Agreement Document for the Study of Leishmaniasis from a One Health Approach in Spain.

Background: Leishmaniasis, a vector-borne disease caused by the parasite Leishmania, is a public health concern in Europe. Although Spain is an endemic country, it lacks a national surveillance network. To address this, the creation of a research and surveillance network is proposed, which would integrate data from various fields and enhance control and public health strategies. Objectives: The first objective is to gather epidemiological data on vectors, reservoirs, and transmission rates in Spain, with a particular focus on the role of dogs and wildlife as primary reservoirs. The plan includes establishing forums, databases, and specialised training programmes. The second objective is to improve case surveillance and reporting by establishing a comprehensive national registry. Implementing molecular diagnostics and bioinformatics tools will aid analysis of retrospective data and tracking of disease evolution. The third objective is to develop a standardised method for the molecular characterisation of Leishmania, using techniques such as PCR and genomic sequencing to detect virulence and resistance patterns. Key actions include collecting isolates, sharing analytical tools and providing genomic training. The fourth objective is to identify new therapeutic targets in response to toxicity and resistance to current treatments by studying specific enzymes (FeSOD, HDAC), metabolic pathways, and natural products. Ultimately, establishing the Leishmaniasis Surveillance Network will support a "One Health" approach and promote interdisciplinary collaboration towards a national control plan. Methods: We created the Working Group on Leishmaniasis funded by the Spanish Society of Tropical Medicine and International Health as a leishmaniasis forum for meetings and discussions on weaknesses and gaps we find in the knowledge and management of the infection based on the background of each academic and healthcare research group. Expected Impact: This study will promote the articulation of a Leishmaniasis Surveillance Network aiming to bring together the main stakeholders in the research and management of leishmaniasis in Spain.