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• Patterns of VL occurrence in the third largest metropolitan area in Brazil, the metropolitan region of belo horizonte (MRBH) were reported. • VL human data from 50 municipalities of MRBH were analysed. • Criteria for prioritizing municipalities with higher VL risk based on Moran's I, LISA indices and Space-time scan cluster analysis. • Ten municipalities from MRBH were categorized as high risk for VL occurrence. Visceral leishmaniasis (VL) is a neglected disease with worldwide distribution. Brazil is the country with the largest number of cases in the Americas, and the state of Minas Gerais presents a high VL-related burden and a high case fatality rate. We aimed to analyse the spatial and spatiotemporal patterns of VL occurrence and to identify priority risk areas for surveillance and control in the metropolitan region of Belo Horizonte-MG, the third largest metropolitan area in Brazil. An ecological study was conducted considering all cases of VL in humans confirmed from 2006 to 2017. The crude and smoothed incidence rates were used to analyse the distribution patterns of the disease (dispersed, random, or clustered) based on global and local indicators of spatial association and space–time risk assessment. Positive spatial autocorrelation and spatial dependence were found between incidence rates. It was possible to observe a high concentration of VL cases in the metropolitan core area, with the identification of two high-risk clusters in strictly urban areas, showing an urban association with the disease. Ten municipalities were categorised as high risk for VL occurrence. Our results provide evidence for making decisions in surveillance programs, suggesting the prioritisation of the municipalities with more risk of transmission. Highlight of municipalities with high priority and risk for Human Visceral Leishmaniasis in the Metropolitan Region of Belo Horizonte, Brazil (2006–2017). Image, graphical abstract [ABSTRACT FROM AUTHOR]

The proposal of prioritization is based on practical and feasible statistical tools and will contribute to a better understanding of VL distribution in urban settings. • Two criteria are proposed for prioritizing VL risk based on Moran's I & LISA indices. • Maximum risk areas showing significant spatial HVL/CVL correlation by bivariate LISA. • High risk areas showing significant spatial HVL autocorrelation by univariate LISA. • HVL and CVL data from 148 primary healthcare areas in Belo Horizonte were analyzed. • According to our proposals, 27 areas were classified maximum risk and 13 high risk. 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. [ABSTRACT FROM AUTHOR]

In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98–4.38) and ≥60 (OR 5.84; 95% CI 3.63–9.38), edema (OR 2.27; 95% CI 1.64–3.13), pallor (OR 1.53; 95% CI 1.06–2.20), infectious condition (OR 1.56; 95% CI 1.12–2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02–4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies. [Display omitted] • Mato Grosso do Sul is the state with the highest risk of visceral leishmaniasis. • Men, children aged ≤5 years, brown and with low education are the most affected. • The age groups ≥20 and < 60 and ≥ 60 are related to death by kala-azar. • Edema, pallor, infection and hemorrhage favor the outcome of death from the disease. [ABSTRACT FROM AUTHOR]

Aims: This study describes the spatio‐temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020. Methods and Results: Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio‐temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central‐West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio‐temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country. Conclusions: The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is an important public health problem in Brazil and in several tropical regions of the world. In the Americas, Brazil is the country with the highest number of registered cases. In Brazil, the state of Minas Gerais has the highest number of cases in the southeastern region. In the present study, we used spatial analysis in the State of Minas Gerais to identify municipalities of priority during a nine-year period (2007-2015), which might be used to guide surveillance and control measures.Methods: An ecological study with spatial analysis of autochthonous cases of CL was performed in the state of Minas Gerais between 2007 and 2015. We calculated incidence rates, used Empirical Bayesian smoothing for each municipality, and divided the analyses into three-year intervals. In order to analyze the existence of spatial autocorrelation, and to define priority areas, Moran's Global Index and Local Indicators of Spatial Association (LISA) were used.Results: The mean incidence rate for the entire state was 6.1/100,000 inhabitants. For Minas Gerais, analysis of CL cases over time revealed a successive increase of indicated mesoregions with high priority municipalities. Eight of the designated mesoregions contained municipalities classified as high priority areas in any of the three evaluated trienniums, and four mesoregions had high priority municipalities throughout the entire investigation.Conclusions: Within the southeastern region of Brazil, Minas Gerais State stands out, with highest CL incidence rates. Using spatial analysis, we identified an increasing numbers of cases in the municipalities classified as high priority areas in different mesoregions of the state. This information might be of value to direct surveillance and control measures against CL and to understand the dynamics of the expansion of CL in Minas Gerais. Similar approaches might be used to map CL in other regions throughout Brazil, or in any other country, where national notification and control programs exist. [ABSTRACT FROM AUTHOR]

