Leishmaniasis in Europe and Central Asia: epidemiology, impact of habitat and lifestyle changes, HIV coinfection

Visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) are endemic to the European region. Mainly the Mediterranean basin, southern Cauca sus, and Central Asia have a long history of outbreaks and burden. Control activities targeting the sand fly vectors or known reservoir hosts such as stray dogs have successfully reduced the incidence. If these efforts are discontinued, as seen in the former Soviet Union, leishmaniasis may reappear. Further, human activities and lifestyle changes are creating new habitats for sand flies and animal reservoir hosts, which has resulted in various recent outbreaks. A major challenge in the control of VL is the coinfection with HIV, which is considered responsible for the re-emergence of VL in southern Europe in the 1990s. Further challenges arise through an increased relocation of infected hosts, dogs in particular, and through the expansion of sand fly habitats due to climate change. For these reasons, we recommend the surveillance of Leishmania spp. and Phlebotomus spp. to be reinforced, not only in the South but also in central European countries that have so far not been affected by autochthonous human leishmaniasis.