Trends in the epidemiology of cutaneous leishmaniasis in a young adult population in Israel: A long-term survey

Background: The Israel Defense Forces (IDF) medical records offer a unique and valid 28-year view of the striking differences in cutaneous leishmaniasis (CL) seasonality patterns and incidence rates between the military and civilian sectors in Israel. Aim: To determine the annual epidemiology and seasonality trends of CL over the long term in the IDF. Methods: The database of the Epidemiology Section of the IDF Medical Corps was reviewed for all reported cases of CL (passive surveillance) from 1 January 1978 to 31 December 2006. The diagnosis of reported CL was based on the clinical presentation, relevant epidemiologic data, and, in most cases, microscopic visualization of the parasite. Polymerase chain reaction (PCR) confirmation of the parasite has been more routinely performed since 2003. Results: Rates of CL were generally characterized by peaks every 10.years, until the last 10.years when a second peak occurred in the same decade. The average monthly rates varied from a low of 0.8 cases per 100,000 population in June to a high of 9.83 cases per 100,000 soldiers in December. Conclusions: he results of this study imply that we are currently in the midst of a re-emergence of CL in Israel, in particular among IDF soldiers. This increase warrants a change in the public health approach.