BACKGROUND A visceral leishmaniasis outbreak was reported from a village in a low-endemic district of Bihar, India. METHODS Outbreak investigation with house-to-house search and rapid test of kala-azar suspects and contacts was carried out. Sandfly collection and cone bio-assay was done as part of entomological study. RESULTS 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, ORMH = 39.2, 95% CI 18.2-84.4). The median durations between onset of fever to first contact with any health services, onset to kala-azar diagnosis, diagnosis to treatment were 10 days (IQR 4-18), 30 days (IQR 17-73) and 1 day (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 kutcha 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 P. argentipes collected post indoor residual spraying (IRS) and low sandfly mortality on cone-bioassay indicated poor effectiveness of vector control. CONCLUSIONS 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.

中文翻译：

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在印度比哈尔邦的一个村庄，由于季节性迁徙，内脏利什曼病（黑热病）的密集集群爆发。

背景技术从印度比哈尔邦低流行地区的一个村庄报告了内脏利什曼病暴发。方法进行逐户调查和快速检测黑热病嫌疑人和接触者的暴发调查。作为昆虫学研究的一部分，进行了fly蝇收集和锥体生物测定。结果在Sheikhpura地区的Kosra村发现了一个时空分布的黑热病暴发，报告到2018年12月已有70例。在诊断和治疗该指数病例之间被拖延了一年多。南部村庄的移民在社会经济上处于不利地位，其受影响程度是该村庄其他地区的几倍（攻击率分别为19.0％和0.5％，ORMH = 39.2，95％CI 18.2-84.4）。从发烧到初次接触任何卫生服务，从开始发现黑热病，诊断到治疗之间的中位持续时间为10天（IQR 4-18），30天（IQR 17-73）和1天（IQR 0.5至3）分别评估了截至2017年6月的50个黑热病病例。这些黑热病病例中，有四分之三的医疗费用用于其病情。在大多数这类情况下，已知有危害黑人的风险因素，例如文盲，贫穷，属于社会处境不利的社区，迁徙，居住在荷包房，睡在没有抹灰墙壁的房间中以及不使用蚊帐。黑热病病例中只有一半的房屋被完全喷洒。完全怀孕的女性P. 室内残留喷雾（IRS）后收集的精子和锥形生物测定法中的sand蝇死亡率低，表明病媒控制的效果较差。结论有必要将重点放在黑热病的低流行地区。消除计划应实施一个针对黑热病暴发应对的常规框架。全面的病例调查，使用符合质量要求的杀虫剂以及对IRS中所有可喷涂表面的覆盖都可能有助于在爆发期间中断传播。