Burden and Seasonal Variations of Cutaneous Leishmaniasis in Afghanistan During 2024.

Background: Cutaneous leishmaniasis (CL) remains a major neglected tropical disease in Afghanistan; however, recent nationwide evidence on its geographical and temporal distribution is limited. This study assessed the reported burden, spatial distribution and seasonal variation of cutaneous leishmaniasis across Afghanistan during 2024. Methods: A nationwide retrospective ecological study was conducted using aggregated routine surveillance data obtained from the National Malaria and Other Vector-Borne Diseases Program. All cases reported from government health facilities across Afghanistans 34 provinces between 1 January and 31 December 2024 were included. Reported incidence rates were calculated per 10,000 population using national and subnational population estimates. Cases were analyzed by surveillance classification, province, city, rural district, month, and season. Results: A total of 87,245 cases were reported during 2024, corresponding to an overall incidence of 25.1/10,000 population. Anthroponotic and zoonotic CL accounted for 80,202 (91.9%) and 7,043 (8.1%) cases, respectively. Jowzjan recorded the highest provincial incidence (105.0/10,000), while Kabul and Herat contributed the largest absolute numbers of cases. Shiberghan had the highest urban incidence, whereas Panjwai, Ghoryan and Hazrat-e-Sultan recorded exceptionally high rural rates. May had the highest monthly burden, while August had the lowest. Autumn accounted for the largest seasonal proportion (27.92%), whereas summer had the lowest burden (16.98%). Considerable incompleteness in district-level reporting was observed. Conclusion: CL constituted a substantial but highly concentrated public health burden in Afghanistan during 2024. Strengthened surveillance, improved diagnostic confirmation and geographically targeted case-management and vector-control interventions are particularly needed in identified high-burden provinces, cities and rural districts.