وضعيت بيماري ليشمانيوز جلدي در منطقه تحت پوشش برنامه كنترل در شهرستان اردكان

SURVEY OF THE STATUS OF CUTANEOUS LEISHMANIASIS IN ARDAKAN COUNTY OF YAZD; AN AREA COVERED BY THE CONTROL PROGRAM

Cutaneous leishmaniasis is one of the most prevalent parasitic diseases in Iran. In recent years, this disease has remained the topmost public health problem in Yazd, especially in Ardakan. Studies over the two last years show a new focus of Zoonotic Cutaneous Leishmaniasis (ZCL) with Leishmania major as the agent, Rhombomys opimus and Meriones libycus as the reservoir hosts and Phlebotomus papatasi as the vector.Secause of very high prevalence of the disease in this area, the public health heads of Yazd decided to take steps to control the disease. The control program was conducted via indoor residual spraying with WP 50% Propoxour in 2g/m2, and also poisoning of reservoir host rodents with Klerat in a radius of 2000 m around the infected area. Investigation of ZCL status by house to house visit in the treated villages, examination the patients and completion of the related questionnaire in early 2001 showed a great decline in the incidence rate of the disease in the controlled area. In Ahmadabad, the incidence rate of ZCL fell from 228.1 per 1000 in 1999 to 107.4 perl000 in 2000. In Torkabad, this rate reduced from 229.8 per 1000 to 35.8 per 1000. This decrease was significant (P<0.0001 in Ahmadabad & P<0.00001 in Torkabad). Due to relative similarity of weather conditions before and after the control program, we concluded that it had an effective role in reduction of the number of disease cases. Due to the exophilic behavior of the vector and the fact that people of this area go to sleep outdoors (in the yard and on the root) during the high risk months, it is suggested that the rodent control has an important role to play in case reduction. Indoor residual spraying can be mentioned as a less effective method alongside rodent control for containing zoonotic cutaneous leishmaniasis (ZCL).