Visceral leishmaniasis control in Brazil: time to re-evaluate DDT?

Controlling visceral leishmaniasis in Brazil has proven difficult for several reasons, including: 1) limitations in diagnosis and treatment, 2) the failure of the dog culling program, and 3) the short-term residual effect of pyrethroids against the main phlebotomine vector Lutzomyia longipalpis . The disease has become more widespread during the last three decades and it now occurs in 21 of the 26 Brazilian states plus the Federal District, and even affects several state capitals and large cities. Although DDT has many environmental drawbacks and possible toxicity to animals, several countries still use this chemical in their public health programs due to its long-lasting effect. Therefore, this study aims to re-evaluate the use of DDT to control zoonotic visceral leishmaniasis.