02888nas a2200349   4500000000100000008004100001260003700042653002400079653005700103100001800160700001400178700001800192700001500210700001500225700002200240700001600262700002000278700001300298700001400311700002300325700001600348700001300364700001200377700001400389700001600403245017300419856009900592300001300691490000700704520181300711022001402524       2022                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health1 aAflatoonian M1 aSharifi I1 aAflatoonian B1 aSalarkia E1 aKhosravi A1 aTavakoli Oliaee R1 aBamorovat M1 aAghaei Afshar A1 aBabaei Z1 aSharifi F1 aTaheri Soodejani M1 aShirzadi MR1 aGouya MM1 aNadim A1 aSharifi H1 aSchönian G00aFifty years of struggle to control cutaneous leishmaniasis in the highest endemic county in Iran: A longitudinal observation inferred with interrupted time series model  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0010271&type=printable  ae00102710 v163 a<p>Negligible data are available following major social activities and environmental changes on leishmaniasis. Therefore, how interactions between these events influence cutaneous leishmaniasis (CL) risk is not well-known. This longitudinal study was undertaken to explore the impact of interventions conducted between 1971 and 2020 in Bam county, which has had the highest disease burden in Iran. Only confirmed CL cases during this period were taken into account. Data were analyzed by SPSS 22 using the X2 test to assess the significance of the difference between proportions. Moreover, we used interrupted time series (ITS) to assess the impact of three environmental events during this period. Overall, 40,164 cases of CL occurred in the past five decades. Multiple complex factors were among the leading causes that synergistically induced the emergence/re-emergence of CL outbreaks in Bam. The main factors attributed negatively to CL control were cessation of malaria spraying activity, expansion of the city spaces, and a massive earthquake creating new breeding potentials for the vectors. The highest impact on CL incidence during these years was related to the earthquake [coefficient = 17.8 (95% CI: 11.3, 22.7); p-value &lt; 0.001]. Many factors can contribute to CL outbreaks in endemic foci. They also can cause new foci in new areas. Since humans are the single reservoir for CL in this area, early detection and effective management significantly contribute to controlling CL to reduce the disease burden. However, essential evidence gaps remain, and new tools are crucial before the disease can ultimately be controlled. Nevertheless, sustained funding and more trained task forces are essential to strengthen surveillance and case management and monitor the interventions’ impact.</p>
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