Abstract
Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.
Highlights
IntroductionHuman leishmaniasis is a zoonotic disease endemic in the Mediterranean basin, including Spain [1,2,3,4]
MethodsHuman leishmaniasis is a zoonotic disease endemic in the Mediterranean basin, including Spain [1,2,3,4].In Spain, the vector involved in the transmission of the parasite is a sandfly of the Phlebotomus genus, which is active between May and October and dogs are the main reservoir [3,4,5].There is a formal system for reporting all compulsorily notifiable diseases, with notification protocols including case definitions
Regular epidemiological surveillance allowed an outbreak of human leishmaniasis to be detected, which started in the second half of 2009
Summary
Human leishmaniasis is a zoonotic disease endemic in the Mediterranean basin, including Spain [1,2,3,4]. There is a formal system for reporting all compulsorily notifiable diseases, with notification protocols including case definitions. The notification process starts from physicians, primary care and hospitals, or from microbiology laboratories, which report to the Spanish. During 2000 to 2009, between 12 and 25 leishmaniasis cases have been reported per year in the region (with an annual incidence rate of around 0.5 per 100,000 inhabitants) [6]. Subsequent research confirmed that an outbreak of leishmaniasis had been occurring since July 2009 in the south-west area of the region of Madrid [8]
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