Qom University of Medical Sciences Journal

Background and Objectives: Cutaneous leishmaniasis (CL) is a common parasitic disease in tropical and subtropical areas. Although CL does not have a high mortality rate, it causes skin lesions that may persist for more than a year. Even after surgery, the scars may remain on the patient's skin for the rest of their lives. In disease endemic areas, disease control strategies are determined based on the endemicity of the disease. The endemicity of diseases is reported in three types: hypoendemic, mesoendemic, and hyperendemic. In each type, the disease control methods are different. This study aims to determine the epidemiological characteristics and endemicity of zoonotic CL in Qom province, Iran.
Methods
In this cross-sectional study, of 45 villages located in endemic areas in central and Kahak districts in Qom province, 8 villages were randomly selected. At the end of each season, the households were visited and their demographic information and history of infection with CL were recorded. The age of people who had acute ulcers was separately recorded. If 85% of patients with acute ulcers were children aged 0-6 years and 25% of patients had age <1 one year, the disease would be considered hyperendemic in the region. If at least 20% of patients with acute ulcers had age >15 years, the disease was hypoendemic, and if the age of patients was between the above-mentioned levels, the disease was considered mesoendemic in the region.
Results
Out of 4228 people living in 8 endemic villages in Qom province, 1920 (45.41%) had scars and a history of getting infected. Totally,165 new cases with active lesions were reported. The incidence of CL was 71.49 per 1000 people. The highest (70.48 %) and the lowest (20.23 %) rates were in Aliabad and Sarajeh villages, respectively. The highest incidence rate (122.39 per 1000 people) was found in Kouh Sefid village and the lowest incidence rate (9.63 per 1000 people) was seen in Sarajeh village. The most cases were reported in autumn (n=125) while no any case was reported in spring. In the present study, 13.33% of patients were under 7 years of age and 67.87% had age >15 years. Therefore, the disease in the study region had hypoendemic focus.

Discussion
The focus of zoonotic CL in Qom province is hypoendemic. Therefore, personal protection methods against sandfly bites such as the use of mosquito nets (especially insecticide-treated mosquito nets), the nets for doors and windows in residential areas, and the insect repellent compounds such as  N, N-Diethyl-meta-toluamide (DEET) are recommended to control the disease in Qom.
Ethical Considerations
Compliance with ethical guidelines
The ethical approval has been gained from the Ethics Committee of Qom University of Medical Sciences  (Code: IR.MUQ.REC.1398.075).
Funding
This study financially supported by Qom University of Medical Sciences.
Authors contributions
Conceptualization, Methodology, Software, Validation, Formal Analysis, Investigation: Arshad Veysi, Samira Ahmadi, Aioub Sofizadeh, Seyed Abbas Hosseinalipour and Abedin Saghafipour. Resources, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing, Visualization, Supervision, Project Administration, Funding Acquisition: Arshad Veysi and Abedin Saghafipour
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors are thankful to Qom University of Medical Sciences for the financial support.