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Objective: To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory., Methods: Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra., Results: The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs - higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%)., Conclusion: The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.

The study aimed to present the methodological proposal entitled "Prompt Response", modelled in the cities of Belo Horizonte (Minas Gerais State) and Natal (Rio Grande do Norte State), Brazil. The proposal aims to identify and demarcate priority areas for timely targeting of surveillance activities, aiming to reduce the intensity and velocity in the spread of epidemics in endemic urban areas. The methodology uses three variables that represent the necessary causes for the production and reproduction of dengue: notified cases (virus), Aedes eggs (vector), and population (host). This was an ecological study that used data from three information planes aggregated in finer temporal and spatial scales of 3 to 4 weeks and 400 to 600-meter grids, respectively. The prompt response areas were defined by Scan statistical analysis with definition of simultaneous spatial clusters for the three planes via the SaTScan program. In Natal, the areas defined as prompt response occupied, on average, 15.2% of the city's territory and concentrated 67.77% of the dengue cases in the period following demarcation of the prompt response areas. In Belo Horizonte, the observed proportions were 64.16% of cases in 23.23% of the territory. These results were obtained in two cities with different socioenvironmental and geographic realities and distinct epidemiological profiles, indicating that the methodology can be applied to different urban realities, allowing control programs to concentrate on reduced portions of the territory and impacting a high percentage of cases in timely fashion.

The scope of this research was to identify and characterize spatial units of epidemiological relevance in the state of Rio de Janeiro, through the highest concentrations of cutaneous leishmaniasis (CL) from 1980 to 2012, considering the geographical aspects. SUCAM, FUNASA and SINAN databases were consulted. A method of adjustment of spatially referenced data for demarcation of the regions with the highest concentrations of cases called circuits and poles was applied. These were superimposed on the socioenvironmental indicator maps. Of the total cases registered in the period, 87% occurred in the municipalities located in the resulting circuits and poles. The variations in the occurrence of cases in the different circuits and poles were not related to the socioenvironmental indicators. The identification of the circuits and poles can subsidize the state CL program of the prioritization of strategies of prevention and control actions and the optimization of the resources of the program. These regions, which are more stable than the localities, allow surveillance and control operations in locations with many cases and in other locations in the identified risk area, because they have the same characteristics as those already affected.

This research applies indicators concerning control of the visceral leishmaniasis canine reservoir in the city of Belo Horizonte, Minas Gerais State, Brazil. Data were obtained from the Zoonoses Control Information System (SCZOO) and the Brazilian Information System on Diseases of Notification (SINAN) database. First we analyzed (i) existing associations between canine epidemiological indicators, where the dependent variable was the canine seroprevalence A (2007 to 2013), and the independent variables were, as follows: canine seroprevalence B (2006 to 2012); percentage of positive dogs by ELISA test reagents that were not euthanized; the relationship between the human and canine population; canine population testing coverage by census surveys; and the years of study (2006 to 2013); (ii) then, we examined the association between human visceral leishmaniasis (HVL) cases between 2007 to 2013 and the mentioned variables related to dogs and years. Statistical analysis was done by a generalized linear model (GLM). One unit increases in canine seroprevalence B and canine seroprevalence A were associated to 13% and 12% increases in HVL rates, respectively. The increase in one human/dog ratio unit was associated with a 13% decrease in HVL rates. Canine seroprevalence, human/dog ratio and non-euthanasia of ELISA-reactive dogs in the environment were adequate indicators for analyzing the canine enzootic transmission and the occurrence of HVL cases.

