Laboratório de Epidemiologia das Doenças Infecciosas e Parasitárias, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Instituto de Ensino e Pesquisa da Santa Casa Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
PLoS Negl Trop Dis. 2017 Oct 6;11(10):e0005950. doi: 10.1371/journal.pntd.0005950. eCollection 2017 Oct.
Visceral 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.
An 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.
The 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/SIGNIFICANCE: The results contribute to further the current understanding about the expansion of VL in Minas Gerais and may help guide actions for disease control.
内脏利什曼病（VL）在巴西和其他南美国家不断蔓延，这一过程与疾病的城市化有关。本研究分析了巴西米纳斯吉拉斯州 VL 的时空分布，并确定了具有更高传播风险的区域。
本研究采用生态研究方法，对 2002 年至 2013 年期间向巴西传染病报告信息系统报告的新确诊 VL 病例进行空间和时间序列分析，共考虑了米纳斯吉拉斯州的 12 个地区。使用了两种互补的方法：发病率主题图和泊松（对数线性）广义线性模型。为四个三年期生成了粗发病率和平滑累积发病率的主题图。泊松回归测量了每个地区每年的平均病例数的变化。
共分析了 5778 例病例，发现米纳斯吉拉斯州 VL 的空间和时间分布存在异质性。六个地区（中米纳斯、杰济津霍纳、贝洛奥里藏特大都市区、米纳斯西北部、米纳斯北部和里约多斯库斯山谷）负责 VL 的扩张和维持，发病率高达 26/100,000 居民。最后研究期，里约多斯库斯山谷和杰济津霍纳地区的发病率显著增加。其他六个地区仅报告了散发病例，发病率低且不稳定，最高为 1.2/100,000 居民。
结论/意义：本研究结果进一步加深了对米纳斯吉拉斯州 VL 扩张的认识，并有助于指导疾病控制行动。
