Introduction: American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys. Methods: Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities. Results: Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5%) corresponded to LCL and 421 (14.5%) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5% versus 12.1%, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40% of the families had emigrated from the Altiplano. Conclusions: It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas. Keywords: American tegumentary leishmaniasis. Surveillance. Bolivia. Treatment. Diagnosis. RESUMO Introdução:A leishmaniose tegumentar americana (LTA), incluindo a leishmaniose mucocutânea (LMC) e a leishmaniose cutânea (LC), é endêmica em várias regiões da Bolívia. Descreve-se um sistema de vigilância da LTA conduzido entre 2001 e 2006 e avaliando-se dados demográficos relacionados à epidemiologia da doença. Métodos: O sistema de busca ativa foi realizado conjuntamente pelas instituições SERVIR e CÁRITAS e pelo Servicio de Salud de La Paz (SEDES), cujos arquivos foram revisados, retrospectivamente. Um estudo transversal foi realizado em duas comunidades para aquisição de dados sócio-demográficos. Resultados: Dois mil novecentos e nove casos de LTA, sendo 2.488 (85,5%) de LC e 421 (14,5%) de LMC foram diagnosticados de 2001 a 2006. Foi observada redução na proporção de casos mucosos ao longo do período. A proporção de LMC aumentou proporcionalmente à idade dos pacientes, sendo mais frequente entre pessoas do sexo masculino (15,5% versus 12,1%, p = 0,018). A taxa de detecção do parasita nos raspados cutâneos e no cultivo foram significativamente maiores em pacientes com LC do que em pessoas com LMC (p < 0,001 e p = 0,009 respectivamente). A reatividade à reação de Montenegro foi mais frequente em pessoas com LMC (p = 0.012). O estudo transversal mostrou que 40% das famílias nas comunidades estudadas emigraram do Altiplano. Conclusões: Faz-se nec...

Human rabies has re-emerged in Latin America due to bat associated transmission. We present data related to attacks by hematophagous bats in three riverine communities in the Rio Negro basin, Brazilian Amazon. A cross-sectional survey was carried out to obtain demographic and epidemiological data through interviews with 201 inhabitants. A total of 721 bat attacks with bites took place from 2004 to 2006, 238 (33%) reported by residents in Campinas do Rio Preto, 329 (46%) in Águas Vivas and 154 (21%) in the community of Malalahá. Incidence density among surveyed inhabitants was 84 attacks/100 persons-years in Campinas do Rio Preto, 249 attacks/100 persons-years in Águas Vivas and 81 attacks/100 persons-years in Malalahá. The proportion of surveyed inhabitants bled by bats at least once was 67% (63/94) in Campinas do Rio Preto, 96% (42/44) in Águas Vivas and 62% (39/63) in Malalahá. Among subjects bled by bats, the average number of bites was 4.6 ± 4.2 standard deviations (SD) in Campinas do Rio Preto, 8 ± 6 SD in Águas Vivas and 4.1 ± 3.9 SD in Malalahá. Regarding houses, 67% (26/39) had animals in the peridomestic environment (chickens and/or dogs) and all were vulnerable to bats due to gaps in the walls and/or in the windows and doors. In 13 dwellings, rudimentary protection against bats through the fixation of fishing nets and/or straw nets to the windows and other openings was observed. Among dwellers reporting attacks, 48% (68/144) received the full post-exposure anti-rabies vaccination protocol with five doses of diploid human cell vaccine, 28% (39/144) received an incomplete schedule (1-4 doses), and 26% (37/144) did not receive any dose. No cases of rabies were reported during the study; however, regular pre-exposure vaccination in the studied populations must be considered.