Cutaneous Leishmania Outbreak at Bani Oshb sub-district, Hajjah Governorate, Yemen, July 2018

Cutaneous leishmaniasis (CL) continues to be one of important health problems in Yemen. On 23 July 2018, the surveillance officer in Hajjah governorate reported an increased number of suspected CL in Bani Oshb sub-district. On 24 July 2018, a field epidemiology team was sent to determine risk factors and recommend control measures.

Descriptive study followed by case-control study was performed. Cases defined as any person who met the WHO suspected or confirmed case definition living in Bani-Oshb sub-district during August 2017 to July 2018. Control is any person living in sub-district having no new or old skin lesion during same period. Data collected on individual, housing and animal risk factors. Attack rate, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. p value < 0.05 was considered as the cut point for significant. Twenty-two skin scrapings were taken for lab confirmation.

Thirty cases were identified. 57% were females and 80% were children <15 who had an attack rate of 7/1000. 77% of cases had one lesion and 67% on their faces. There were significant associations between CL and female gender, (OR=5.2, 95% CI:1.7 – 16.5), malnutrition (OR = 5.2, 95% CI:1.7 – 16.5), not using bed net (OR = 14.5, (95% CI: 1.7 – 122.4), dark houses (OR=6.4, 95% CI:2.1 – 19.7), houses without windows screen (OR = 5.2, 95% CI: 1.3-21.2), plantation around (OR = 6.5, 95% CI: 2.1-20.5), animals inside or close to house (OR = 9.3, 95% CI: 1.9-46.7), rising animals (OR=8.1, 95% CI:1.6 – 40.7), existence of rodent (OR=14.5, 95% CI:1.7 – 122.4). Out of the 22 skin scrapings, 21 (96%) were positive for amastigotes.

CL Outbreak was confirmed. The identified risk factors suggest suitable environment for vector. Effective vector control (e.g. impregnated mosquito nets, pesticide spraying) together with raising community awareness are recommended. Introducing community-based surveillance will foster surveillance sensitivity.

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