title: Epidemiologic aspects of an emerging focus of visceral leishmaniasis in Tbilisi, Georgia.
abstract: BACKGROUND
  Over the last 15 years, visceral leishmaniasis (VL) has emerged as a public health concern in Tbilisi, the capital of Georgia.
  
  
  RESULTS
  Seroepidemiological surveys were conducted to determine the prevalence and incidence of infection in children and dogs within the main focus of VL, and to identify risk factors associated with human infection. Of 4,250 children investigated, 7.3% were positive by direct agglutination test in a baseline survey; an apparent incidence rate of 6.0% was estimated by one year follow-up. None of the seropositive children progressed to VL during the survey. Increased seropositivity at one year was predicted by presence at baseline of clustered flying insects (OR = 1.49; P = 0.001), perceived satisfactory sanitation (OR = 1.65; P<0.001), stray dogs (OR = 1.33; P = 0.023), and by persistent fever during the 6 months prior to baseline survey (OR = 14.2; P<0.001). Overall, 18.2% (107/588) of domestic and 15.3% (110/718) of stray dogs were seropositive by the rk39 dipstick test. Clinical VL signs were found in 1.3% of domestic and 2.9% of stray, seropositive dogs. Parasites isolated from human and dog samples were identified by PCR and phylogenetic analysis of the Leishmania 70 kDa heat-shock protein (HSP70) gene as Leishmania infantum.
  
  
  CONCLUSIONS
  There is an active focus of L. infantum transmission in Tbilisi with a high prevalence of human and canine infections.
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia. egiorgobiani@yahoo.com
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Giorgobiani
authors.forename: Nazibrola
authors.initials: N
authors.lastname: Chitadze
authors.forename: Gvantsa
authors.initials: G
authors.lastname: Chanturya
authors.forename: Marina
authors.initials: M
authors.lastname: Grdzelidze
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Jochim
authors.forename: Anna
authors.initials: A
authors.lastname: Machablishvili
authors.forename: Tsiuri
authors.initials: T
authors.lastname: Tushishvili
authors.forename: Yulia
authors.initials: Y
authors.lastname: Zedginidze
authors.forename: Marina K
authors.initials: MK
authors.lastname: Manjgaladze
authors.forename: Nino
authors.initials: N
authors.lastname: Iashvili
authors.forename: Manana P
authors.initials: MP
authors.lastname: Makharadze
authors.forename: Tsiuri
authors.initials: T
authors.lastname: Zakaraya
authors.forename: Konstantin
authors.initials: K
authors.lastname: Kikaleishvili
authors.forename: Ivan
authors.initials: I
authors.lastname: Markhvashvili
authors.forename: Goderdzi
authors.initials: G
authors.lastname: Badashvili
authors.forename: Teymuraz
authors.initials: T
authors.lastname: Daraselia
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fay
authors.forename: Shaden
authors.initials: S
authors.lastname: Kamhawi
authors.forename: David
authors.initials: D
authors.lastname: Sacks
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000469:parasitology / Q000662:veterinary; D004285:Dogs; D005191:Family Characteristics; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D018314:Leishmania infantum / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000469:parasitology / Q000662:veterinary; D016017:Odds Ratio; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D016036:Seroepidemiologic Studies