title: Epidemiology of paediatric visceral leishmaniasis in Hebron district, Palestine.
abstract: Seventy-six cases of visceral leishmaniasis (VL) were reported from the Hebron district of the West Bank, Palestine between 1993 and 2007. All cases were in children less than 9 years old (median age 2 years). The average number of cases was 5.06/year and the average annual incidence was 3.02/100000 children. Ribosomal internal transcribed spacer 1 (ITS1) PCR-RFLP was performed using DNA extracted from two cultures and 36 archived Giemsa-stained slides from VL patients. Leishmania infantum was revealed as the causative agent of VL in the focus. Isoenzyme analysis identified two isolates as zymodeme MON-1. A serological survey of 455 children screened for serum anti-Leishmania antibodies revealed 8.4% seropositivity. Seropositivity was highest for children in households of previous VL cases [odds ratio (OR) 7.5; 95% CI 3.17-17.61; P<0.001] and among people who had domestic dogs and/or other animals (OR 2.4; 95% CI 1.19-4.68; P=0.017). No difference was seen between males and females (P=0.073). A preliminary survey of sand fly distribution showed the abundance of two putative vector species: Phlebotomus syriacus (45%) and Ph. tobbi (10%). The focus of VL in Hebron district was shown to follow the epidemiological pattern of paediatric disease characteristic of the Mediterranean region.
authors.affiliation: Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany. ahmadymm@hotmail.com
authors.forename: Ahmad
authors.initials: A
authors.lastname: Amro
authors.forename: Kifaya
authors.initials: K
authors.lastname: Azmi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schönian
authors.forename: Abedelmajeed
authors.initials: A
authors.lastname: Nasereddin
authors.forename: Mohamed Barakat
authors.initials: MB
authors.lastname: Alsharabati
authors.forename: Samer
authors.initials: S
authors.lastname: Sawalha
authors.forename: Omar
authors.initials: O
authors.lastname: Hamarsheh
authors.forename: Suhair
authors.initials: S
authors.lastname: Ereqat
authors.forename: Ziad
authors.initials: Z
authors.lastname: Abdeen
mesh_terms: D000818:Animals; D000829:Animals, Domestic / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D042241:Early Diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D018314:Leishmania infantum / Q000235:genetics / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D010691:Phlebotomus; D018570:Risk Assessment; D013045:Species Specificity; D015047:Zoonoses / Q000453:epidemiology* / Q000469:parasitology