Abstract
BackgroundVisceral leishmaniasis (VL) is expanding in Brazil and in other South American countries, a process that has been associated with the urbanization of the disease. This study analyzes the spatial and temporal distribution of VL in the Brazilian state of Minas Gerais and identifies the areas with higher risks of transmission.MethodologyAn ecological study with spatial and time series analyzes of new confirmed cases of VL notified to the Brazilian Notifiable Disease Information System between 2002 and 2013, considering the 12 mesoregions of Minas Gerais. Two complementary methodologies were used: thematic maps of incidence and Poisson (log-linear) generalized linear model. Thematic maps using crude and smoothed cumulative incidences were generated for four trienniums. Poisson Regression measured the variation of the average number of cases from one year to the following, for each mesoregion.Principal findingsThe 5,778 cases analyzed revealed a heterogeneous spatial and temporal distribution of VL in Minas Gerais. Six mesoregions (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL, with incidence rates as high as 26/100,000 inhabitants. The Vale do Rio Doce and Jequitinhonha mesoregions showed a considerable increase in the incidence rates in the last period studied. The other six mesoregions reported only sporadic cases and presented low and unsteady incidence rates, reaching a maximum of 1.2/100,000 inhabitants.Conclusions/SignificanceThe results contribute to further the current understanding about the expansion of VL in Minas Gerais and may help guide actions for disease control.
Highlights
Until 1980, visceral leishmaniasis (VL) was considered a strictly rural disease in Brazil, the main parasite (Leishmania infantum) reservoirs being foxes (Dusicyon vetulus and Cerdocyon thous) and marsupials (Didelphis albiventris) [1]
The results showed that during the 12-year time series the VL had a heterogeneous spatial and temporal distribution in the state of Minas Gerais
The Vale do Rio Doce and Jequitinhonha mesoregions presented a considerable increase in the incidence rates of the disease in the last period
Summary
Until 1980, visceral leishmaniasis (VL) was considered a strictly rural disease in Brazil, the main parasite (Leishmania infantum) reservoirs being foxes (Dusicyon vetulus and Cerdocyon thous) and marsupials (Didelphis albiventris) [1]. Migration of people from rural endemic areas to urban centers, adaptation of the vector to the domestic environment, the presence of disease reservoirs such as domestic dogs, malnutrition, and the lack of basic sanitation are considered contributing factors to the urbanization and geographic expansion of VL [3,4,5]. In this context, the Visceral Leishmaniasis Control and Surveillance Program (VLCSP) was implemented in Brazil to reduce the risk of transmission, the lethality, and the morbidity rates of VL in urban and rural areas. This study analyzes the spatial and temporal distribution of VL in the Brazilian state of Minas Gerais and identifies the areas with higher risks of transmission
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