Geographic and epidemiologic analysis of the cutaneous leishmaniasis outbreak in Northern Israel, 2000-2003

Background: The incidence of cutaneous leishmaniasis in northern Israel began to rise in 2000, peaking at 41.0 per 100,000 in the Kinneret subdistrict during the first half of 2003. Objectives: To examine the morbidity rates of CL in northern Israel during the period 1999-2003, which would indicate whether new endemic areas were emerging in this district, and to identify suspicious hosts. Methods: The demographic and epidemiologic data for the reported cases (n=93) were analyzed using the GIS and SPSS software, including mapping habitats of suspicious hosts and localizing sites of infected sand flies. Results: The maximal incidence rate in the district was found in the city Tiberias in 2003: 62.5/100,000 compared to 0-1.5/100,000 in other towns. The cases in Tiberias were concentrated on the peripheral line of two neighborhoods, close to the habitats of the rock hyraxes. Sand flies infected with Leishmania tropica were captured around the residence of those affected. Results of polymerase chain reaction were positive for Leishmania tropica in 14 of 15 tested patients. Conclusions: A new endemic CL area has emerged in Tiberias. The most suspicious reservoir of the disease is the rock hyrax.