Objective: To test the hypotheses that emerging viruses are associated with neurological hospitalizations and that statistical models can be used to predict neurological sequelae from viral infections., Methods: An ecological study was carried out to observe time trends in the number of hospitalizations with inflammatory polyneuropathy and Guillain-Barré syndrome (GBS) in the state of Rio de Janeiro from 1997 to 2017. Increases in GBS from month to month were assessed using a Farrington test. In addition, a cross-sectional study was conducted analyzing 50 adults hospitalized for inflammatory polyneuropathies from 2015 to 2017. The extent to which Zika virus symptoms explained GBS hospitalizations was evaluated using a calibration test., Results: There were significant increases (Farrington test, P<0.001) in the incidence of GBS following the introduction of influenza A/H1N1 in 2009, dengue virus type 4 in 2013, and Zika virus in 2015. Of 50 patients hospitalized, 14 (28.0%) were diagnosed with arboviruses, 9 (18.0%) with other viruses, and the remainder with other causes of such neuropathies. Statistical models based on cases of emerging viruses accurately predicted neurological sequelae, such as GBS., Conclusion: The introduction of novel viruses increases the incidence of inflammatory neuropathies., (© 2020 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Aedes spp. are considered the main vectors of dengue (DENV), Zika (ZIKV) and chikungunya (CHIKV) viruses in the world. Arbovirus detection in Aedes mosquitoes can alert authorities to possible outbreaks, reducing the impact of these diseases. The purpose of this study was to perform an operational strategy for virological surveillance of DENV, ZIKV and CHIKV in adult Aedes aegypti and Aedes albopictus mosquitoes captured at different key-sites in an endemic urban area of the Northeast Region of Brazil, with the prospect of discussing its role as part of an alert system for outbreaks in critical areas. Residential and non-residential premises located in areas of recent of transmission of these arboviruses were selected for adult mosquito collection in the rainy season (July) of 2018. A total of 1068 adult mosquitoes were collected: 946 Culex quinquefasciatus (88.6%), 118 Ae. aegypti (11.0%), two Ae. albopictus (0.2%) and two Aedes taeniorhynchus (0.2%). Among the premises surveyed, recycling points (N = 48, 40.7%), municipal schools (N = 36, 30.5%) and junkyards (N = 31, 26.2%) were the places with the highest frequency of adult Ae. aegypti. Health units (including primary health care facilities and one hospital) (N = 23; 19.5%) together with residential premises (N = 11; 9.3%) presented the lowest frequencies. Total RNAs of the samples were extracted from Aedes mosquitoes and a nested reverse transcription (RT) polymerase chain reaction (PCR) assay for detecting and typing DENV, ZIKV and CHIKV was performed. From the 37 Aedes spp. pools analyzed (35 Ae. aegypti, one Ae. albopictus and one Ae. taeniorhynchus), seven were positive for DENV-3, including three pools containing Ae. aegypti females, one containing an Ae. aegypti engorged female and three comprised of Ae. aegypti males. The positive pools were composed of mosquitoes collected in public schools, health units, junkyards, recycling points and residential premises. Our findings reinforce the importance of continuous virological surveillance in Aedes mosquitoes, as a useful tool for detecting arboviruses circulation in vulnerable areas, even in low infestation seasons., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.

Background: Extra-Amazonian malaria mortality is 60 times higher than the Amazon malaria mortality. Imported cases correspond to approximately 90% of extra-Amazonian cases. Imported malaria could be a major problem if it occurs in areas with receptivity, because it can favor the occurrence of outbreaks or reintroductions of malaria in those areas. This study aimed to model territorial receptivity for malaria to serve as an entomological surveillance tool in the State of Rio de Janeiro, Brazil. Geomorphology, rainfall, temperature, and vegetation layers were used in the AHP process for the receptivity stratification of Rio de Janeiro State territory., Results: The model predicted five receptivity classes: very low, low, medium, high and very high. The 'very high' class is the most important in the receptivity model, corresponding to areas with optimal environmental and climatological conditions to provide suitable larval habitats for Anopheles (Nyssorhynchus) vectors. This receptivity class covered 497.14 km 2 or 1.18% of the state's area. The 'high' class covered the largest area, 17,557.98 km 2 , or 41.62% of the area of Rio de Janeiro State., Conclusions: We used freely available databases for modeling the distribution of receptive areas for malaria transmission in the State of Rio de Janeiro. This was a new and low-cost approach to support entomological surveillance efforts. Health workers in 'very high' and 'high' receptivity areas should be prepared to diagnose all febrile individuals and determine the cause of the fever, including malaria. Each malaria case must be treated and epidemiological studies must be conducted to prevent the reintroduction of the disease.

An ecological study aimed at analyzing homicide rates and actual bodily harm was conducted in Itaboraí, in the years 2010 to 2011. The entire municipality was used in the study covering critical and non-critical areas. The data came from the Information System for the Public Security Institute in Rio de Janeiro state. The territories were identified and defined by referring to studies on illegal occupations of areas. The snowballing method was used for the social recognition of poor conditions. The morphological differentiation of urban and housing standards marked the locations. The areas were georeferenced, and the problems were located geographically and organized according to their corresponding critical area. We calculated the municipal rates using population estimates from IBGE. For the critical areas, we obtained estimates of the number of households multiplied by a factor equal to the average household density in the corresponding census tract. There was a decrease in homicide rates and a rise in actual bodily harm in Itaboraí. We also found that there was an increased risk of bodily injury in critical areas with the worst living conditions, suggesting the existence of social inequalities that make certain social spaces more vulnerable to incidents involving violent injuries.

