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Leishmania spp. are sand fly-borne protozoan parasites causing leishmaniasis in humans and animals. The aim of the study was to analyse the epidemiology of leishmaniasis in Turkey, Azerbaijan and Georgia from 2005 to 2020 and evaluate the associated risk for disease emergence in European countries. It is based on an analysis of WHO and OIE reported cases between 2005 and 2020, a review of scientific articles published in SCOPUS between 2009 and 2020 and a questionnaire survey to public health and veterinary authorities in these countries. Endemic Leishmania spp. include L. infantum in the three countries, L. major in Azerbaijan and Turkey and L. tropica and L. donovani in Turkey. Leishmaniasis is reported in humans, animals and sand flies and incidence is spatially and temporarily variable. In the southern Caucasus and particularly in Georgia, reported incidence of human visceral leishmaniasis by L. infantum remains high. However, whilst Georgia experienced a gradual decrease from >4.0 cases per 100,000 population in 2005-09 to 1.13 cases per 100,000 population in 2020, the period with highest incidence in Azerbaijan, which ranged between 0.40 and 0.61 cases per 100,000 population, was 2016-2019, and no cases have so far been reported for 2020. Visceral leishmaniasis in the Southern Caucasus affects mostly young children from deprived urban areas and its closely associated to canine leishmaniasis. Turkey reported cases of visceral leishmaniasis between 2005 and 2012 and in 2016 only, and incidence ranged between 0.02 and 0.05 per 100,000 population. In contrast, the reported annual incidence of cutaneous leishmaniasis in Turkey was much greater and peaked at 7.02 cases per 100,000 population in 2013, associated to imported cases from cutaneous leishmaniasis endemic Syria. Leishmaniasis by L. infantum in Azerbaijan and Georgia represents a regional public and animal health challenge that requires support to improve diagnosis, treatment and control. The unprecedented rise of cutaneous leishmaniasis and the spread of L. tropica and L. donovani in Turkey is an important risk factor for their emergence in Europe, especially in Mediterranean countries where competent vectors are widespread., European Centre for Disease Prevention and Control (ECDC) [NP/2020/DPR/11745], This manuscript was commissioned by the European Centre for Disease Prevention and Control (ECDC) under the negotiated procedure reference NP/2020/DPR/11745.

Purpose Sand flies are the only proven vectors of leishmaniases, a tropical neglected disease endemic in at least 92 countries. Vector-parasite interactions play a significant role in vector-borne disease transmission. There are various bottlenecks to Leishmania colonization of the sand fly midgut. Such bottlenecks include the production of innate immune-related molecules, digestive proteases, parasite impermeable peritrophic membrane, and resident gut microbiota. These barriers determine the parasite load transmitted and, consequently, the disease outcome in mammalian host. Therefore, it is important to understand the molecular responses of both sand fly and Leishmania during infection. Method Here, we reviewed the published literature on sand fly-Leishmania interactions bringing together earlier and current findings to highlight new developments and research gaps in the field. Conclusion Recent research studies on sand fly-Leishmania interaction have revealed contrasting observations to past studies. However, how Leishmania parasites evade the sand fly immune response still needs further research. Sand fly response to Leishmania infection can be best understood by analyzing its tissue transcriptome. Better characterization of the role of midgut components could be a game changer in development of transmission-blocking strategies for leishmaniasis.

Background The determination of the acceptance of the COVID‐19 vaccine by the health personnel will also be a guide for the upcoming vaccination studies. The aim of this study is to determine the acceptance status of COVID‐19 vaccine amongst healthcare professionals. Materials and methods A total of 1138 healthcare workers participated in this cross‐sectional study between 17th and 20th of September, 2020. The questionnaire, which was delivered via social media, was filled out by the participants over "Google Forms." Results As a result of the questionnaire, 68.6% of the healthcare professionals stated that they could be vaccinated. Men, students, the younger age group, and those who had a previous flu shot were all willing to get the COVID‐19 vaccine. Conclusions Efforts to increase the knowledge of healthcare professionals about the new vaccine and to eliminate their doubts and concerns are important.

