Abstract
BackgroundCutaneous leishmaniasis (CL) is a vector-borne disease classified by the World Health Organization as one of the most neglected tropical diseases. Brazil has the highest incidence of CL in America and is one of the ten countries in the world with the highest number of cases. Understanding the spatiotemporal dynamics of CL is essential to provide guidelines for public health policies in Brazil. In the present study we used a spatial and temporal statistical approach to evaluate the dynamics of CL in Brazil.MethodsWe used data of cutaneous leishmaniasis cases provided by the Ministry of Health of Brazil from 2001 to 2017. We calculated incidence rates and used the Mann–Kendall trend test to evaluate the temporal trend of CL in each municipality. In addition, we used Kuldorff scan method to identify spatiotemporal clusters and emerging hotspots test to evaluate hotspot areas and their temporal trends.ResultsWe found a general decrease in the number of CL cases in Brazil (from 15.3 to 8.4 cases per 100 000 habitants), although 3.2% of municipalities still have an increasing tendency of CL incidence and 72.5% showed no tendency at all. The scan analysis identified a primary cluster in northern and central regions and 21 secondary clusters located mainly in south and southeast regions. The emerging hotspots analysis detected a high spatial and temporal variability of hotspots inside the main cluster area, diminishing hotspots in eastern Amazon and permanent, emerging, and new hotspots in the states of Amapá and parts of Pará, Roraima, Acre and Mato Grosso. The central coast the state of Bahia is one of the most critical areas due to the detection of a cluster of the highest rank in a secondary cluster, and because it is the only area identified as an intensifying hotspot.ConclusionsUsing a combination of statistical methods we were able to detect areas of higher incidence of CL and understand how it changed over time. We suggest that these areas, especially those identified as permanent, new, emerging and intensifying hotspots, should be targeted for future research, surveillance, and implementation of vector control measures.Graphic abstract
Highlights
Cutaneous leishmaniasis (CL) is a vector-borne disease classified by the World Health Organization as one of the most neglected tropical diseases
The CL incidence reported per year in Brazil showed that there is a tendency for reduction in number of cases
Despite the wide distribution of cases approximately 80% of them occurred in only 10% of municipalities which were located mainly in Brazilian Legal Amazon (BLA), especially in the states namely Maranhão (MA), Mato Grosso (MT), Pará (PA) and Rondônia (RO), and outside of BLA in the state of Bahia (BA) (Fig. 3A)
Summary
Cutaneous leishmaniasis (CL) is a vector-borne disease classified by the World Health Organization as one of the most neglected tropical diseases. Cutaneous leishmaniasis (CL) is a vector-borne disease infecting from 0.7 to 1.2 million people per year [1] and it is classified as one of the most neglected tropical diseases [2]. Leishmania and is transmitted to humans by the bite of infected female sandflies [3] It has three primary clinical forms: (1) localized cutaneous, which is characterized by one or multiple ulcerated skin lesions; (2) diffuse, in which the patients present nodular lesions disseminated all over the body; and (3) mucocutaneous, which is characterized by necrosis of the nasopharyngeal mucous tissue [4]. The World Health Organization classified this disease as a public health problem in the Americas and estimated that between 187 200 and 307 800 cases occur every year [7, 8]. Brazil is one of the countries with the highest number of cases of CL in the world, and alongside Afghanistan, Algeria, Colombia, Iran, Syria, Ethiopia, Northern Sudan, Costa Rica, and Peru account together for 70–75% of the global incidence of the disease [1]
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