![]() ![]() 1.1 Precision Medicine and Precision Public Health There are serious gaps in understanding transmission dynamics leading to lack of precision. It is likely that the approach to control in each endemic area is guided by regional specific factors there is no ‘one size, fits all’ in diagnostics, therapeutics or other determinants of control. In neighboring Ethiopia HIV VL co-infection is common that may contribute considerably to transmission ( Diro et al., 2014). In control efforts, there are important regional differences: with the spectacular reduction of VL cases in the Indian Subcontinent (ISC) due to the successful Kala-azar Elimination Program (KAEP), Africa now has equal numbers of VL cases ( Rijal et al., 2019 World Health Organization, 2020). PKDL is thought to play an important role in transmission and is largely restricted to VL caused by L. ![]() The clinical features are determined by the immune responses. It is an intermediate disease state that precedes complete cure from VL. Post-kala-azar dermal leishmaniasis (PKDL) is a skin condition characterized by macules, papules, nodules or polymorphic lesions that develop after successful treatment for VL around persisting parasites in the skin, while systemically parasites may no longer be demonstrable in an otherwise healthy individual. children, women, pregnancy, HIV-VL co-infection), and eventually targeted to the individual level. From this, further precision may be defined for groups (e.g. donovani as an important final common pathway, for which innovative new genomic and non-genomic tools in various disciplines have become available that provide new insights in clinical management and in control. These 5 priorities share the immune responses of infection with L. From this 5 major priorities arise: diagnosis, treatment, PKDL, asymptomatic infection and transmission. donovani, precision may currently be targeted to the regional level in nosogeographic entities that are defined by the interplay of the circulating parasite, the reservoir and the sand fly vector. Precision public health would lead to the right intervention in each VL endemic population for control, based on relevant population-based data, vector exposures, reservoirs, socio-economic factors and other determinants. Precision medicine and precision global health in visceral leishmaniasis (VL) have not yet been described and could take into account how all known determinants improve diagnostics and treatment for the individual patient. Clinical Sciences, Rotterdam Centre for Tropical Medicine, Rotterdam, Netherlands. ![]()
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