Objective: To propose a new operational unit in the locality scale capable of subsidizing the construction of an information system to control the transmission of tegumentary leishmaniasis at this scale, in a region of high endemicity of the Atlantic Forest., Methods: We examined the adequacy of data and instruments in an area of high endemicity in the Atlantic Forest located in the South of the State of Rio de Janeiro from 1990 to 2012. The study proposed an operational unit called Local Surveillance Unit to make all used databases compatible by adjusting census sectors. This enabled the overlap and comparison of information in different periods., Results: The spreading process of the transmission of tegumentary leishmaniasis in the Baía da Ilha Grande region does not depend on great population movements, and can occur in areas with population growth or decrease. The data information system allowed the adequate identification and characterization of the place of residence. We identified relevant characteristics of the place of transmission, such as self-limited in time and not associated with recent deforestation. The results also highlight the lack of synchronicity in the case production in territorial units involved in the endemic-epidemic process, noting that this process is in constant motion., Conclusions: The transmission process seems more connected to the presence and movement of rodents that move continuously in the region than to the local density of vectors or the permanence of infected dogs at home. New control strategies targeted at the foci of transmission must be considered. The construction of a new operational unit, called Local Surveillance Unit, was instrumental in the endemic-epidemic process analysis., Objetivo: Propor uma nova unidade operacional na escala de localidade capaz de subsidiar a construção de um sistema de informação orientado para o controle da transmissão da leishmaniose tegumentar nesse nível., Métodos: Uma região de alta endemicidade da Mata Atlântica no sul do estado do Rio de Janeiro de 1990 a 2012 foi selecionada para analisar a adequação dos dados e instrumentos. Uma unidade operacional denominada Unidade de Vigilância Local foi proposta para compatibilizar todos os bancos de dados utilizados por meio de ajustes dos setores censitários. Isso possibilitou a sobreposição das informações e a sua comparação em diferentes períodos., Resultados: O processo de deslocamento da transmissão da leishmaniose tegumentar na região da Baía da Ilha Grande não dependeu de movimentos populacionais importantes, podendo ocorrer tanto em áreas com crescimento como em áreas com decremento populacional. Os dados do sistema de informação permitiram a identificação e caracterização adequada do local de residência. Identificaram-se características relevantes do lugar de transmissão, como autolimitados no tempo e não associados a desmatamentos recentes. Os resultados evidenciam também a falta de sincronicidade na produção de casos nas unidades territoriais envolvidas no processo endêmico-epidêmico, mostrando que esse processo está em constante movimento., Conclusões: O processo de transmissão parece estar mais ligado à presença e circulação de roedores que se desloquem continuadamente na região do que da densidade local de vetores ou da permanência de cães infectados no domicílio. Novas estratégias de controle orientadas para os focos de transmissão devem ser consideradas. A construção de uma nova unidade operacional, denominada Unidade de Vigilância Local, foi fundamental na análise do processo endêmico-epidêmico.

Objective: To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability., Methods: This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran's I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran's I was used to identify spatial clusters., Results: We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability., Conclusions: The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease., Objetivo: Analisar determinantes para a ocorrência da leishmaniose visceral humana vinculados às condições de vulnerabilidade., Métodos: Estudo ecológico, cuja unidade de análise espacial foi a Unidade de Análise Territorial em Araguaína, TO, de 2007 a 2012. Foi realizada análise da situação sociodemográfica e de infraestrutura urbana no município. Indicadores primários normalizados foram calculados e utilizados na construção de indicadores de vulnerabilidade de estrutura social, de estrutura domiciliar e de infraestrutura urbana. A partir deles, foi composto um índice de vulnerabilidade. A estimativa de Kernel foi utilizada para avaliar a densidade de casos de leishmaniose visceral humana, com base nas coordenadas dos casos. O I-Moran Global Bivariado foi empregado para verificar a existência de autocorrelação espacial entre a incidência de leishmaniose visceral humana e os indicadores e índice de vulnerabilidade. I-Moran Local Bivariado foi utilizado para identificar clusters espaciais., Resultados: Foi observado um padrão de disseminação centrífuga da leishmaniose visceral humana no município, em que surtos da doença atingiram progressivamente áreas centrais e periurbanas. Houve correlação entre maiores incidências de leishmaniose visceral humana e piores condições de vida. Foram observados clusters estatisticamente significativos entre as incidências de leishmaniose visceral humana nos dois períodos analisados (2007 a 2009 e 2010 a 2012) e os indicadores e índice de vulnerabilidade., Conclusões: O ambiente em áreas circunscritas contribui como fator de proteção ou aumenta a vulnerabilidade local à ocorrência de leishmaniose visceral humana. O uso de metodologia que analisa as condições de vida da população e distribuição espacial da leishmaniose visceral humana é essencial na identificação de áreas mais vulneráveis à disseminação/manutenção da doença.