Additional file 1: Table S1. Historical data review on the sand fly fauna of the study area. Table summarizing essential published literature between 1910 and 2019.

World Health Organization reported that approximately one billion people are at risk in endemic areas, one million cases of cutaneous leishmaniasis (CL) and approximately 300,000 cases of visceral leishmaniasis (VL) were reported per year in the last five years. The number of deaths due to VL is reported to be approximately 20,000 per year. Approximately 2500 cases/year have been reported as CL, caused by Leishmania tropica and Leishmania infantum, in Turkey. The significant increase observed in many cities mainly in the provinces of Mediterranean and Aegean regions in cases and foci in recent years, suggests that there may be an increase in this infections in the following years as well. In Turkey, the causative agent of CL is L.tropica and meglumine antimoniate is used in the treatment of CL. We aimed to determine antimony resistance genes specific for L.tropica by comparing the gene and protein expressions of antimony-resistant and non-resistant L.tropica strains. Ltropica isolates obtained from 3 CL patients without antimonate resistance from Aegean, Mediterranean and Southeastern regions of Turkey were provided to transform into 3 resistant isolates against meglumine antimony in the laboratory conditions. Gene expression alterations by microarray method

Leishmaniases are a group of vector-borne diseases, and two clinical forms, visceral (VL) and cutaneous leishmaniasis (CL, Oriental sore), are seen in Turkey. While VL cases are recorded as 20-25 per year, CL cases are reported around 2000 per year, and nearly half of CL cases were recorded in anliurfa province. Therefore, by knowing the epidemiology of the disease in anliurfa province, it is possible to develop control measures and reduce the total number of cases across the country. Although Leishmania tropica is known as the main causative agent in anliurfa, other Leishmania species have also been identified as a result of mass human movements in the last 10 years. in this study, we aimed to present the first CL cases caused by Leishmania infantum in $anllurfa. A total of 14 cases, which were admitted with the suspicion of CL and diagnosed as positive by direct microscopy and/or real-time ITS1-PCR using lesion aspiration samples are included in the study. Two or more smears were prepared from the samples taken from the lesions of the patients by fine needle aspiration. One of the smears was stained with Giemsa stain after fixation with methyl alcohol and examined under the light microscope at x1000 magnification for the presence of Leishmania amastigotes. DNA isolation was made from the other unstained preparations with a commercial kit (Qiagen DNeasy, Germany) according to the recommendations of the manufacturer. the real-time ITS1-PCR method was performed by using the Old World species-specific primers and probes. As a result, by the identification of the species with real-time ITS1-PCR, it was determined that the causative agent was L.infantum in five cases, Lmajor in one case and L.tropica in eight cases. It was learned that four of the cases in which L.infantum was detected as the causative agent were local, one was Syrian and they lived in the city center. Also two of the eight cases, which were identified as L.tropica, were Syrian and six of them were domestic cases and all of them lived in the city center. While all 14 patients included in the study were positive with real-time ITS1-PCR, amastigotes were detected in 10 cases only. the cases of CL presented in this study are the first cases caused by L.infantum reported from anliurfa, and are important in terms of concretely demonstrating the effect of mass human mobility and migration on the epidemiology of the infection.

Additional file 4: Figure S3. Haplotype networks obtained for the 83 Paraphlebotomus specimens analyzed from Turkey (a P. alexandri, b P. sergenti (s.l.), c P. caucasicus, P. jacusieli and Paraphlebotomus sp.). Haplotypes are sized according to their relative frequencies and colored by their geographical origin. Missing haplotypes are denoted by small black circles and the numbers of mutational steps are represented by the dashes.

