Timing matters: a new ISMED-CLIM protocol tests season-specific notifications to protect dogs and people from leishmaniasis
A new study protocol published in BMC Veterinary Research outlines an innovative approach to fighting leishmaniasis in Portugal. By combining tailored education with seasonal notifications timed to local sand fly activity, researchers are testing whether this integrated intervention can help dog caregivers take the right preventive steps at the right moments.
A disease that often goes unnoticed
Leishmaniasis caused by Leishmania infantum is endemic across the Mediterranean. The parasite is transmitted by infected female phlebotomine sand flies, and dogs are its main host and the principal reservoir for human infection.
The disease manifests unpredictably in dogs. While some experience severe, life-threatening symptoms, others carry the parasite for years without showing any signs of illness. Crucially, even treated and apparently healthy dogs rarely achieve full parasitological cure. This means asymptomatic, treated, or vaccinated dogs can still pass the parasite back to sand flies, perpetuating the cycle.
The situation in Europe is changing. Climate and environmental change, urbanisation and the movement of people and animals are all contributing to higher sand fly density and a wider geographic range. Because the disease threatens both animal and human health, effective control requires a One Health approach where veterinarians, health professionals, dog caregivers and the public work together.
What dog caregivers know, and what they miss
Previous surveys in Portugal found that between 83 and 91% of participants recognised canine leishmaniasis, but only 38.6% knew that people can also be infected. Many do not recognise sand flies as the vector and confuse them with mosquitoes, which makes it harder to control the places where sand flies breed, such as animal shelters, burrows and leaf litter.
Knowledge alone is not the full picture. How people perceive risk shapes whether they act on what they know. Recommended measures are already promoted through veterinarians and the media, but compliance is often poor.
The study
To address these gaps, researchers designed a study taking place across Portugal’s five mainland regions: Norte, Centro, Lisboa, Alentejo and Algarve.
This study combines an initial questionnaire completed by dog caregivers recruited in veterinary clinics and hospitals to map out current gaps in awareness and prevention practices. A group of these caregivers will then be followed with periodic check-ins throughout the entire sand fly season. This setup allows researchers to evaluate how effectively caregivers adopt and maintain preventive practices over time when prompted by real-time seasonal notifications.
How the results will be measured
Researchers will evaluate changes in knowledge, perceptions, and practices by following up with participants at several points throughout the study:
- Questionnaires: Participants complete questionnaires before the intervention begins, shortly after the first training, and at the end of the season.
- Check-in after notifications: Following each seasonal notification, researchers check in with caregivers to record which prevention steps were implemented, what practical obstacles arose, and whether the notification and training materials were clear and useful.
While the study relies on self-reported actions from caregivers, this evaluation will provide crucial insights into how feasible and acceptable this seasonal EWRS is in real-world settings.
Why this matters
Most leishmaniasis prevention advice is general and delivered once. This study tests whether linking prevention to predicted, local sand fly activity helps caregivers act at the moments that count and keep going through the whole sand fly season. The results will show whether a system like this is practical to run through routine veterinary care and whether dog caregivers find it useful.
The findings will be shared through scientific publications, with Portuguese Regional Task Forces to inform public health policy, and in reports to participants. The training materials are designed to be adapted for other Mediterranean countries where the disease is endemic.
Part of ISMED-CLIM
The study is part of Living Lab 4 of ISMED-CLIM, Innovative Solutions across the Mediterranean for mitigation of Climate change-related health risks and enhancing health system resilience, funded by the European Climate, Infrastructure and Environment Executive Agency under the European Commission’s Horizon Missions programme (grant agreement no. 101156653).
Participating institutions: Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (lead); Portuguese Association of Companion Animal Veterinary Specialists (APMVEAC); Medical School, University of Cyprus; Climate and Atmosphere Research Center, The Cyprus Institute; Faculty of Physics, University of Belgrade.
Read the full open access protocol: https://doi.org/10.1186/s12917-026-05901-1
Publication details
Title: A protocol for early warning and response to zoonotic leishmaniasis: feasibility and acceptability among dog caregivers in Portugal
Journal: BMC Veterinary Research (Study Protocol)
Authors: Carla Maia, Lisa Mestrinho, Manuel Magalhães-Sant’Ana, Mariana Gonçalves, Felisbina Queiroga, Filipe Gonçalves, Emir Chaher, Panayiotis K. Yiallouros, Kamil Erguler, Suzana Blesic, Panayiotis Kouis