THE EFFECTS OF LEISHMANIASIS IN COLOMBIA

S E C R E T BOGOTA 008545

SIPDIS

PLEASE PASS TO SONJA MADERA DHHS/NIH/FIC

E.O. 12958: DECL: 08/31/2015
TAGS: ECON PARM SOCI CO
SUBJECT: THE EFFECTS OF LEISHMANIASIS IN COLOMBIA

REF: SECSTATE 138350

Classified By: DCM Milton Drucker for Reasons: 1.4 (b) and (d)



1. (S) Leishmaniasis, the parasitic disease spread by the
bite of infected sand flies, is a disease plaguing the
military and rural poor in Colombia. Reported civilan cases
have risen from 4,000 in 1990 to nearly 10,000 in 2003 to a
record 13,000 in 2004. Growth in outbreaks within the
Colombian Army has been proportionate to outbreaks within the
general Colombian public. Within the last year and a half,
the Colombian military reported 11,000 cases of
Leishmaniasis. In comparison, 455 soldiers died and 1,713
were wounded in 2004 fighting the Revolutionary Armed Forces
of Colombia (FARC). During that same year, Leishmaniasis was
the direct or indirect cause of removing 3,400 soldiers from
combat.

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Effect on the military
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2. (S) Leishmaniasis is present throughout areas where the
Colombian military and FARC are present. The standard
treatment for the parasite requires intermuscular injections
of 10 to 15 milliliters of Glucantime each day for 20-30
days. Because of the toxicity of the drug, a patient's blood
chemistry must be closely monitored. The treatment of
leishmaniasis also requires that patients be kept out of the
sun and heat. However, this is very difficult to do in many
of the areas where the armed conflict is taking place. As a
result, the soldiers, recovery period is generally longer
than usual. In an attempt to improve treatment for infected
soldiers, the government is now moving them out of their
units to receive treatment in Bogota or at Silva Plazas'
mechanized calvary group in Duitama, Boyaca.


3. (S) The disease is also affecting the GOC's canine bomb
detection units. Once dogs are infected, they are
immediately euthinized as dangerous carriers of the parasite.
This has had an adverse affect on morale in the canine
units, as many of the handlers have been partnered with their
dogs since they were puppies.

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Limited Treatment Options
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4. (S/NF) The GOC has struggled with providing preventive
measures for many troops. Although uniforms are often
impregnated with insect repellent, after months of constant
wear, rain, and sweat, such measures loose their
effectiveness. Some troops have turned to repellent soaps
and lotions to help combat the disease, but these products
have been hard to supply to remote areas. Unfortunately, the
GOC has found there is still a high incidence of the disease
amongst soldiers who use the Nopikex soap and other
repellents.


5. (S/NF) Between January and March 2005, the Colombian
military treated 2,127 patients with 142,175 ampoules of
Glucantime, at a cost of USD 497,612. Sanofi Aventis, the
sole manufacturer of Glucantime, is no longer producing
enough of the drug to meet Colombian demand due to
profitablity concerns. The Colombian military is currently
looking into alternative therapies, such as miltefosine,
although studies show this is a less effective drug.


6. (U) The Embassy, through MilGroup and SOUTHCOM, is not
permitted to provide funding for most drugs that treat
leishmaniasis because they are not approved by the U.S. Food
and Drug Administration. The experimental drug Pentostam,
currently in trials in the United States, is not effective
against most strains of leishmaniasis found in Colombia.


7. (S//NF) This year the USG, through SOUTHCOM, provided
the Colombian Army with USD 500,000 of insect repellent which
included DEET and Permethrin. Although many soldiers have
found the repellent to be effective, the Colombian military
would prefer additional U.S. technical support in the area of
early diagnosis and identification of the parasite strain,
which would enable the Colombian Army medical teams to make
more effective use of Glucantime and antibiotic supplies in
the fight against the disease.
DRUCKER