Abstract
In 1999, Birigui and Araçatuba were the first municipalities in the State of São Paulo to present autochthonous cases of visceral leishmaniasis in humans (VLH). The aim of this study was to describe the temporal, spatial and spatiotemporal behaviors of VLH in Birigui. Secondary data were obtained from the Notifiable Diseases Information System from 1999 to 2012. The incidence, mortality and case fatality rates by sex and age were calculated. The cases of VLH were geocoded and grouped according to census tracts. Local empirical Bayesian incidence rates were calculated. The existence of spatial and spatiotemporal clusters was investigated using SaTScan software. There were 156 confirmed cases of autochthonous VLH. The incidence rate was higher in the 0-4-year-old children, and the mortality and case fatality rates were higher in people aged 60 years and older. The peaks of incidence occurred in 2006 and 2011. The Bayesian rates identified the presence of VLH in all of the census tracts in the municipality; however, spatial and spatiotemporal clusters were found in the central area of the municipality. Birigui, located in the Araçatuba region, has recently experienced increasing numbers of VLH cases; this increase is contrary to the behavior observed over the entire region, which has shown a decreasing trend in the number of VLH cases. The observations that the highest incidence is in children 0-4 years old and the highest mortality is in people 60 years and older are in agreement with the expected patterns of VLH.
Highlights
In 1999, Birigui and Araçatuba were the first municipalities in the State of São Paulo to present autochthonous cases of visceral leishmaniasis in humans (VLH)
Considering the entire study period, the VLH incidence rate was higher in children aged 0-4 years old (Figure 1B), and the mortality and case fatality rates were higher in people aged 60 years and older (Figures 1C and D)
The distribution of VLH between genders was presented in a homogeneous fashion, further analysis of the incidence rates by gender and age revealed that girls aged 0-4 years were more affected than boys, and men aged between 20-59 years were more affected than women (Figure 1B)
Summary
In 1999, Birigui and Araçatuba were the first municipalities in the State of São Paulo to present autochthonous cases of visceral leishmaniasis in humans (VLH). The Bayesian rates identified the presence of VLH in all of the census tracts in the municipality; spatial and spatiotemporal clusters were found in the central area of the municipality. The vector Lu. longipalpis was first identified in 1997 in the western region of the State of São Paulo in the municipality of Araçatuba[8]. Thereafter, VLH spread to other municipalities, in the western region of the state; between 1999 and 2011, 73 municipalities of São Paulo had human cases[10] and 125 municipalities documented the presence of the vector[11]
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