Control of cutaneous leishmaniasis in Afghanistan: achievements and challenges

Overview

Cutaneous leishmaniasis (CL) is a major public health problem in Afghanistan, where, since 1978, there has been political instability. In 2002, as many as 200 000 people were reported to be infected with Leishmania spp. in Kabul alone,1 and the city was considered to be the world’s largest focus of CL, with an estimated annual incidence of 67 500 cases.2 In the period 2003–2007, up to 226 000 new cases were estimated to occur each year, although, because of a weak surveillance system, 5–10 times fewer cases were reported.

Most cases of CL in Afghanistan are due to Leishmania tropica, which is transmitted by the sandfly, Phlebotomus sergenti. The disease is an anthroponosis and in Afghanistan is generally characterized by large and/or multiple cutaneous lesions with a variable tendency to self-cure. Most lesions occur on the face, and the lesions and the resulting scarring are disfiguring and often lead to severe stigmatization of affected individuals, especially women, who may be considered unfit for marriage. A small fraction of the cases of CL in Afghanistan are due to L. major, which is transmitted by the sandfly P. papatasi. The rodents Rhombomys opimus and Meriones spp. are the reservoirs for zoonotic CL, which occurs mainly in the northern provinces of Afghanistan, such as Mazar-e-Sharif.

Overall, CL is reported from 21 of the 34 provinces of the country, and some 11 million people are estimated to be at risk of infection. The current surveillance system does not provide information on how many districts in each province are actually endemic.