Sand flies (Diptera: Psychodidae: Phlebotominae) are the vectors of Leishmania species. Since the larval control of the sand flies is very difficult and almost impossible, the fighting has mainly been carried out for the adults. In this research, the fumigant toxicity of two plant essential oils obtained from Satureja cuneifolia Ten. and Ziziphora clinopodioides Lam. was evaluated against field collected adult Phlebotomus sand flies under laboratory conditions. The fumigant activity was tested by exposing the sand flies to essential oil vapors at 10, 20, 50 and 100 mu L/L air concentrations. Knock time 50 (KT50) values and the 95% confidence limits were calculated by using a probit analysis program. A decrease in the KT50 value is observed in S. cuneifolia and Z clinopodioides essential oils in a concentration dependent manner. KT5o values at the highest concentration (100 mu L/L air) are 9,3 and 11,6 min, respectively. After a 1 h exposure period, both test oils produced 100% mortality at all the concentrations tested. The results of the research suggest that essential oils from these two plants have a potential as control agents for sand flies.

WOS: 000399725900010, PubMed ID: 29026855, Background: In Turkey, vector control programs are mainly based on indoor residual spraying with pyrethroids against mosquitoes. No special control program is available for sand flies. Most insecticide susceptibility tests were done for mosquitoes but not for sand flies. We therefore aimed to determine the insecticide susceptibility against two commonly used insecticides; deltamethrin and permethrin, on wild-caught sand fly populations collected in two geographically separated leishmaniasis endemic areas. Methods: Insecticide susceptibility of wild-caught sand flies to deltamethrin (0.05%) and permethrin (0.75%) using ready-to use impregnated insecticide papers of WHO was investigated in 2010 based on knockdown time using standard WHO tube-test kit and procedures. Sand flies used in this study were collected from villages of Aydin (Bascayir) and Mugla (Tepecik). Results: The resistance and early resistance were detected on the sand fly population from Mugla province against deltamethrin and permethrin, respectively. However, populations from Aydin Province were sensitive to both insecticides. Conclusion: The resistance against deltamethrin and permethrin was detected on sand fly population in Mugla Province where both insecticides have been applied for long time while no resistance was found in the insecticide free area, Aydin Province. These findings can be an indicator for showing the ability for developing the insecticide resistance in sand flies. Because of the presence and dominancy of vector sand fly species of Leishmania infantum (Phlebotomus neglectus, P. tobbi) in both study areas, the systematic monitoring for resistance of sand fly populations and more attention are needed by the authorities involved in control programs for sand fly-borne diseases.

WOS: 000428835400004, PubMed ID: 29153064, Visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) are seen endemically in Turkey and CL caused by Leishmania tropica is an important public health problem in southeastern as well as other regions of Turkey. The diagnosis has been usually made by clinical view of lesion and/or parasitologically using lesion aspiration smears. Histological examination does not, always reveal the parasite in the skin biopsy, particularly in chronic lesions. Besides this, due to CL infections caused by different species in endemic areas, diagnostic methods enabling species identification are in great need. Species identification, in the time of diagnosis, is an important procedure for helping the clinicians in the planning of treatment as well as control measures. Polymerase chain reaction (PCR) is a specific and sensitive diagnostic tool that can also identify the parasite at species level. Kinetoplast DNA (kDNA) is one of the genetic regions that can be used for the detection of Leishmania parasites in clinical specimens, kDNA PCR is reported as one of the most sensitive methods related to species-specific variable regions in mini-circle long time ago. It has been considered as one of the most ideal targets for the diagnosis of leishmaniasis. The aim of the study was to perform PCR targeting kDNA by using the primers of Uni21/Lmj4 in clinical samples and compare the results with other parasitological methods like smear and culture, for the diagnosis of CL. The kDNA PCR, parasite culture and microscopical evaluation of stained smears of 62 specimens from suspected CL cases who have referred to Cutaneous Leishmaniasis Diagnosis and Treatment Center in Sanliurfa, Turkey were included in the study. The kDNA PCR showed the highest sensitivity 100% of the samples (35/35) among all diagnostic assays, followed by the microscopy (25/35 positive, 71.4% sensitivity) and culture (19/35 positive, 54.3% sensitivity). The sensitivity of combination of culture and microscopy was 88.6% (31/35 positive). These results suggested that performing kDNA PCR in addition to conventional techniques is important for improving the true diagnosis of CL to the species level and also important for establishing treatment regimens and designing appropriate precautions in highly endemic area like the southeastern region of Turkey.