Background: This study aims to describe the role of mobility in malaria transmission by discussing recent changes in population movements in the Brazilian Amazon and developing a flow map of disease transmission in this region., Methodology/principal Findings: This study presents a descriptive analysis using an ecological approach on regional and local scales. The study location was the municipality of Porto Velho, which is the capital of Rondônia state, Brazil. Our dataset was obtained from the official health database, the population census and an environmental database. During 2000-2007 and 2007-2010, the Porto Velho municipality had an annual population growth of 1.42% and 5.07%, respectively. This population growth can be attributed to migration, which was driven by the construction of the Madeira River hydroelectric complex. From 2010 to 2012, 63,899 malaria-positive slides were reported for residents of Porto Velho municipality; 92% of the identified samples were autochthonous, and 8% were allochthonous. The flow map of patients' movements between residential areas and areas of suspected infection showed two patterns of malaria transmission: 1) commuting between residential areas and the Jirau hydropower dam reservoir, and 2) movements between urban areas and farms and resorts in rural areas. It was also observed that areas with greater occurrences of malaria were characterized by a low rate of deforestation., Conclusions: The Porto Velho municipality exhibits high malaria endemicity and plays an important role in disseminating the parasite to other municipalities in the Amazon and even to non-endemic areas of the country. Migration remains an important factor for the occurrence of malaria. However, due to recent changes in human occupation of the Brazilian Amazon, characterized by intense expansion of transportation networks, commuting has also become an important factor in malaria transmission. The magnitude of this change necessitates a new model to explain malaria transmission in the Brazilian Amazon.

Objective: This study aims to analyze the association between the incidence of tuberculosis and different socioeconomic indicators in a territory of intense transformation of the urban space., Methods: This is an ecological study, whose analysis units were the neighborhoods of the city of Itaboraí, state of Rio de Janeiro, Brazil. The data have been analyzed by generalized linear models. The response variable was incidence of tuberculosis from 2006 to 2011. The independent variables were the socio-demographic indicators. The spatial distribution of tuberculosis was analyzed with the elaboration of thematic maps., Results: The results have shown a significant association between the incidence of tuberculosis and variables that reflect different dimensions of living conditions, such as consumer goods, housing conditions and its surroundings, agglomeration of population, and income distribution., Conclusions: The disproportionate incidence of tuberculosis in populations with worse living conditions highlights the persistence of socioeconomic determinants in the reproduction of the disease. Different municipal public sectors need to better articulate with local tuberculosis control programs to reduce the social burden of the disease., Objetivo: Analisar a associação entre incidência de tuberculose e diferentes indicadores socioeconômicos em território em intensa transformação do espaço urbano., Métodos: Estudo ecológico, cujas unidades de análise foram os bairros do município de Itaboraí, RJ. Os dados foram analisados por modelos lineares generalizados. A variável resposta foi incidência de tuberculose de 2006 a 2011. As variáveis independentes foram os indicadores sociodemográficos. A distribuição espacial da tuberculose foi analisada por meio da elaboração de mapas temáticos., Resultados: Os resultados apontaram associação significativa entre a incidência de tuberculose e variáveis que refletem diferentes dimensões de condições de vida, como bens de consumo, condições de moradia e seu entorno, aglomeração populacional e distribuição de renda., Conclusões: O acometimento desproporcional da tuberculose em grupos populacionais com piores condições de vida ressalta a persistência dos determinantes socioeconômicos na reprodução da doença. Faz-se necessária a melhor articulação de diferentes setores públicos municipais com o programa local de controle da tuberculose visando à redução da carga social da doença.

Urban occurrence of human and canine visceral leishmaniasis (VL) is linked to households with characteristics conducive to the presence of sand flies. This study proposes an ad hoc classification of households according to the environmental characteristics of receptivity to phlebotominae and an entomological study to validate the proposal. Here we describe the phlebotominae population found in intra- and peridomiciliary environments and analyse the spatiotemporal distribution of the VL vector Lutzomyia longipalpis of households receptive to VL. In the region, 153 households were classified into levels of receptivity to VL followed by entomological surveys in 40 of those properties. Kruskal-Wallis verified the relationship between the households' classification and sand fly abundance and Kernel analysis evaluated L. longipalpis spatial distribution: of the 740 sand flies were captured, 91% were L. longipalpis; 82% were found peridomiciliary whilst the remaining 18% were found intradomiciliary. No statistically significant association was found between sandflies and households levels. L. longipalpis counts were concentrated in areas of high vulnerability and some specific households were responsible for the persistence of the infestation. L. longipalpis prevails over other sand fly species for urban VL transmission. The entomological study may help target the surveillance and vector control strategies to domiciles initiating and/or maintaining VL outbreaks.

Background: We identified dengue transmission areas by using the Geographic Information Systems located at local surveillance units of the Itaboraí municipality in state of Rio de Janeiro. We considered the association among the house infestation index, the disease incidence, and sociodemographic indicators during a prominent dengue outbreak in 2007 and 2008., Methods: In this ecological study, the Local Surveillance Units (UVLs) of the municipality were used as spatial pattern units. For the house analysis, we used the period of higher vector density that occurred previous to the larger magnitude epidemic range of dengue cases. The average dengue incidence rates calculated in this epidemic range were smoothed using the Bayesian method. The associations among the House Infestation Index (HI), the Bayesian rate of the average dengue incidence, and the sociodemographic indicators were evaluated using a Pearson's correlation coefficient. The areas that were at a higher risk of dengue occurrence were detected using a kernel density estimation with the kernel quartic function., Results: The dengue transmission pattern in Itaboraí showed that the increase in the vector density preceded the increase in incidence. The HI was positively correlated to the Bayesian dengue incidence rate (r = 0.641; p = 0.01). The higher risk areas were those that were close to the main highways. In the Kernel density estimation analysis, we observed that the regions that were at a higher risk of dengue were those that were located in the UVLs and had the highest population densities; these locations were typically located along major highways. Four nuclei were identified as epicenters of high risk., Conclusions: The spatial analysis units used in this research, i.e., UVLs, served as a methodological resource for examining the compatibility of different information sources concerning the disease, the vector indices, and the municipal sociodemographic aspects and were arranged in distinct cartographic bases. Dengue is a multi-scale geographic phenomenon, and using the UVLs as analysis units made it possible to differentiate the dengue occurrence throughout the municipality. The methodological approach used in this research helped improve the Itaboraí municipality monitoring activities and the local territorial monitoring in other municipalities that are affected by this public health issue.

