Introducao e expansao da Leishmaniose visceral americana em humanos no estado de Sao Paulo, 1999-2011

Abstract

OBJECTIVE:To analyze the spread of human American visceral leishmaniasis and identify the key municipalities for developing surveillance and control activities. METHODS:The area of the study was composed of the 316 municipalities in the state of Sao Paulo belonging to the fi ve health districts in which human American visceral leishmaniasis occurs, using data on autochthonous cases and deaths according to the reporting year and municipality in which the death occurred. The incidence, mortality and case fatality rates for each municipality and for the entire area were calculated. An empirical Bayes estimator was used to calculate the local Bayesian incidence and rates of mortality per municipality, and Kriging was used to visualize the spatial distribution of temperature and rainfall. RESULTS:A total of 73 municipalities with transmission of the disease were identifi ed. Human American visceral leishmaniasis was fi rst detected in areas with higher temperatures and lower rainfall, but it also spread in cooler and wetter areas. The expansion of human American visceral leishmaniasis occurred along a main axis of dissemination, from Northwest to Southeast, following the Marechal Rondon highway and the Bolivia-Brazil gas pipeline, and along a secondary axis that was derived from the main axis, which runs both North and South, following the highway network. Rates of incidence according to health district exhibit a peak, followed by a fall, except the Sao Jose do Rio Preto region. Higher concentrations of municipalities with high incidence and mortality rates were observed in the Araçatuba, Presidente Prudente and Marília health districts. CONCLUSIONS:This study indicates possible determinants of the spread of disease, including the Marechal Rondon highway and the construction of the Bolivia-Brazil gas pipeline. Climatic factors seemed to play no role in the spread. The use of spatial analysis techniques allowed the municipalities where cases and deaths are possibly underreported to be identifi ed, which indicated the municipalities which should be prioritized for the development of surveillance and control activities.

Temporal, spatial and spatiotemporal analysis of the occurrence of visceral leishmaniasis in humans in the City of Birigui, State of São Paulo, from 1999 to 2012

“…There was a steady increase in incidence rates in the AR from 1999 to 2003, which was followed by a continuous downward trend in incidence 10 . Although the incidence decreased in the AR of Araçatuba, Birigui presented increasing rates that spiked in 2006 and 2011 10 . These two peaks might be related to the cyclic behavior expected for this disease and to variations in the level of application of control measures in Birigui.…”

“…However, the fi rst autochthonous cases of VLH were recorded in 1999 in the municipalities of Araçatuba and Birigui 9 . Thereafter, VLH spread to other municipalities, particularly in the western region of the state; between 1999 and 2011, 73 municipalities of São Paulo had human cases 10 and 125 municipalities documented the presence of the vector 11 .…”

Occurrence of Lutzomyia longipalpis andhuman and canine cases of visceral leishmaniasis and evaluation of their expansion in the Northwest region of the State of São Paulo, Brazil

“…included in the work of Cardim et al (12) , Antonialli et al (13) , Martins-Melo et al (14) , and Guimarães et al (15) .…”

“…In the State of São Paulo, L. longipalpis had previously been identifi ed only in rural areas of municipalities located in the eastern part of the state (8) (9) (10) ; the fi rst detection of this vector in an urban area occurred in 1997 in Araçatuba, which is in the western region of the state (11) . This occurrence was followed by the fi rst reports of autochthonous cases of canine visceral leishmaniasis (CVL) and human visceral leishmaniasis (HVL), also occurring in Araçatuba, with the disease expanding later to other municipalities of this region and the regions of Bauru, Marília, Presidente Prudente, and São José do Rio Preto (12) . The study of the expansion of VL in Brazil, particularly in São Paulo, makes it possible to infer its determinants and can contribute to the improvement of surveillance and control activities for this important public health problem.…”

Modelling of the distribution of Biomphalaria glabrata and Biomphalaria straminea in the metropolitan region of Recife, Pernambuco, Brazil

“…Since the beginning of this century, several authors have started to use these techniques also towards advancing human health (Campos et al, 2002;Fortes et al, 2004;Lourenço and Landim, 2005;Castro and Singer, 2007;Cardim et al, 2013;Samy et al, 2014). In particular, these techniques have been used to model diseases such as schistosomiasis in studies developed by Guimarães et al (2009Guimarães et al ( , 2010Guimarães et al ( , 2012 to estimate the spatial distribution of Biomphalaria snails in the state of Minas Gerais.…”