Objective: To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods: Spatiotemporal cluster analysis was conducted retrospectively to find spatio-temporal clusters of CL cases.Time-series data were recorded from 29 201 cases in Fars province,Iran from 2010 to 2015,which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters.Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results: This study resulted in statistically significant spatiotemporal clusters of CL (P<0.05).The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters(P<0.05). Conclusions: Transmission of CL followed spatiotemporal pattern in Fars province, Iran.This can have an important effect on future studies on prediction and prevention of CL.

Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis (CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied time-series models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria (P

Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic (ROC) curve. SPSS version 22, ArcGIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters (P<0.05) resulted in finding seven significant and accurate endemic values (P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.

Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29 201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.

Objective To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods Spatiotemporal cluster analysis was conducted retrospectively to find spatiotemporal clusters of CL cases. Time-series data were recorded from 29 201 cases in Fars province, Iran from 2010 to 2015, which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters. Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results This study resulted in statistically significant spatiotemporal clusters of CL (P < 0.05). The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters (P < 0.05). Conclusions Transmission of CL followed spatiotemporal pattern in Fars province, Iran. This can have an important effect on future studies on prediction and prevention of CL.