Every child had an average of three episodes of diarrhea per year in developing countries in the twentieth century. The decrease of the number of deaths due to diarrhea in Brazil was more closely related to the use of control techniques than to changes in lifestyle conditions. This article seeks to analyze the spatial distribution of morbidity due to diarrhea among children and its relation with lifestyle conditions. This was an ecological study, with the suburbs of the city of Itaborai as units of analysis. The population studied was the number of hospitalizations of children < 5 years for diarrhea between 2006 and 2009, available in Hospital Information Systems. The Diarrhea Hospitalization Ratio (DHR) indicator and Composite Lifestyle Quality (CLQ) indicator were established. Diarrhea still accounts for a large number of hospitalizations of children (15.5% between 2006 and 2009). The DHR was high in this period (69.7 hospitalizations/ 1.000 NV). The spatial analysis identified that the suburbs with the highest DHR were, in most cases, those with the highest population agglomerations and better lifestyle conditions.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

The aim of this study was to analyze the limits and possibilities of the Information System in the Schistosomiasis Control Program (SISPCE) for characterization and surveillance of the disease at the local level. The data were aggregated to calculate epidemiological indicators such as the program's coverage and intensity of mansoni schistosomiasis infection in the endemic municipalities (counties) in Bahia State, Brazil, from 1999 to 2005. The results indicate that few municipalities have the program activities properly in place, with insufficient records in the system and lack of reporting for characterizing the endemic or providing feedback for proper surveillance and control. However, the SISPCE is still a step forward in schistosomiasis surveillance, requiring systematic action by the municipalities and maintaining a continuous data flow to orient health system managers. It is necessary to incorporate local communities as units of analysis, given their unique characteristics in the production and reproduction of schistosomiasis.

This study analyzes the characteristics of one of the main foci for cutaneous leishmaniasis transmission in the city of Rio de Janeiro, Brazil, examining its territorial configuration and the relations with spatial organization processes. An analytical model was applied to the process of occupation and organization of urban space on a local scale, considering the new functions acquired by the spatial elements expressed by different work relations, land use, and land value. The study employed geoprocessing techniques and classification of images obtained by remote sensing, localization of households, and cases of cutaneous leishmaniasis, associated with qualitative data on the historical process of land occupation and use. The analysis detected areas with distinct conditions of vulnerability and showed that changes in these conditions allowed production of the epidemic in a given time period and its subsequent reduction. The study contributes to monitoring of the disease at the local level and application of effective measures for cutaneous leishmaniasis surveillance and control.

Objective: To identify areas at risk of dengue transmission by means of cluster analysis., Methods: A cluster analysis in which the primary analysis units were the 48 districts of the municipality of Niterói, Southeastern Brazil, was conducted. The districts were grouped into six strata according to sociodemographic conditions, using the k-means cluster analysis method. After defining the strata, the incidence of dengue was calculated for each stratum in relation to four different periods: 1998 - 2000; 2001; 2002; 2003 - 2006., Results: The analysis on the incidence showed that the rates for the last three study periods were greatest in the stratum 2.1, which had the worst sanitation infrastructure conditions and high population increases, and in stratum 3.1, which had the highest percentage of shantytowns. Stratum 1.2 presented the lowest incidence and the best sanitation and income indicators, along with small increases in population and a low proportion of shantytowns. The incidence rates in 2001 and 2002 were high in most strata except for stratum 1.2, which had the districts with the least heterogeneity in relation to the indicators used. In 2001, the strata presented high rates of incidence when group immunity had supposedly become established for serotype I, thus expressing the transmission strength of this agent., Conclusions: The cluster analysis technique made it possible to recognize priority areas. It indicated areas where the dengue control and surveillance actions needed to be improved, along with structural improvements that influenced the living conditions and health of the municipality's population.

