International Journal of Medical Microbiology 298 (2008) 543–550 Zoonotic cutaneous leishmaniasis outbreak in Mazar-e Sharif, northern Afghanistan: An epidemiological evaluation Michael Faulde a,Ã , Joachim Schrader b , Gerhard Heyl c , Mohammed Amirih d , Achim Hoerauf e a Central Institute of the Bundeswehr Medical Service, Department of Medical Entomology/Zoology, PO Box 7340, D-56065 Koblenz, Germany b Regional Medical Command, Division of Health Affairs, Feldstraße 213, Kiel, Germany c Bundeswehr Medical Office, Division of Preventive Medicine, Dachauer Street 128, D-80637 Munich, Germany d Balkh Province Leishmaniasis Center, Mazar-e Sharif, Afghanistan e Institute of Immunology, Medical Microbiology and Parasitology, University Clinic Bonn, D-53105 Bonn, Germany Received 15 March 2007; received in revised form 11 June 2007; accepted 31 July 2007 Abstract In 2005, 200 cases of zoonotic cutaneous leishmaniasis (ZCL) were recorded among International Security Assistance Force (ISAF) troops stationed in the Mazar-e Sharif airport area. Within the local population, investigations revealed 3782 cases of ZCL, 174 cases of anthroponotic cutaneous leishmaniasis (ACL), and 2 cases of visceral leishmaniasis (VL) in the period from March 21, 2004 to March 20, 2005, and 4045 cases of ZCL, 198 cases of ACL, and no cases of VL from March 21, 2005 to March 20, 2006. The previously unknown transmission dynamics of ZCL, and differing seasonal distribution of ZCL and ACL, are here defined, thus permitting quantification and prediction of infection rates in deployed troops for the first time. At Mazar-e Sharif, Phlebotomus papatasi and Rhombomys opimus occurred in the highest densities yet observed, together with record-high Leishmania major infection rates. Data indicate the existence of high-density, anthropogenically induced ZCL in Afghanistan. r 2007 Elsevier GmbH. All rights reserved. Keywords: Zoonotic cutaneous leishmaniasis; Outbreak; Mazar-e Sharif; Leishmania major; Rhombomys opimus; Phlebotomus papatasi Introduction In central Asia, cutaneous leishmaniasis is considered to be focally endemic. In Kabul City, Afghanistan, a prolonged epidemic of urban anthroponotic cutaneous leishmaniasis (ACL) has been reported since 1987, with an estimated 12% of the population suffering from active disease, according to a study conducted from 1997 to 1998 (Reyburn et al., 2003). Currently, Kabul is thought to have the highest incidence of cutaneous leishmaniasis in the world, with an estimated 67,500– 200,000 cases annually (Reithinger et al., 2005). In 1997, a major outbreak of ACL occurred in the Timargara Afghan refugee camp in northwestern Pakistan, located in Dir District (Rowland et al., 1999). Linked to wartime conditions, the incidence of endemic but ARTICLE IN PRESS www.elsevier.de/ijmm 1438-4221/$ - see front matter r 2007 Elsevier GmbH. All rights reserved. doi:10.1016/j.ijmm.2007.07.015 Ã Corresponding author. Tel.: +49 261 400 6950; fax: +49 261 400 7084. E-mail address: MichaelFaulde@bundeswehr.org (M. Faulde).