title: Community outbreak of cutaneous leishmaniasis in La Ribera region of Valencia, Spain: Public Health measures.
abstract: BACKGROUND
  Outbreaks of human leishmaniasis are not very common in Spain, despite being considered an endemic disease. In this study, a new outbreak in the Valencian Community is presented. Its principal objective is to describe the clinical-epidemiological characteristics and to present the main Public Health measures established to contain the outbreak.
  
  
  METHODS
  A case was defined as anyone residing in the village of Tous (in Valencian Community), diagnosed with leishmaniasis according to clinical and laboratory criteria, defined by the Epidemiological Surveillance Network, and date of symptoms onset between 1 January 2012 and 31 December 2013. A descriptive analysis was performed on the epidemiological variables collected.
  
  
  RESULTS
  A total of 19 cases were reported from the 28th week of 2012 to the 30th week of 2013. Adults were most affected by the disease (73%). The most common clinical form was cutaneous leishmaniasis (89%). More than three-quarters (79%) of cases were confirmed by PCR. Species typing was performed on seven samples, with the parasite Leishmania infantum being identified. Patient outcome was favourable after physical (31%), or pharmacological (69%) treatment. Some kind of residual damage was observed in 37% of cases. Different measures were applied, aimed at health professionals, and vector and reservoir control, as well as general recommendations to the population for the containment of the outbreak.
  
  
  CONCLUSIONS
  This cutaneous leishmaniasis outbreak confirms the endemic nature and the high prevalence of the disease in the Mediterranean area. The most commonly used treatment was intralesional meglumine antimoniate. A comprehensive plan of action had to be developed in order to control the outbreak.
authors.affiliation: Servicio de Medicina familiar y Comunitaria, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Patricia
authors.initials: P
authors.lastname: Roth-Damas
authors.affiliation: Servicio de Medicina familiar y Comunitaria, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Mara
authors.initials: M
authors.lastname: Sempere-Manuel
authors.affiliation: Servicio de Medicina familiar y Comunitaria, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Mialaret-Lahiguera
authors.affiliation: Salud Pública, Centro de Salud de Alzira, Departamento de Salud de La Ribera, Alzira, Valencia, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-García
authors.affiliation: Servicio de Microbiología, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Jesús J
authors.initials: JJ
authors.lastname: Gil-Tomás
authors.affiliation: Servicio de Microbiología, Hospital Universitario de La Ribera, Alzira, Valencia, España. Electronic address: jcolomina@hospital-ribera.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Colomina-Rodríguez
authors.affiliation: Dirección Asistencial, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Palop-Larrea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D004285:Dogs / Q000469:parasitology; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D007303:Insect Vectors; D007306:Insecticides; D018314:Leishmania infantum / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D000068316:Parks, Recreational; D011634:Public Health / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D000981:Antiprotozoal Agents; D007306:Insecticides
keywords: Brote; Control; España; Leishmania; Outbreak; Spain