Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices

IF 2 Q3 INFECTIOUS DISEASES Parasite Epidemiology and Control Pub Date : 2024-10-05 DOI:10.1016/j.parepi.2024.e00385

Ngwa Niba Rawlings , Mark Bailey , Peter Craig , Orin Courtenay

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Abstract

Background

British soldiers undergoing jungle training in Belize typically experience a relatively low risk of developing cutaneous leishmaniasis. However, an uncharacteristically large outbreak of cutaneous leishmaniasis occurred in 2022. This study aimed to determine the cumulative incidence of the disease and highlight potential shortcomings in personal protective measures to mitigate exposure to sand fly vector bites.

Methods

A retrospective analysis was conducted on medical records of cutaneous leishmaniasis cases between 2005 and 2022, as well as on questionnaire responses regarding personal protective measures administered to cutaneous leishmaniasis cases in 2022. Data were sourced from Defence Public Health Unit, Military Environmental Health Department and British Army Training Support Unit Belize.

Results

Eighty-one confirmed clinical cutaneous leishmaniasis cases were recorded between 2005 and 2022, with a substantial peak (38 cases) in 2022. Most cases occurred during the wet season. Pre-2022, the median cumulative incidence per 8-week deployment was 0.90 % (Q1–Q3: 0.34 %–1.34 %), with an annual variation of 0.2 % to 2.0 %. In 2022, the cumulative incidence spiked to 4.22 %, associated with a risk ratio of 5.3 (95 % C.I.s, 3.41, 8.16), and rising to a cumulative incidence of 7.3 % in a single unit of 450 men (33 cases) in late 2022. These values are significantly higher than the median cumulative incidence of all previous years, and to published reports for other cutaneous leishmaniasis -endemic regions. Troop responses identified limitations in the supply of optimal equipment, and in sand fly bite and leishmaniasis risk avoidance information provided by the pre-deployment health education programme. Compliance with health education advise was also suboptimal, with irregular use of insect repellents, protective clothing / head netting, and insecticide-treated hammocks.

Conclusions

The reasons behind the unusually high numbers of cutaneous leishmaniasis cases and cumulative incidence in 2022 remain unclear, emphasising the need to improve personal protective measures provision and implement a comprehensive health education programme for troops undergoing jungle training in Belize.

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在伯利兹接受丛林训练的英军中的皮肤利什曼病：累积发病率和潜在风险实践

背景在伯利兹接受丛林训练的英国士兵患皮肤利什曼病的风险通常相对较低。然而，2022 年却一反常态地爆发了大规模的皮肤利什曼病。本研究旨在确定该疾病的累积发病率，并强调个人防护措施在减少沙蝇病媒叮咬暴露方面可能存在的不足。方法对 2005 年至 2022 年期间皮肤利什曼病病例的医疗记录以及 2022 年皮肤利什曼病病例个人防护措施调查问卷进行了回顾性分析。数据来源于国防公共卫生部门、军事环境卫生部门和伯利兹英军训练支援部队。结果 2005 年至 2022 年期间共记录了 81 例经确诊的临床皮肤利什曼病病例，其中 2022 年达到高峰（38 例）。大多数病例发生在雨季。2022 年之前，每 8 周部署的累计发病率中位数为 0.90%（第一季度至第三季度：0.34%-1.34%），年变化率为 0.2%-2.0%。2022 年，累计发病率飙升至 4.22%，风险比为 5.3（95% 置信区间，3.41, 8.16），2022 年末，在一个 450 人的单位（33 例）中，累计发病率上升至 7.3%。这些数值明显高于往年累计发病率的中位数，也高于其他皮肤利什曼病流行地区的公开报告。部队的反应表明，最佳设备的供应以及部署前健康教育计划提供的沙蝇叮咬和利什曼病风险规避信息存在局限性。结论 2022 年皮肤利什曼病病例和累计发病率异常高的原因尚不清楚，强调有必要改善个人防护措施的供应，并为在伯利兹接受丛林训练的部队实施全面的健康教育计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Parasite Epidemiology and Control Medicine-Infectious Diseases

CiteScore

5.70

自引率

3.10%

发文量

审稿时长

17 weeks

期刊介绍： Parasite Epidemiology and Control is an Open Access journal. There is an increasing amount of research in the parasitology area that analyses the patterns, causes, and effects of health and disease conditions in defined populations. This epidemiology of parasite infectious diseases is predominantly studied in human populations but also spans other major hosts of parasitic infections and as such this journal will have a broad remit. We will focus on the major areas of epidemiological study including disease etiology, disease surveillance, drug resistance and geographical spread and screening, biomonitoring, and comparisons of treatment effects in clinical trials for both human and other animals. We will also look at the epidemiology and control of vector insects. The journal will also cover the use of geographic information systems (Epi-GIS) for epidemiological surveillance which is a rapidly growing area of research in infectious diseases. Molecular epidemiological approaches are also particularly encouraged.