Nas regiões do mundo em que ocorrem casos de Leishmaniose Visceral, a OMS defende que a doença pode ser controlada através de medidas integradas como: combate ao vetor, diagnóstico eficaz e precoce, tratamento completo e efetiva vigilância sanitária. Essa forma de controle é consenso em toda comunidade científica.
Além das medidas descritas, também é necessário o controle dos reservatórios, caninos, felinos, marsupiais, primatas e o próprio homem. Nos centros urbanos o controle é centrado nos cães, considerados o principal reservatório urbano em todas as áreas de ocorrência da doença.
A OMS refere-se ao controle canino em pelo menos três documentos, publicados em 1990, 2006 e 2010. Nesses documentos é considerada como medida de controle a eliminação de cães infectados, mas em casos de animais de alta estima e com proprietários responsáveis, o tratamento é visto com normalidade.
Dois países no mundo tem se destacado pela truculência em relação a doença nos cães, o Brasil e a China.
No Brasil, o programa de controle oficial da LVH, desde 1963, propõe o diagnostico e tratamento dos casos humanos, o diagnostico e eliminação dos cães doentes e o controle do vetor.
O documento da OMS – 2010 ressalta a eliminação em massa de cães no Brasil e sua pouca eficácia.
(trecho na íntegra abaixo).
Entendemos que o programa deve ser revisto imediatamente, a equipe responsável pelo controle renovada com a presença de cientistas de visão contemporânea e progressista. A rotina praticada há 50 anos deve ser questionada e modernizada.
Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22–26 March 2010 – Páginas 76; 77
”… Ideally, all symptomatic or seropositive dogs should be eliminated; however, screening and mass culling of seropositive dogs has not proved uniformly effective in control programmes (for example, in Brazil). The suboptimal effectiveness has been attributed to delays between serology and culling, poor sensitivity of serological tests to identify the most infectious dogs and, mainly, only partial coverage of the infected canid population. In several Mediterranean countries, euthanasia of infected domestic dogs is reserved for special cases, such as drug resistance, recurrent relapse or dangerous epidemiological situations. Most veterinarians prefer to manage canine leishmaniasis by giving antileishmanial treatment, while watching attentively for relapses. The medicines used primarily for treatment of human disease (see section 3.2.2) should not be used for treatment of canine leishmaniasis because of their low parasiticidal efficacy in this host and the potential for promoting parasite resistance. Alternative medicines, such as the leishmaniostatic allopurinol, should be used. A large percentage of treated dogs recover their infectivity to sandflies a few months after chemotherapy, despite clinical healing, thereby hiding the epidemiological problem of the source of infection. Use of topical insecticides with proven efficacy against sandfly bites (deltamethrin- impregnated collars or permethrin-based spot-on formulations) has been shown to reduce the incidence of visceral leishmaniasis in dogs significantly (for example in Brazil, Italy and Tunisia) and humans (Islamic
Republic of Iran), depending on the level of endemicity in a given area (see below). This approach has not, however, been tested in mass campaigns and cannot be endorsed as an alternative for interrupting transmission.
…
Control of canine visceral leishmaniasis could, in some countries, be associated with campaigns against rabies, which include (1) dog registration, to obtain useful information on the composition of the canine population and its dynamics; (2) evaluation of the health status of the canine population and regular veterinary surveillance; (3) access to serological diagnosis, medicines, topical insecticides and culling; and (4) mobilization of community participation (owners’ responsibility).”
