Cutaneous (CL) and visceral (VL) leishmaniasis are important public health problems in Saudi Arabia. "Leishmania major, L. tropica, L. infantum, L. arabica" and "L. donovani" have all been identified, but only two sandfly species; "Phlebotomus papatasii" and "P. sergenti" , have been confirmed among six possible sandfly vectors. "Psammomys obesus, Meriones libycus, Meriones crassus" and dog have been confirmed as vertebrate hosts. Surveillance was established in 1983, and a trial of integrated control measures was started in one region in 1986.
Methodology
For surveillance, a clinical diagnosis of CL was accepted. VL was diagnosed in the laboratory by isolation of amastigotes from bone marrow. All cases of leishmaniasis were reported to the infectious diseases department in the regional health offices. The regions reported all data to the Ministry of Health for analysis. We reviewed and analyzed surveillance data from 1986 to 1992.
Results
Between 1986 and 1992, 83,947 cases of CL were reported from all 13 regions of Saudi Arabia. Incidence rates were highest in the central (144/100,000) and southern (83/100,000) areas. In 7 of the country's 13 regions, 55% of the cases were among Saudis. In the remaining six regions, all in the central areas, 81% were not Saudi. Exposure was highest (49%) among males 15-44. During the same years, 1,881 cases of VL were reported, mostly in the southern and southwestern areas (incidence rate=13.7/100,000). Saudis comprised 87% of the cases; 63% were males under 14. Trials of integrated control measures (insecticide application and environmental manipulation) in the Hassa area of the Eastern Region were associated with a reduction in the number of CL cases from 6,000 in 1986 to 900 in 1992. By comparison, other regions showed no favorable change in the number of CL or VL cases.
Conclusion
Both CL and VL continue as public health problems in all regions of Saudi Arabia. Higher CL case numbers in adult males may reflect outdoor exposure during agricultural activities. Higher case numbers of VL in boys could reflect the parasite species ("L. infantum") and peridomestic exposure. Active surveillance should be expanded to all regions and include reporting about types of sandflies and reservoir hosts as well as the number of cases. Such information will be used to determine control measures.