**6. Conclusions**

The prevalence and the incidence of ZCL infection are increasing, which may reflect the higher endemicity of ZCL transmission in Tunisia over time and across geographic space. This suggests that the control strategy was not effective enough to reduce man vector contacts in endemic regions. The lack of efficacy of the control tools available is partly explained by the complexity of the transmission cycle and the insufficient knowledge of the epidemiology and the natural history of the disease. Due to its limited health resources, prioritization of successful public health interventions and identification of populations likely to be exposed to sandflies are essential in disease management in Tunisia.

In the absence of a safe and efficacious vaccine, control measures should be adapted accord‐ ing to the epidemiological characteristics of the foci concerned. More researches are needed to study the diversity, the dynamics and the ecology of infectious agents and endemic foci in the country. There is also a need to develop more appropriate and effective treatment.

Finally, collaboration among medical physicians, veterinarians, researchers and public health authorities is critical to find a suitable platform and strategy for the control and prevention of CL in Tunisia.
