Bayesian spatial analysis of the surgical incidence rate of human cystic echinococcosis in north-eastern Iran.
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BACKGROUND: Cystic echinococcosis (CE) is a zoonotic disease that presents a public health challenge and a socioeconomic burden on developing areas in the Middle East. This study used spatial methods to assess the distribution of surgically managed CE cases in an endemic region of north-eastern Iran. METHODS: For the years 2001-2007, a case series of all 446 patients that were surgically treated for CE in a referral hospital in north-eastern Iran was evaluated. Patients seen at the referral hospital represent 35 counties in three provinces (Razavi Khorasan, North Khorasan, and South Khorasan). A Besag, York and Mollie (BYM) spatial model was used to produce smoothed standardized incidence ratios (SIRs) for surgically managed cases of CE for the 35 counties represented in this study. RESULTS: Out of 446 surgically managed patients, 54% were male. County-level crude incidence rates ranged from 0 to 3.27 cases per 100,000 population. The highest smoothed SIR (3.46) was for Sarakhs County in the province of Razavi Khorasan, while the lowest smoothed SIR (0.05) was for Birjand County, located in the province of South Khorasan. CONCLUSION: SIRs for CE were highest for the province of Razavi Khorasan, which has large ranching and agricultural industries. Additional studies are needed to better evaluate the role of climate, land cover, and livestock rearing on local Echinococcus granulosus transmission in Iran.