Geographical distribution and epidemiological characteristics of visceral leishmaniasis in Bulgaria, 1988 to 2012

Visceral leishmaniasis is a sporadic illness in Bulgaria. However, cases in humans are registered nearly every year. This study describes the geographical distribution of the disease in Bulgaria from 1988 to 2012, over a period of 25 years. Cases were analysed according to age, sex, and place of residence. A total of 122 cases were registered in 25 years, 118 of which were autochthonous and four of which were imported from endemic countries in southern Europe. The average annual incidence for the study period was 0.06 per 100,000 population, or an average of five cases per year (maximum 15 in 1989; no cases notified in 1991, 1995, 1996 and 2008). Cases of visceral leishmaniasis were recorded in 13 out of 28 regions in Bulgaria, mainly in the southern part of the country. The highest number of cases were registered in the regions of Blagoevgrad (n=36) and Stara Zagora (n=34). Data presented in this study show that there is ongoing transmission of visceral leishmaniasis in Bulgaria with a high mortality rate (1:7), affecting mostly children.