ANTHROPONOTIC CUTANEOUS LEISHMANIASIS IN KABUL, AFGHANISTAN - VERTICAL-DISTRIBUTION OF CASES IN APARTMENT BLOCKS

Owing to the civil war, the inhabitants of Kabul in Afghanistan are su ffering a major epidemic of anthroponotic cutaneous leishmaniasis (ACL ) caused by Leishmania tropica. Surveys conducted among children in 2 high-rise apartment blocks in the city revealed that the prevalence of active lesions was much lower on upper storeys: 84% lower in one bloc k (chi(2)=7.13, d.f.=1, P=0.008) and 54% lower in the other (chi(2)=6. 17, d.f.=1, P=0 01). Similar trends were apparent with regard to scars from old lesions.These results suggest that in Kabul most transmissio n of ACL takes place in the home. In addition, the results imply that there must be limited vertical movement of the vector within apartment blocks. Together, these findings suggest that indoor spraying should be an effective means of control and that insecticidal applications co uld probably be restricted to lower storeys.