Zheng Qi  2021-03-23

The only proven effective way to avoid leishmaniasis infection is to prevent bites from infected female phlebotomine sandflies carrying the Leishmania parasite, though this can be challenging to fully achieve in real-world endemic field conditions. Unlike common mosquitoes, sandflies are only 2 to 3 mm long, making their bites far harder to notice, and their highly variable resting and biting behaviors across different regions create unique barriers to uniform prevention. Some sandfly species rest and feed primarily indoors, while others are fully outdoor-dwelling, and their distinct host preferences for humans or wild mammals further shift local exposure risks for residents and travelers. Currently, there are no widely deployed, fully licensed human vaccines or routine preventive medications for leishmaniasis, making bite avoidance the absolute foundation of all protection strategies.

Personal Protection Measures

For individuals living in or visiting endemic areas, a set of evidence-based personal precautions can drastically reduce bite exposure risk. Sleeping under long-lasting insecticide-impregnated bed nets, especially those treated with pyrethroid compounds, creates a reliable physical and chemical barrier against indoor sandfly bites. Wearing long-sleeved shirts, long trousers and closed-toe shoes during peak sandfly activity hours at dusk and night, and applying EPA-registered repellents containing DEET or picaridin to all exposed skin surfaces, adds an extra layer of protection for outdoor activities. People should also avoid lingering near sandfly breeding sites such as rodent burrows, piles of household rubbish, and unkempt livestock shelters, and keep all broken skin properly covered to minimize any rare non-vector exposure risks.

Community-Level Vector Control

Population-wide integrated interventions are far more effective at curbing local transmission than individual actions alone. Indoor residual spraying of approved insecticides on residential wall surfaces can eliminate large numbers of indoor-resting sandflies, a strategy that has proven highly successful in eliminating visceral leishmaniasis in multiple historic endemic regions. Regular community clean-up campaigns that remove accumulated organic waste, trim overgrown vegetation, and properly maintain livestock enclosures reduce the number of suitable sandfly breeding sites around residential areas. For dog-transmitted endemic zones, equipping domestic dogs with insecticide-treated collars and conducting regular serological screening to identify and manage infected canine reservoir hosts can break the parasite’s zoonotic transmission cycle at its source.

Edited by: Secretariat of the Asia-Pacific Network for Drug and Diagnostics Innovation
Produced by: Zheng Qi
Reviewed by: Zhang Haobing
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