title: Prevalence and determinants of Leishmania major infection in emerging and old foci in Tunisia.
abstract: BACKGROUND
  Zoonotic Cutaneous Leishmaniasis (ZCL) due to Leishmania major (L. major) is still a serious public health problem in Tunisia. This study aimed to compare the prevalence and risk factors associated with L. major infection in old and new foci using leishmanin skin test (LST) in central Tunisia.
  
  
  METHODS
  A cross sectional household survey was carried out between January and May 2009 on a sample of 2686 healthy individuals aged between 5 and 65 years. We determined the prevalence of L. major infection using the LST. Risk factors of LST positivity were assessed using a logistic regression model.
  
  
  RESULTS
  The overall prevalence of LST positivity was 57% (95% CI: 53-59). The prevalence of L. major infection was significantly higher in the old focus (99%; 95% CI: 98-100) than in the emerging foci (43%; 95% CI: 39-46) (p = <0.001). Multivariate analysis of LST positivity risk factors showed that age, the nature of the foci (old/emerging), personal and family history of ZCL are determinants of positive LST results.
  
  
  CONCLUSIONS
  The results updated the current epidemiologic profile of ZLC in central Tunisia. Past history of transmission in a population should be considered as a potential confounder in future clinical trials for drugs and vaccines against L. major cutaneous leishmaniasis.
authors.affiliation: Department of Medical Epidemiology, Pasteur Institute of Tunis, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), 13 Place Pasteur BP-74, 1002 Tunis Belvedere, Tunisia. bettaiebjihene@yahoo.fr.
authors.forename: Jihene
authors.initials: J
authors.lastname: Bettaieb
authors.forename: Amine
authors.initials: A
authors.lastname: Toumi
authors.forename: Sadok
authors.initials: S
authors.lastname: Chlif
authors.forename: Bilel
authors.initials: B
authors.lastname: Chelghaf
authors.forename: Aicha
authors.initials: A
authors.lastname: Boukthir
authors.forename: Adel
authors.initials: A
authors.lastname: Gharbi
authors.forename: Afif
authors.initials: A
authors.lastname: Ben Salah
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D018320:Leishmania major / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012882:Skin Tests; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult