Laboratório de Epidemiologia Veterinária, Departamento de Veterinária Preventiva, Universidade Federal de Pelotas, Capão do Leão, Rio Grande do Sul, Brazil.
Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Zoonoses Public Health. 2024 Mar;71(2):144-156. doi: 10.1111/zph.13092. Epub 2023 Nov 20.
This study describes the spatio-temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020.
Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio-temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central-West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio-temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country.
The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years.
本研究描述了 2001 年至 2020 年期间巴西新内脏利什曼病（VL）病例报告的时空动态。
通过巴西卫生部的法定传染病信息系统获得疾病发生数据。使用 Joinpoint、时间广义加性模型和条件自回归（CAR）模型分析巴西各州和地区的发病率的时间演变。使用时空广义加性和 CAR 模型来确定巴西境内 VL 发生的年风险分布与空间平均值变化之间的关系。在目标期间有 63966 例 VL 病例（每年 3.198 例），平均发病率为 1.68 例/10 万居民。其中 4451 例导致死亡，这意味着平均死亡率为 0.12 例/10 万居民，病死率为 6.96%。发病率最高的地区是北部地区，其次是东北部地区，死亡率分别为第二和第一高。对于巴西所有地区，以及东北部地区，发病率稳定，而其他地区在该时期的不同时间段呈上升趋势：中西部地区直至 2011 年，北部地区直至 2008 年，东南部地区直至 2004 年，南部地区直至 2010 年。另一方面，所有地区在该系列的最后几年都经历了发病率的下降。东北部地区有最多的市具有统计学意义上显著升高的相对风险。时空分析显示，在时间序列开始时，高风险区域主要在东北部地区。从 2002 年到 2018 年，该区域扩展到该国内陆。
本研究表明，VL 在巴西已经扩大。然而，北部和东北部地区仍然具有最高的发病率，并且近年来感染风险已经降低。
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