This study analyzes the specific conditions involved in dengue transmission in various areas in Itaipu, a coastal neighborhood in the city of Niterói, Rio de Janeiro State, Brazil, with a focus on socio-environmental determinants and conditioning factors. Four areas were selected with similar dengue incidence rates but different urban planning and socioeconomic patterns. The socio-spatial characteristics of each area were obtained through interviews with key informants and systematic observation. Two distinct factors were identified that may potentially condition the risk of dengue transmission. The first related to the limited water supply and scarce financial resources in a lower-income population. The second was associated with a group having better socioeconomic status, which allowed them to store water in larger tanks. The implementation of a housing infrastructure generated by real estate speculation was a determining factor for the creation of socio-spatial segregation, resulting in different forms of receptiveness and vulnerability to dengue. In this sense, the incomplete and unequal installation of housing infrastructure is a determining factor for the differentiated generation of vector breeding sites and thus for dengue transmission.

Dengue fever has become the most important vector-borne viral disease in Brazil. Human facilitated transport of desiccation-resistant eggs has led to its two most important vectors, Aedes aegypti and Ae. albopictus, becoming widespread. In this paper, we report seasonal and spatial variation in larval abundances of Ae. aegypti and Ae. albopictus across a small-scale transition zone between an urban area and an urban wooded/forested area within Rio de Janeiro, Brazil. We installed 400 ovitraps across 10 sites with different human population densities and vegetation coverage. Eggs and larvae were collected for three weeks during the wet and dry seasons of 2002 and 2003. Ae. albopictus was predominantly found in the forested areas of the study site whereas in the urbanized area Ae. aegypti was more abundant. Both species peaked during the wet season. This distribution pattern, which may reflect adult flight range, may favor the co-occurrence of larvae of these species in a small-scale urban/urban forest transition zone.

A comparative study was performed on the initial and final bacillary indexes of 213 multibacillary leprosy patients who received 12 doses (Group 1: 128 patients) or 24 doses (Group 2: 85 patients) of multidrug therapy (MDT/WHO) to measure the effectiveness of the two regimens. All patients were evaluated at treatment baseline, 12 months, and 24 months. The reduction in bacillary levels and mean bacillary indexes at 24 months was similar in the two groups. No statistical difference in reaction rates was observed between the two treatment regimens.

This study provides a preliminary analysis of the Information System in the Schistosomiasis Control Program (SISPCE) in the States of Bahia, Sergipe, Alagoas, and Pernambuco, Brazil, from 1999 to 2003. The data analysis suggests a sharp decline in data entry in the system during the transition period involving health services decentralization, followed by a gradual increase. Major under-recording was observed in Pernambuco. SISPCE-DATASUS and IBGE (National Census Bureau) data are insufficient to construct a surveillance index for serious forms of the endemic disease and other aspects that could relate sanitary conditions to schistosomiasis. Reformulation of the SISPCE is key for schistosomiasis control measures, given the new reality in the Brazilian health system. The data system should be redesigned in order to integrate the health policies with the Unified National Health System's guidelines, using a systematic data collection methodology in keeping with local specificities and allowing prospective comparisons and evaluations, in addition to constructing new indicators with an emphasis on morbidity and determinants of the endemic and the adoption of analytical of the that express the real situation of the schistosomiasis in the States.

Leptospirosis, one of the most widely disseminated zoonoses in the world, is endemic in Brazil and is characterized by outbreaks during seasons with the greatest rainfall. In 1996 the city of Rio de Janeiro experienced one of the largest urban epidemics in the country, shortly after heavy rainstorms in the month of February, with 1,732 reported cases and 51 deaths. The objective of this work was to describe the spatial distribution of leptospirosis in the city of Rio de Janeiro during the period 1996-1999. Data were from the National Information System for Reportable Diseases. The kernel ratio for cases and population generated a smoothed surface, which estimates the intensity of the leptospirosis incidence rate. In the resulting maps over the course of the study period, the sites with the highest leptospirosis intensity were not repeated, and the sites normally considered as having the highest risk -- slum areas and flooded areas -- were not always the most heavily affected. The techniques used can represent an important methodological acquisition for establishing territory-based surveillance.

The objective of this study, based on a systematic literature review, is to present the characteristics and potentialities of remote sensing as a useful environmental surveillance tool for applied research in the control of endemics in Brazil. Onboard satellite sensors allow for monitoring the territory, furnishing spatial and temporal information on various scales and regions in the electromagnetic spectrum. Based on the literature review on the application of this technology to the study of endemics and the identification of the potential of new sensors with better spectral, spatial, and temporal resolutions, this study highlights perspectives for the use of remote sensing in the study of important endemics for Brazil.

This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.

The authors analyze the historical and spatial determinants of the implantation, persistence, and spread of cutaneous leishmaniasis in the municipality of Rio de Janeiro and the links between the disease and the organization of urban space and occupation processes on the periphery of the city beginning in the early 20th century through the 1980s. A pattern of outbreaks that was restricted and spatially discontinuous but sequenced was observed and seen to be linked to a dynamic process of urban real estate appreciation, comprising a large endemic area for cutaneous leishmaniasis. An analysis of the occupation and organization of urban space in the so-called Western Zone of Rio de Janeiro was conducted, considering new functions of spatial elements expressed through changing work relations, land use, and land value. Urbanization of the area produced the necessary conditions to intensify an endemic pattern of well-defined outbreaks where human mobility and the work process increased contact between susceptible individuals and vectors. Analysis showed spatial units with differentiated risk levels.

