Cutaneous Leishmaniasis Outbreak-Iraq, November 2014-April 2016

  • Vector-borne
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Background:
Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis affecting humans. It is endemic in Iraq and it was recognized as an important public health problem. Recently, an outbreak occurred during 2014-2016. This study was done to describe the outbreak by person, place, and time as well as recommend further measures for prevention and control.

Methods:
Data obtained from the counterpart zoonosis units in all affected provinces on weekly basis. Case investigation forms were received from all public health outlets in all Iraqi provinces. CL case was defined as a person showing the characteristic skin lesions who was clinically diagnosed by a general practitioner or dermatologist. Estimated population data were obtained from the Central Statistics Office.

Results:
The outbreak started late in 2014 at week 47 in Wassit governorate and continued throughout 2015 and early 2016 to involve most Iraqi governorates. The total reported cases were 32,349. Epidemic curve showed three peaks (week 11 and 50 in 2015; and week 5 in 2016). The overall incidence was 87.6/105 population). The highest incidence rate was in Diyala governorate (398/105 population) and the lowest incidence rate was in Duhok governorate (1.4/105 population). Higher incidence was below 15 years old (112/105 population). There was a higher incidence in males than female in 15-45 years old (84.7 vs. 69.4/105 population). Only 6.9% of the cases were reported among the Internally Displaced Population (IDPs) with incidence rate (88.9/105 population). All the patients received treatment. No outbreak investigation was done and no data obtained about risk factors.

Conclusion and Recommendations:
This outbreak had a large magnitude. Further in-depth studies are recommended to identify the exact causative agents, vectors, reservoirs, and risk factors.

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