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. 2018:40:e2018032.
doi: 10.4178/epih.e2018032. Epub 2018 Jul 13.

Spatial modeling of cutaneous leishmaniasis in Iranian army units during 2014-2017 using a hierarchical Bayesian method and the spatial scan statistic

Erfan Ayubi  1 , Mohammad Barati  2 , Arasb Dabbagh Moghaddam  3 , Ali Reza Khoshdel  1
Affiliations

Spatial modeling of cutaneous leishmaniasis in Iranian army units during 2014-2017 using a hierarchical Bayesian method and the spatial scan statistic

Erfan Ayubi et al. Epidemiol Health. 2018.

Abstract

Objectives: This study aimed to map the incidence of cutaneous leishmaniasis (CL) in Iranian army units (IAUs) and to identify possible spatial clusters.

Methods: This ecological study investigated incident cases of CL between 2014 and 2017. CL data were extracted from the CL registry maintained by the deputy of health of AJA University of Medical Sciences. The standardized incidence ratio (SIR) of CL was computed with a Besag, York, and Mollié model. The purely spatial scan statistic was employed to detect the most likely highand low-rate clusters and to obtain the observed-to-expected (O/E) ratio for each detected cluster. The statistical significance of the clusters was assessed using the log likelihood ratio (LLR) test and Monte Carlo hypothesis testing.

Results: A total of 1,144 new CL cases occurred in IAUs from 2014 to 2017, with an incidence rate of 260 per 100,000. Isfahan and Khuzestan Provinces were found to have more CL cases than expected in all studied years (SIR>1), while Kermanshah, Kerman, and Fars Provinces were observed to have been high-risk areas in only some years of the study period. The most significant CL cluster was in Kermanshah Province (O/E, 67.88; LLR, 1,200.62; p<0.001), followed by clusters in Isfahan Province (O/E, 6.02; LLR, 513.24; p<0.001) and Khuzestan Province (O/E, 2.35; LLR, 73.71; p<0.001), while low-rate clusters were located in the northeast areas, including Razavi Khorasan, North Khorasan, Semnan, and Golestan Provinces (O/E, 0.03; LLR, 95.11; p<0.001).

Conclusions: This study identified high-risk areas for CL. These findings have public health implications and should be considered when planning control interventions among IAUs.

Keywords: Cutaneous leishmaniasis; Iran; Military personnel; Spatial analysis.

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Conflict of interest statement

The authors have no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
The smoothed standardized incidence ratios (SIRs) of cutaneous leishmaniasis in Iranian army units based on a Besag, York, and Mollié model (2014-2017).
Figure 2.
Figure 2.
Clusters with a statistically significantly higher or lower than expected incidence of cutaneous leishmaniasis in Iranian army units (2014-2017).
Figure 3.
Figure 3.
The smoothed standardized incidence ratios (SIRs) of cutaneous leishmaniasis in Iranian army units based on a Besag, York, and Mollié model (A) 2014-2015, (B) 2015-2016, and (C) 2016-2017.
See this image and copyright information in PMC

References

    1. Bamorovat M, Sharifi I, Aflatoonian MR, Sharifi H, Karamoozian A, Sharifi F, et al. Risk factors for anthroponotic cutaneous leishmaniasis in unresponsive and responsive patients in a major focus, southeast of Iran. PLoS One. 2018;13:e0192236. - PMC - PubMed
    1. Ramezankhani R, Sajjadi N, Nezakati Esmaeilzadeh R, Jozi SA, Shirzadi MR. Climate and environmental factors affecting the incidence of cutaneous leishmaniasis in Isfahan, Iran. Environ Sci Pollut Res Int. 2018;25:11516–11526. - PubMed
    1. Saghafipour A, Vatandoost H, Zahraei-Ramazani AR, YaghoobiErshadi MR, Jooshin MK, Rassi Y, et al. Epidemiological study on cutaneous leishmaniasis in an endemic area, of Qom Province, central Iran. J Arthropod Borne Dis. 2017;11:403–413. - PMC - PubMed
    1. Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671. - PMC - PubMed
    1. Aflatoonian MR, Sharifi I, Hakimi Parizi M, Fekri AR, Aflatoonian B, Sharifi M, et al. A prospective cohort study of cutaneous leishmaniasis risk and opium addiction in south eastern Iran. PLoS One. 2014;9:e89043. - PMC - PubMed

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