Abstract
Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria. The MENTOR Initiative, an international not-for-profit organization, was commissioned to implement an integrated leishmaniasis control program, providing an opportunity to reassess the epidemiology of leishmaniasis in northern Syria. Epidemiologic data and biologic samples for molecular species diagnostics were collected from collaborating local health centers. Incidence peaked in March 2015 at 7,743 estimated monthly cases. High levels of transmission were observed in traditional endemic regions but extended to previously hypoendemic regions, such as Al-Raqqa and Al-Hasakah. Incidence decreased to 3,209 in July 2015. Data indicate that the prewar trend of increasing incidence of cutaneous leishmaniasis accelerated during the beginning of armed conflict but declined after implementation of the comprehensive control program by the MENTOR Initiative. Molecular analysis revealed a spectrum of Leishmania species and sporadic cases of visceral leishmaniasis.
Highlights
Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria
The MENTOR Initiative’s Leishmaniasis Control Program in Northern Syria The MENTOR Initiative’s first target regions were the provinces of Aleppo and Idlib; the group subsequently expanded its activities to Al-Raqqa, Al-Hasakah, and Hama
Epidemiology of cutaneous leishmaniasis (CL) in Northern Syria The number of healthcare centers (HCCs) varied over the study period, mostly because of the changing security situation, which, in turn, led to movement of persons and, in some cases, loss of access to these health facilities
Summary
Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria. The MENTOR Initiative, an international not-for-profit organization, was commissioned to implement an integrated leishmaniasis control program, providing an opportunity to reassess the epidemiology of leishmaniasis in northern Syria. Data indicate that the prewar trend of increasing incidence of cutaneous leishmaniasis accelerated during the beginning of armed conflict but declined after implementation of the comprehensive control program by the MENTOR Initiative. After the onset of civil war, reports emerged about a dramatic increase in CL cases in Syria and neighboring Jordan [2,3,4]. The principal aims of this system were to collect reliable data for the epidemiology of leishmaniasis, to investigate the comparative distribution of Leishmania species in clinical samples, and to evaluate diagnostic and therapeutic activities of affected populations in northern Syria
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