The environmental context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with socio-demographic data using Geographic Information System (GIS). Risk areas were mapped based on flood and solid waste accumulation information for the region. Incidence rates were calculated for each area by the division of number of cases per total population in the specific areas. Higher rates were observed for census tracts inside the flood risk area and in the vicinities of waste accumulation sites. These findings are in agreement with the expected risk of leptospirosis, evidencing the role of environmental and collective factors in the determination of the disease.

The environmental and social context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with population and environmental data in a Geographical Information System (GIS). Important differences were observed between places where residences of leptospirosis cases are concentrated and other places in the region. Water supply coverage, solid waste collection, sewerage system coverage and flood risk area were the main determining variables from an initial list of ten. The influence of these unfavorable social and environmental factors is verified hundreds of meters distant from the leptospirosis case residences, demonstrating a necessity to broaden the area of health surveillance practices. The geocoding indicated that some cases did not report contact with flood water, even though they were geographically adjacent to cases who did report this contact. Cases may only report exposures they believe are related to the disease. Geocoding is a useful tool for evaluating such bias in the exposure recall.

A decreasing trend in the prevalence rate of leprosy was reached in Brazil only after the introduction of the World Health Organization multidrug therapy (WHO/MDT) program in 1990. This paper analyzes leprosy morbidity indicators and the prevalence rate, and their utilization in monitoring the progress of leprosy elimination in Brazil. Since these indicators are modified by changes in health service procedures, comparing prevalence rates from different endemic countries or current prevalence rates with old ones from the same endemic region needs careful attention. The current official prevalence rate of 6.72/10,000 inhabitants in Brazil could be considered high when compared with rates from other countries, but it is important to remember that defaulters and patients being treated with old regimens are kept on the active registers in Brazil, while in most other endemic countries they are not.

This study focused on the prevalence of V. cholerae O(1) infection in 1,196 individuals living in Manacapuru, Amazonas State, through microtitering of vibriocidal antibody and somatic agglutination test. The role of living conditions and individual characteristics as possible risk factors for infection was also assessed. Vibriocidal titers >/= 1: 40 and/or agglutinating titers >/= 1: 80 were considered indicators of V. cholerae O(1) infection. Infection prevalence was 25.7%. There was no significant statistical difference (p=0.05) when analyzed against housing patterns, sanitary facilities, source and treatment of water, destination of domestic waste, sex, or profession. Household location, number of occupants/household, age, and schooling showed significant statistical differences in infection prevalence (p=0.05).

Bancroftian filariasis is a major public health problem in the city of Recife in north-eastern Brazil. In some of its urban areas microfilaraemia prevalence reaches 14%. This study describes epidemiological characteristics, infection and disease, in 2 urban areas, Coque and Mustardinha, before control measures were applied. The parasitological survey was performed by a 'door-to-door' census covering 5563 subjects, aged between 5 and 65 years. Microfilaraemia was detected by the thick drop technique, using 45 microL of peripheral blood collected between 20:00 and 24:00. In both areas the prevalence of microfilaraemia was 10%, and males had higher prevalences of infection and disease than females. The prevalence of microfilaraemia was higher in the 15-24 and 25-34 years age groups in both sexes. Most microfilaria (mf) carriers (72.1% in Coque and 79.7% in Mustadrinha) had mf densities < 100/60 microL of blood. Females of reproductive age had significantly lower mf densities than males. The overall disease prevalence in both areas was 6.3%. Amongst the subjects who presented with chronic disease 15.7% were microfilaraemic. Chronic disease prevalence increased from 1.4% in the 5-14 years age group to 11.3% in the oldest age group. The most frequent clinical manifestation was hydrocele (5.4%), followed by lymphoedema (1.8%). The epidemiological pattern of filariasis in the populations studied was marked by high prevalence of microfilaraemia, low mf density, and relatively low prevalence of filarial disease considering the level of endemicity.

A cross-sectional study was carried out to characterize the contribution of several household characteristics to the transmission of leprosy. Households with diagnosed cases of illness were compared to two healthy groups. All randomly selected households were located in the municipality of Sao Goncalo, in the State of Rio de Janeiro. Using an aerial map with the description of the census tract, 2,412 cases were marked. Three groups were established, while the household was the analytical unit: group I - households with cases; group II - neighboring households; and group III - households located in tracts with no reported case of illness, that is, outside disease foci. Group I was compared with that of neighboring households using a multiple logistic regression model by conditional methods. Unconditional methods were used to compare groups I and III. Group I as compared to Group II showed an association with age and educational level for households and heads of families. Comparison of characteristics of the heads of families and households with cases of leprosy with those located outside the focus showed that the differential factors were age, type of dwelling, and availability of running water. This is probably due to more recent settlement in a peripheral region where water resources are not available yet. Households are the basic ecological unit, and age and educational level are determinant factors for leprosy morbidity in this area.

