A protocol for early warning and response to zoonotic leishmaniasis: feasibility and acceptability among dog caregivers in Portugal

Leishmaniasis, caused by Leishmania infantum and transmitted by phlebotomine sand flies, remains endemic in the Mediterranean region, where dogs serve as primary hosts and reservoirs for human infection. In the Iberian Peninsula, canine seroprevalence varies widely, reflecting heterogeneous transmission dynamics. Climate change, environmental alterations, and globalisation are expected to expand vector distribution and increase transmission potential. The study aims to evaluate the feasibility of an integrated intervention combining evidence-based training with a seasonal Early Warning and Response System (EWRS) to promote knowledge, perceptions, and protective behaviours against zoonotic leishmaniasis among dog caregivers in mainland Portugal. This study uses a prospective, single-arm longitudinal design with an integrated cross-sectional baseline questionnaire. Dog caregivers attending veterinary care centres across Portugal’s five mainland regions will complete a Knowledge, Perceptions, and Practices (KPP) questionnaire to establish baseline indicators. From this cohort, a subset of participants will then enter a longitudinal phase, receiving structured training programme (via leaflets, videos, and one-to-one appointments) and seasonal EWRS notifications. The intervention will be evaluated through changes in KPP scores, before and after the training and at the end of the sand fly season. Adherence to recommended preventive measures, such as using repellents and keeping dogs indoors at night, will be monitored via periodic telephone checklists. EWRS-related metrics will be assessed by user engagement, retention, and self-reported feasibility and acceptability. Repeated measures and multivariable analyses will be conducted to assess changes over time and associations between exposure to the intervention and behavioural outcomes. This study is expected to provide valuable data on the feasibility and acceptability of integrating an innovative and dynamic approach to the management of leishmaniasis in endemic regions. By providing caregivers with a targeted training programme and risk alerts through the EWRS, this study will help identify effective ways to establish evidence-based preventive behaviours and ultimately develop practical One Health scalable strategies to reduce the transmission of zoonotic leishmaniasis.