Epidemiology and spatiotemporal analysis of visceral leishmaniasis in Palestine from 1990 to 2017
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Objectives: Visceral leishmaniasis (VL) is a deadly disease endemic in all countries around the Mediterranean Sea. In Palestine, VL is transmitted to humans from infected dogs by a sandfly bite. The aim of this study was to investigate the epidemiology and spatiotemporal pattern of VL in Palestine within a period of 27 years (1990–2017). Methods: A long-term descriptive epidemiological study on human VL was conducted based on patient's profiles to calculated disease prevalence, geographical, spatiotemporal and seasonal distribution, distribution by age and gender, diagnosis, treatment, and treatment outcome. Results: A total of 343 patients were reported, the average annual incidence rate was 0.73 case/100 000 population. Most cases came from the western parts of the West Bank. The number of reported males was 162 (51%), and patient’s age ranged from 4 months to 16 years (average 2.5 years), of which 93.3% were 5 years old. The annual incidence rate increased between 1993–1999, peaked in 1995, and dropped as from 2002. The future projections of VL indicate that the endemic foci in most governorates are projected to disappear in the future and only the very northwest of the West Bank will be at risk of VL. Conclusions: Visceral leishmaniasis continues to be endemic in the West Bank but not the Gaza Strip. Pentavalent antimonial sodium stibogluconate continues to be the first line treatment and physicians are recommended to consider liposomal Amphotericin B (AmBisome) for refractory patients only. Geographical, spatiotemporal and seasonal trends of VL were identified.