The World Health Organization (WHO) has unveiled new treatment guidelines for kala-azar, a lethal parasitic disease transmitted by sandflies, aiming to reduce treatment duration and improve patient safety.

Kala-azar, medically known as visceral leishmaniasis (VL), causes prolonged fever, weight loss, anaemia, and enlargement of the spleen and liver. Without treatment, it is often fatal. Post-kala-azar dermal leishmaniasis (PKDL), a skin condition that can develop after treatment, also poses challenges due to its potential to spread the parasite.

New Treatment Regimen

  • The updated WHO protocol replaces the long-standing sodium stibogluconate (SSG) injections with a combination of oral miltefosine and injectable paromomycin.
  • This new combination achieves over 90% cure rates and significantly reduces the number of painful injections from 34 to 14.
  • Hospital stays for PKDL patients have been shortened from up to 90 days to just 14 days, with part of the treatment completed at home.

In South Asia, WHO also recommends liposomal amphotericin B, alone or combined with miltefosine, for PKDL treatment.

Impact in Eastern Africa

Eastern Africa, which carries the highest burden—accounting for 79% of global kala-azar cases—stands to benefit substantially from these changes. Clinical trials in Ethiopia, Kenya, Sudan, and Uganda demonstrated the efficacy and safety of the new regimen, especially in reducing PKDL incidence after treatment.

Dr Daniel Ngamije Madandi, WHO Director of Malaria and Neglected Tropical Diseases, emphasized that these guidelines mark a turning point by improving care and accelerating efforts to eliminate kala-azar.

Considerations and Next Steps

  • Women of childbearing age must test negative for pregnancy and use contraception during miltefosine treatment due to potential risks to the fetus.
  • Patients unable to use miltefosine will continue with existing standard treatments.
  • Countries affected by kala-azar, including Kenya, are preparing to update their national treatment protocols to align with WHO’s recommendations.

Professor Ahmed Musa from Sudan highlighted the improvement in patient experience, noting the reduction in painful injections and toxicity.

Ongoing research by the non-profit Drugs for Neglected Diseases initiative (DNDi) aims to develop even more patient-friendly oral treatments, potentially eliminating the need for injections altogether.

Health workers, particularly in Uganda and Ethiopia, expressed optimism that shorter, less toxic treatments will enhance treatment completion rates and improve survival, especially among children and HIV co-infected patients.

As kala-azar remains endemic in 80 countries with an estimated 50,000 to 90,000 new cases annually, these advancements offer renewed hope for affected populations and health systems.