Background: Tegumentary leishmaniasis (TL) is a significant public health issue in Brazil. The present ecological study describes the clinical and epidemiological characteristics of TL cases reported in the country, and analyzes the spatial and temporal patterns of the incidences and risks of occurrence across the five geopolitical regions and 27 federative units. Methodology/Principal findings: Data regarding new cases of TL notified between 2001 and 2020 were obtained from the Information System for Notifiable Diseases of the Brazilian Ministry of Health. Joinpoint and spatial and temporal generalized additive models were used to establish trends in the evolution of TL during the target period. The incidence rate for the entire period was 226.41 cases/100,000 inhabitants. All regions of Brazil showed trends of decreasing incidence rates, albeit with fluctuations at specific times, with the exception of the Southeast where rates have increased since 2014, most particularly in Minas Gerais state. The disease was concentrated predominantly in the North region, with Acre state leading the incidence rank in the whole country, followed by Mato Grosso (Midwest), Maranhão and Bahia (Northeast) states. The spatial distribution of the risk of TL occurrence in relation to the annual averages was relatively stable throughout the period. The cutaneous form of TL was predominant and cases most frequently occurred in rural areas and among men of working age. The ages of individuals contracting TL tended to increase during the time series. Finally, the proportion of confirmations by laboratory tests was lower in the Northeast. Conclusion/Significance: TL shows a declining trend in Brazil, but its widespread occurrence and the presence of areas with increasing incidence rates demonstrate the persistent relevance of this disease and the need for constant monitoring. Our findings reinforce the importance of temporal and spatial tools in epidemiologic surveillance routines and are valuable for targeting preventive and control actions. Author summary: Leishmaniasis, a neglected tropical disease caused by parasitic protozoa, exists in various clinical forms, the most common of which is tegumentary leishmaniasis (TL). The lethality of TL is low, but the skin lesions may produce physical deformities and stigma. Brazil has the highest number of TL cases in the American continent and the disease is present in all federative units. However, studies performed so far have been restricted to localized areas of Brazil and do not provide a broad view of the situation in the country. Therefore, we described the clinical and epidemiological characteristics of TL cases in Brazil and evaluated the spatial and temporal patterns from 2001 to 2020. Our findings show that the occurrence of TL declined between 2001 and 2020 in all regions of the country except for the Southeast where incidence rates have recently increased. We have identified those areas of the country where the population remains at greater risk of contracting the disease and have found that the situation has changed little over the years. The knowledge gained about the spatial and temporal variations of the incidence of TL, the profiles of those affected by the disease, and the diagnostics and treatment employed might be valuable to improve the policies and actions against the disease. [ABSTRACT FROM AUTHOR]

Background: Responsible companion animal guardianship (RCAG) comprises a set of concepts involving activities, behavior and care that guardians must provide to ensure the welfare of their animals. When such principles are disregarded, the risk of animals developing zoonotic diseases, such as canine visceral leishmaniasis (CVL), increases. This disease is a public health problem in many urban settings in Brazil because dogs are the main reservoirs of Leishmania and are involved in the transmission of the parasites to humans. Our analytical cross-sectional epidemiological survey aimed to investigate the prevalence of CVL in a city in southeastern Brazil and to establish the association between the disease and a number of predictor variables including dog traits, socioeconomic status of guardians, ecological features of the domicile and RCAG. Results: Our study showed that the global prevalence of CVL in the sample canine population was 6.7% (47/704). All variables related to better dog care were associated with lower chances of infection. Multiple regression analysis revealed that the chances of animals being seropositive for CVL were significantly (p < 0.05) higher when guardians had no formal education or possessed a university degree (vs. those with complete primary or secondary schooling) and when dogs were sheltered outside the house and had free access to the streets. An additional novel finding was that dogs that were acquired as puppies presented half of the chance of developing the disease in comparison with those acquired at the adult stage. Geographically weighted logistic regression coefficients showed that the strengths of the predictor/CVL associations varied depending on the studied geographical space. Both models demonstrated that the associations were always in the same directions. Conclusions: Our findings indicate that regardless of age and mode of acquisition, adult dogs should be submitted to clinical evaluation and tests for CVL. RCAG can exert positive effects on the control of CVL. [ABSTRACT FROM AUTHOR]

Introduction: Due to recent outbreaks of Dengue and Chikungunya and an absence of effective monitoring of the mosquito Aedes spp. in the municipality of São Raimundo das Mangabeiras, State of Maranhão, we aimed to demonstrate the potential of ovitraps used together with mathematical models and geotechnology to improve control of this mosquito. Methodology: From January to December of 2017, ovitraps were set up in five different neighborhoods (Centro, Vila Cardoso, Nazaré, São José e São Francisco). Positivity indices were calculated for each ovitraps, besides the egg density and average number of eggs. Some of the eggs were used for species identification. Mathematical models of correlation and logistic regression were used to evaluate the influence of abiotic factors on egg distribution during each month. Spatial analysis was carried out using georeferencing. Results: A total of 4,453 eggs were counted, with A. aegypti and A. albopictus present in each month and neighborhood. The mathematical models show that rainfall can result in a significant increase in the number of eggs. Entomological calculation indicates that there is a high risk of dissemination of arboviruses in the area. Spatially, it was possible to indicate sites with the largest number of collected eggs, which may facilitate future interventions. Conclusions: As such, ovitraps have proven to be an effective and low cost method for the monitoring of Aedes spp., and that its use may help in arboviruses prevention campaigns. [ABSTRACT FROM AUTHOR]

• There is a spatial concentration of cases of visceral leishmaniasis (VL) in brazil. • The disease, however, expanded territorially in brazil in the 21st century. • The number of priority municipalities for control actions showed an upward trend. • Spatio-temporal clusters of high-risk were higher in the north and northeast regions. • The identified risk areas should be prioritized for VL control actions. 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. [Display omitted] [ABSTRACT FROM AUTHOR]