VectorNet ‘‘A European network for sharing data on the geographic distribution of arthropod vectors, transmitting human and animal disease agents’’ project is supported by the EU-ECDC/EFSA consortium and coordinated by Avia-GIS, Belgium. This study shows some of the results and achievements of the sand fly-team efforts in eight Balkan countries in 2015 in the framework of the VectorNet Project. Eight countries (Bosnia & Herzegovina, Montenegro, Croatia, Bulgaria, Macedonia, Serbia, Kosovo, Slovenia), including 267 locations and 36 cities were studied by the sand fly team with the aim of determining the altitudinal and trans-sectional distribution of species, identifying species and detecting possible pathogens in the Balkans. Sand flies were collected with light traps for a total of 951 trap nights during the field missions. From this study, 12 species were identified and a total of 9, 096 specimens collected from fieldwork. The results show that Phlebotomus neglectus (74%) is the dominant species in Balkan countries and this species was collected from all eight countries together with Ph. tobbi (10%). These two species comprise 84% of total sand fly abundance. Other species include: Ph. perfiliewi s.l (6.13%), Sergentomyia minuta (3.56%), Ph. perniciosus (1.57%), Ph. papatasi (1.35%), Ph. simici (0.9%), Ph. mascitti (0.45%), Ph. sergenti (0.1%), Ph. alexandri (0.07%), and Ph. balcanicus (0.03%) (found only in Montenegro). We also calculated some of the important community parameters such as similarity, richness, species diversity, species evenness and dominance for each country. The most similar countries in terms of species composition are B&H-Kosovo (0.77), Bulgaria-Kosovo (0.85), Serbia-Kosovo (0.86), Croatia-Macedonia (0.80) and Bulgaria-Macedonia (0.80). From these results, it appears that Macedonia and Serbia are ecotones (transition areas) in the Balkans. The highest species diversities were observed in Macedonia (1.366), Bulgaria (1.247) and Serbia (1.169), respectively. The lowest was B&H with 0.386 values. In contrast, B&H, like other less diverse countries, has the highest dominance value (81.4%). In pathogen detection studies, two novel viruses in B&H and Macedonia and Leishmania infantum parasites in B&H, Macedonia and Kosovo were detected. To the best of our knowledge, most of the information derived from this study was new to the Balkan countries.

Vector-borne diseases are a group of infections transmitted by the bite of arthropod species such as mosquitoes, ticks and sand flies infected with a pathological agent. Certain species of Phlebotomine sand flies can transmit protozoon parasite Leishmania, a bacteria Bartonella and a group of viruses called phleboviruses worldwide. Two clinical forms of leishmaniasis in human, visceral and cutaneous, and canine leishmaniasis are seen in Turkey. Several phleboviruses and a particular Turkish strain are circulating in certain endemic areas of Turkey. Among 22 species of sand flies recorded in Turkey, 7 are proven or suspected vectors of human leishmaniases and phlebovirus infections. Here, sand fly-borne infections are seen in Turkey, leishmaniases and sand fly fever were briefly reviewed, Vektör kaynaklı hastalıklar, patolojik bir ajanla infekte olmuş sivrisinekler, keneler ve kum sinekleri gibi artropod türleri ile bulaştırılan bir grup infeksiyondur. Kum sineklerinin belirli türleri bir protozoon parazit olan Leishmania türlerini, bir bakteri olan Bartonella’yı ve phlebovirüsler olarak da adlandırılan bir grup virüsü nakledebilir. Türkiye’de insanlarda leishmaniasisin iki klinik formu, visseral ve kutanöz fomları ile kanin leishmaniasis görülmektedir. Birkaç phlebovirüs ve ülkemize özgü bir Türk suşu belli bazı endemik alanlarda sirküle olmaktadır. Türkiye’de şimdiye dek kaydedilen 22 kum sineği türünden 7’si leishmaniasis ve phlebovirüs infeksiyonları açısından kanıtlanmış veya şüpheli vektörlerdir. Bu yazıda, Türkiye’de görülen kum sineği kaynaklı infeksiyonlar olan leishmaniasis ve tatarcık humması konularında bir özet verilmiştir