\u20132019) of visceral leishmaniasis in Nepal: Trends and elimination challenges","volume":"117","author":"Pandey","year":"2023"}],"container-title":["The American 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