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Leptospirosis is a zoonotic disease with significant global impact and a challenging diagnosis. The utilization of adequately validated rapid tests is relevant for the opportune identification of the disease and for reduction in fatality rates. The present study analyzes the accuracy and reliability of the Dual Path Platform (DPP) assay -produced in Brazil by the Oswaldo Cruz Foundation (Fiocruz)- for diagnosing leptospirosis. Firstly, a serological panel was constructed in the Brazilian Reference Laboratory for Leptospirosis using samples routinely handled by reference laboratories of six Brazilian states. It consisted of 150 positive (according to MAT and IgM-ELISA) and 250 negative samples for leptospirosis. Subsequently, the panel samples were distributed to the reference laboratories for the performance of DPP assays in triplicate. Different measures were used in the assessment of diagnostic quality. Predictive values were estimated for different pre-test probability settings. Sensitivities varied between 67.33 % and 74.00 % and specificities between 93.20 % and 98.40 % in the states, and there were adequate agreements between them. Accuracies were lower for the samples of patients with less than 7 days of symptoms. In contexts of prevalence values up to around 25 %, positive and negative predictive values were around 90 %. However, in situations of high pre-test probabilities, NPVs were low. This study improves understanding of the use of DPP in diagnosing leptospirosis, particularly its application in healthcare settings. As long as the time of symptoms onset and clinical and epidemiological contexts are adequately considered for the interpretation of results, DPP is a valid option to be used in the leptospirosis diagnostic routine., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Visceral leishmaniasis (VL) is a pressing public health problem in Brazil. The proper implementation of disease control programs in priority areas is a challenge for healthcare managers. The present study aimed to analyze the spatio-temporal distribution and identify high risk areas of VL occurrence in the Brazilian territory. We analyzed data regarding new cases with confirmed diagnosis of VL in Brazilian municipalities, from 2001 to 2020, extracted from the Brazilian Information System for Notifiable Diseases. The Local Index of Spatial Autocorrelation (LISA) was used to identify contiguous areas with high incidence rates in different periods of the temporal series. Clusters of high spatio-temporal relative risks were identified using the scan statistics. The accumulated incidence rate in the analyzed period was 33.53 cases per 100,000 inhabitants. The number of municipalities that reported cases showed an upward trend from 2001 onward, although there was a decrease in 2019 and 2020. According to LISA, the number of municipalities considered a priority increased in Brazil and in most states. Priority municipalities were predominantly concentrated in the states of Tocantins, Maranhão, Piauí, and Mato Grosso do Sul, in addition to more specific areas of Pará, Ceará, Piauí, Alagoas, Pernambuco, Bahia, São Paulo, Minas Gerais, and Roraima. The spatio-temporal clusters of high-risk areas varied throughout the time series and were relatively higher in the North and Northeast regions. Recent high-risk areas were found in Roraima and municipalities in northeastern states. VL expanded territorially in Brazil in the 21st century. However, there is still a considerable spatial concentration of cases. The areas identified in the present study should be prioritized for disease control actions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Leishmaniasis represents a major neglected public health problem and the control measures have not been successful in Brazil. Recent studies have shown leishmaniasis importance to Brazilian border zones which reinforces the need to investigate its spread in those regions. This study aimed to analyze epidemiologic profile and its spatial distribution or aggregation process in both tegumentary and visceral leishmaniasis in the Brazilian border strip from 2009 to 2017. This is an ecological study of the epidemiological profile and spatial patterns encompassing municipalities in the Brazilian border strip. The presence of spatial autocorrelation and determination of priority areas for disease control were performed using global (Moran I) and local (LISA) Moran spatial techniques. The annual mean coefficients of tegumentary and visceral leishmaniasis were 29.8 and 0.6 by 100,000 inhabitants in the border strip, respectively. The indigenous population rates of leishmaniasis in the border zone appears to be higher than in the rest of the country (cutaneous changed from 33.2% to 6.6% and visceral rising from 1.0% to 17.5%) in the period. The most affected municipalities were located in the North and Central arches of the border zone. The results can subsidize the development of more targeted and effective strategies that can contribute to the surveillance and control of leishmaniasis in border zones, as the provision of epidemiological and spatial data on the disease. For better control of the disease, we recommend and emphasize the need to integrate public health policies of neighboring countries., Competing Interests: Declaration of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in the paper “Spatio-temporal patterns and integrated approach to prioritize areas for surveillance and control of visceral leishmaniasis in a large urban agglomeration in Brazil”., (Copyright © 2022. Published by Elsevier B.V.)

Human and canine visceral leishmaniasis (HVL and CVL, respectively) represent serious public health issues in Brazil. The surveillance and control measures currently employed have had limited effect in impeding the territorial expansion of the disease and in reducing the number of cases. We have investigated the space-time distribution of HVL incidence rates and CVL prevalence in the coverage areas of the 148 primary healthcare units in Belo Horizonte (MG, Brazil) during a 6-year period in order to identify those that should be prioritized for disease control actions. Data were smoothed using the empirical Bayes method and analyzed by space-time scanning and application of univariate global Moran's I index and local indicators of spatial association (LISA) statistics to identify spatial autocorrelations. Point data of CVL were analyzed using the Kernel method. Bivariate global Moran's I and LISA techniques were employed to identify spatial correlations between HVL and CVL. Based on our results, we were able to formulate two proposals for establishing the prioritization of coverage areas, namely: (i) classification of maximum priority areas as identified by bivariate LISA for HVL and CVL, and (ii) combination of maximum priority areas with high priority areas as identified by univariate LISA for HVL. According to our proposals, 27 coverage areas in Belo Horizonte were categorized as maximum priority and a further 13 were classified as high priority. Our proposals, which are based on practical, feasible and inexpensive statistical tools, will contribute to a better understanding of VL distribution in urban settings and improving the efficiency of governmental control programs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Moran's I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Moran's I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I=0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The transmission of Leishmania involves several species of sand flies that are closely associated with various parasites and reservoirs, with differing transmission cycles in Brazil. A study on the phlebotomine species composition has been conducted in the municipality of Divinópolis, Minas Gerais, Brazil, an endemic area for cutaneous leishmaniasis (CL), which has intense occurrence of visceral leishmaniasis (VL) cases. In order to study the sand flies populations and their seasonality, CDC light traps (HP model) were distributed in 15 houses which presented at least one case of CL or VL and in five urban parks (green areas). Collections were carried out three nights monthly from September 2010 to August 2011. A total of 1064 phlebotomine specimens were collected belonging to two genera and seventeen species: Brumptomyia brumpti, Lutzomyia bacula, Lutzomyia cortelezzii, Lutzomyia lenti, Lutzomyia sallesi, Lutzomyia longipalpis, Lutzomyia migonei, Lutzomyia intermedia, Lutzomyia neivai, Lutzomyia whitmani, Lutzomyia christenseni, Lutzomyia monticola, Lutzomyia pessoai, Lutzomyia aragaoi, Lutzomyia brasiliensis, Lutzomyia lutziana, and Lutzomyia sordellii. L. longipalpis, the main vector of Leishmania infantum in Brazil, was the most frequent species, accounting for 76.9% of the total, followed by L. lenti with 8.3%, this species is not a proven vector. Green and urban areas had different sand flies species composition, whereas the high abundance of L. longipalpis in urban areas and the presence of various vector species in both green and urban areas were also observed. Our data point out to the requirement of control measures against phlebotomine sand flies in the municipality of Divinópolis and adoption of strategies aiming entomological surveillance., (Copyright © 2012 Elsevier B.V. All rights reserved.)