Montenegro skin tests were carried out in 1985 and 1987 on two groups of school children in the city of Rio de Janeiro. Group A consisted of 449 children residing in the Jacarepagua district, in areas where transmission of human and canine American cutaneous leishmaniasis (ACL) has been high; this group was considered to be the one at greatest risk of acquiring the infection through L. braziliensis. Group B consisted of 282 children from Bonsucesso, a suburb of Rio de Janeiro that is at a considerable distance from any area where ACL is endemic; this was a lowest risk group, and was thus used as a control. Analysis of the cutaneous test results showed that in Group A, 8.9% of the sample tested positive, whereas in Group B the result was only 2.1%. In group A there were no significant differences in the proportion of positives when analysed according to sex, age and the year when the tests were carried out. A study of the effects associated with place of residence together with other variables was carried out using log-linear regression analysis. It showed that effects arising from place of residence were maintained; that this was the only significant effect; and that it was independent of other variables. The testing of school children using the Montenegro intradermal test was shown to be a useful procedure in the characterization of localities in which there is a risk of ACL infection.

Diarrhea and pneumonia are common diseases in children aged under one year, for which there are simple therapeutic measures. However, infant mortality due to these diseases is still very high, varying markedly according to socio-economic status. The characteristics of children who died (cases) and of those who were hospitalized with diarrhea or pneumonia, but survived (controls), were studied. The following groups of variables were studied: socio-economic, environmental and biological conditions, nutritional status and breast-feeding. Information on cases and controls was collected from hospital records and through home interviews. Important losses occurred in the latter: 40% of cases and 50% of controls were not interviewed. There were no significant differences between cases who were included and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold) associated with nutritional deficit. The duration of breast-feeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses) which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.

Within the scope of an investigation into infant mortality determinants in the metropolitan region of Rio de Janeiro during one-year period, the original death certificates of a sample of children were studied and compared with information provided on them by hospital case-histories and records. This was done with a view to assessing the quality of the filling in of certificates for the purpose of calling the attention of health officers to their use as documents furnishing data for the preparation and evaluation of health programmes and note simply as a legal requirement for burying. Only 52.3% of the basic causes given on the certificates were maintained after the examination of the case histories. Necropsy was carried out on only 42.8% of those neonatal deaths and 21.5% of post-neonatal deaths which took place outside the hospital. Other items that were evaluated included mother's age and education, time interval and complementary examination, birth weight and necropsy, all of which presented a degree of accuracy in their filling-in far below that required, thus evidencing the limitations of the official death statistics based on this information.

Forty dogs from the periphery of the city of Rio de Janeiro were studied. All dogs where diagnosed as positive for leishmaniasis either parasitologically and/or serologically. Among them, 19 came from areas where only Visceral Leishmaniasis (VL) occurs (Realengo, Bangu, Senador Camará). Clinical signs of the disease were seen in 36.8% of the cases, including emaciation - 100%, lymphadenopathy and depilation - 85.7%. The other 21 dogs came from an area (Campo Grande) where both diseases (VL, and American Cutaneous Leishmaniasis - ACL) occur. Clinical signs of the disease, mainly cutaneous or mucocutaneous ulcers were seen in 76.2% of the cases. Leishmania parasites were found in 39 cases: 22% in viscera, 42.5% in viscera and normal skin and 35% in cutaneous or mucocutaneous ulcers. All the Leishmania stocks isolated from dogs which came from Realengo, Bangu, Senador Camará (VL area), and from Campo Grande (VL + ACL area) were characterized as L. donovani (except in one case) according to their schizodeme, zymodeme and serodeme. The only stock characterized as L. b. braziliensis, was isolated from the lymph node of a dog from Campo Grande with visceral disease and without skin lesions. Antimony therapy attempted in eight Leishmania donovani positive dogs was unsuccessful.

Limiting dilution analysis was used to estimate the frequency of Leishmania-specific T cells from the peripheral blood of 18 human cases of American Cutaneous Leishmaniasis (ACL). Sixteen patients had localized cutaneous leishmaniasis (LCL) and two were recovered LCL patients. In 10 patients with active disease and in two with healed lesions the Leishmania-specific T cell frequencies ranged from 1/10(5) to 1/10(3). In six patients no proliferation was detected after 21 days of cell culture. This finding points to very low precursor frequencies in the peripheral blood of these patients. A significant correlation was found between the two groups with low or high Leishmania-specific T cell frequencies and the lymphoproliferative responses to leishmanial antigens. The majority of the blast-like Leishmania-specific T cells showed a helper/inducer (CD4) phenotype.