Post-earthquake outbreak of cutaneous leishmaniasis in a rural region of southern Iran.

Human cutaneous leishmaniasis (CL) is of increasing public-health importance in Iran. On 10 July 2003, two mild earthquakes struck the rural town of Zarindasht in the southern Iranian province of Fars. The results of passive detection of CL cases in this town (in which patients with any skin lesions were evaluated) from April 2002 to April 2004 indicated that the earthquakes may have led to an outbreak of the disease; annual incidence increased from 58·6 detected cases/100,000 in the 12 months before the earthquakes to (an outbreak peak of) 864 detected cases/100,000 in the following 12 months. In addition, the incidence of detected CL in the town that was struck by the earthquakes in 2003 was significantly higher in the 12 months after the earthquakes than that recorded, over the same 12 months, for Fars province as a whole (P<0·05). Most (70%) of the cases detected in the town were aged ≤10 years, about half (50·4%) of the detected skin lesions were on the face, and most (89·7%) of the skin lesions were caused by Leishmania major. Incidence over the study period showed marked seasonality, with most (79·5%) of the detected cases occurring between November and February. In areas where the disease is endemic, CL may need to be considered among the health threats posed by natural disasters such as earthquakes, and increased surveillance for CL after future earthquakes may be justified.