Cutaneous Leishmaniasis in Israel in the Era of Changing Environment

Background: Cutaneous leishmaniasis (CL) is a zoonotic disease, endemic and notifiable in Israel. The vectors are sandflies of the genus Phlebotomus, the hosts are mainly field rodents. The infective agents are Leishmania parasites. Ph. papatasi is the recognized vector of L. major, while Ph. sergenti is considered to be the vector of L. tropica.

Aim: To increase awareness of leishmaniasis, enhance surveillance, and improve reporting.

Methods: Morbidity data were obtained from disease notifications reported to the Department of Epidemiology of the Israeli Ministry of Health.

Results: The annual number of reported CL cases during the period 1961-2000 varied between less than 10 to over 250, with rates varying between 0.13 to over 7 per 100,000. Two peaks, between 1967-1969 and 1980-1982, are clearly seen. These peaks reflect environmental changes caused by the introduction of non-immune people (mainly Jews) into the area of endemic foci, enhanced urbanization by expansion of settlements bordering this area, agricultural/industrial projects, and most probably the effect of Global Warming. Recently, an increasing trend in the prevalence of the disease has been reported also by the Palestinian Authority and countries in the Mediterranean basin, reflecting shared changes in modern demographic and environmental conditions. These factors include population growth and movements, as well as ecological changes.

Conclusions: Cooperation of the Ministries of Health and Environment of the countries of the whole Middle East region in combating the vectors and the reservoirs in animal hosts are a major need.