Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices
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 t...
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Elsevier
2024-11-01
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| Series: | Parasite Epidemiology and Control |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405673124000497 |
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| author | Ngwa Niba Rawlings Mark Bailey Peter Craig Orin Courtenay |
| author_facet | Ngwa Niba Rawlings Mark Bailey Peter Craig Orin Courtenay |
| author_sort | Ngwa Niba Rawlings |
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| description | 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. |
| format | Article |
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| institution | Kabale University |
| issn | 2405-6731 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
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| series | Parasite Epidemiology and Control |
| spelling | doaj-art-a3b7ae85ebc64abe9bda1d5b13d797bb2024-12-18T08:49:40ZengElsevierParasite Epidemiology and Control2405-67312024-11-0127e00385Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practicesNgwa Niba Rawlings0Mark Bailey1Peter Craig2Orin Courtenay3Department of Environmental Health, Defence Medical Services, Ministry of Defence, United Kingdom; School of Life Sciences, University of Warwick, United Kingdom; Corresponding author at: University of Warwick, School of Life Sciences, and Defence Medical Services, Ministry of Defence, United Kingdom.Warwick Medical School, University of Warwick, United Kingdom; Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, United KingdomBelize Healthcare Partners, Dermatology Department, BelizeSchool of Life Sciences, University of Warwick, United Kingdom; Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, United KingdomBackground: 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.http://www.sciencedirect.com/science/article/pii/S2405673124000497LeishmaniaCutaneous leishmaniasisCumulative incidenceRisk practicesBritish soldiersJungle training |
| spellingShingle | Ngwa Niba Rawlings Mark Bailey Peter Craig Orin Courtenay Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices Parasite Epidemiology and Control Leishmania Cutaneous leishmaniasis Cumulative incidence Risk practices British soldiers Jungle training |
| title | Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices |
| title_full | Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices |
| title_fullStr | Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices |
| title_full_unstemmed | Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices |
| title_short | Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices |
| title_sort | cutaneous leishmaniasis in british troops following jungle training in belize cumulative incidence and potential risk practices |
| topic | Leishmania Cutaneous leishmaniasis Cumulative incidence Risk practices British soldiers Jungle training |
| url | http://www.sciencedirect.com/science/article/pii/S2405673124000497 |
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