Leishmaniose visceral: aspectos epidemiológicos, espaciais e temporais no município de Sobral, nordeste do Brasil, 2007-2019 / Visceral leishmaniasis: epidemiological, spatial and temporality aspects in the municipality of Sobral, northeast Brazil, 2007-2019

Objetivos: descrever os aspectos epidemiológicos, espaciais e temporais da leishmaniose visceral humana, no município de Sobral, no período de 2007 a 2019. Métodos: foi realizado um estudo epidemiológico descritivo e ecológico de análise espacial e temporal, com uso dos programas Quantum-Gis e Joinpoint. Resultados: foram confirmados 316 casos novos, predominantemente, no sexo masculino, nas faixas etárias de 1 a 4 anos (26,3%) e de 20 a 39 anos (24,0%), na zona urbana. Febre (95,9%), fraqueza (85,1%), emagrecimento (80,1%), palidez (73,7%), esplenomegalia (75,6%) e hepatomegalia (69,3%) foram os sinais clínicos mais frequentes. A doença se concentrou em quatro bairros: Terrenos Novos, Centro, Expectativa e Sinhá Saboia, expressando áreas mais densas (quentes). A incidência e a letalidade foram crescentes no início do período e decrescentes no final, com uma inversão destes indicadores no ano de 2014. Conclusão: em Sobral, a leishmaniose visceral humana é um agravo considerado relevante para o serviço de vigilância em saúde com necessidade de intensificação das ações de controle entomológico, zoonótico e de manejo ambiental, principalmente nas áreas mais densas.

Objectives: the objective was to describe the epidemiological, spatial, and temporal aspects of human visceral leishmaniasis, in the municipality of Sobral, from 2007 to 2019. Methods: A descriptive, spatial and temporal ecological study was carried out using Quantum-Gis and Joinpoint programs. Results: 316 new cases were confirmed, predominantly in males, in the age groups of 1 to 4 years (26.3%) and 20 to 39 years (24.0%), mainly in the urban area. Fever (95.9%), weakness (85.1%), weight loss (80.1%), pallor (73.7%), splenomegaly (75.6%), and hepatomegaly (69.3%) were the most frequent clinical signs. The disease was concentrated in four neighborhoods (Terrenos Novos, Centro, Expectativa, and Sinhá Saboia), hot spots. The incidence and case-fatality increased at the beginning of the period but decreased at the end, with an inversion in these in the year 2014. Conclusion: In Sobral, human visceral leishmaniasis is a disease considered relevant to the health surveillance service, with the need to intensify entomological, zoonotic, and environmental management actions, especially in denser areas.

Epidemiological and clinical factors associated with lethality from Human Visceral Leishmaniasis in Northeastern Brazil, 2007 to 2018

ABSTRACT Human Visceral Leishmaniasis (HVL) presents a subacute clinical evolution with systemic involvement, which can result in high case fatality, especially among untreated individuals or those with low socioeconomic status. This study aimed to identify epidemiological and clinical factors associated with HVL case fatality in the Ceara State, from 2007 to 2018. This is an analytical cross-sectional study. The bivariate analysis was performed by Stata 15.1 using Pearson's Chi-square or Fisher's exact test; and Poisson regression for age-controlled multivariate analysis. From 2007 to 2018, there were 4,863 new confirmed cases and 343 deaths from HVL (case fatality rate=7.05%). The risk factors associated with case fatalities were: age group (RR=8.69; 95%CI:3.56-21.20); black population (RR=2.21; 95%CI:1.45-3.35); jaundice symptoms (RR=1.72; 95%CI:1.38-2.14); edema (RR=2.62; 95%CI:2.10-3.26) and hemorrhagic phenomena (RR=1.63; 95%CI:1.26-2.10); and no prescription drug intake (RR=4.03; 95%CI:2.98-5.46). Treatment with pentavalent antimonial was a protective factor (RR=0.35; 95%CI:0.27-0.45). The number of deaths increased among the elderly, illiterate, urban residents, and black skin color individuals. The drugs pentavalent antimonial and amphotericin B showed an association with death, but were not considered causal factors. Treatment failure led to a high risk of death. In multivariate analysis, the risk factors for fatal cases were age group, black skin, symptoms of jaundice, edema and hemorrhagic phenomena; and failure to take the prescription drugs. Treatment with pentavalent antimonial was shown to be a protective factor. Knowing the factors associated with the fatality of VL-HIV cases may help to improve public policies, in order to refine the epidemiological surveillance program and, consequently, prevent deaths related to the disease in Ceara.

Epidemiological Aspects and High Magnitude of Human Visceral Leishmaniasis in Ceará, Northeast of Brazil, 2007-2021

ABSTRACT Background: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. Methods: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. Results: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. Conclusions: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.

Magnitude and temporal trends of leprosy relapse in the state of Ceará, Brazil in the period 2001-2018

Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.

Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017 / Leishmaniasis visceral: distribución temporal y espacial en Fortaleza, Ceará, Brasil, 2007-2017 / Visceral Leishmaniasis: temporal and spatial distribution in Fortaleza, Ceará State, Brazil, 2007-2017

Objetivo: Analisar a tendência temporal e descrever a distribuição espacial da leishmaniose visceral (LV) em Fortaleza, 2007-2017. Métodos: Estudo ecológico, mediante regressão temporal segmentada e mapeamento temático. Resultados: No período 2007-2017, foram confirmados 1.660 casos novos e 97 óbitos. No período 2007-2010, a incidência foi ascendente (variação percentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), enquanto a mortalidade (APC=-25,9 - IC95% -48,5; -10,6) e a letalidade (APC=-33,0 - IC95% -53,7;-17,6), descendentes. No período 2010-2015, a incidência reduziu (APC=-15,8 - IC95% -25,1;-4,0), mas a mortalidade (APC=18,7 - IC95% 9,4;50,6) e a letalidade (APC=40,1 - IC95% 22,5;72,0) apresentaram tendência de crescimento. Em 2015-2017, decresceram a incidência (APC=-24,6 - IC95% -36,2;-10,3) e a mortalidade (APC= -44,6 - IC95% -58,8;-17,6); a letalidade se manteve estável (APC=-13,5 - IC95% -38,7;3,8). Houve concentração de bairros com incidência elevada na região oeste da cidade; porém, a mortalidade e a letalidade não apresentaram padrões espaciais definidos. Conclusão: A LV é endêmica em Fortaleza, embora tenha havido declínio no último triênio estudado.

Objetivo: Analizar la tendencia temporal y describir la distribución espacial de la leishmaniasis visceral (LV) en Fortaleza de 2007 a 2017. Métodos: Estudio ecológico utilizando regresión temporal segmentada y mapas temáticos. Resultados: Entre 2007-2017, se confirmaron 1,660 casos nuevos y 97 muertes. La incidencia fue ascendente (cambio porcentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), y mortalidad y letalidad descendentes: APC=-25,9 (IC95% -48,5;-10,6) y APC=-33,0 (IC95% -53,7;-17,6), respectivamente. Desde 2010-2015, la incidencia disminuyó (APC=-15,8 - IC95% -25,1;-4,0), pero la mortalidad (APC=18,7 - IC95% 9,4; 50,6) y la letalidad (APC=40,1 - IC95% 22,5; 72,0) tuvieron una tendencia al alza. En 2015-2017, disminuyeron incidencia (APC=-24,6 - IC95% -36,2;-10,3), y mortalidad (APC=-44,6 - IC95% -58,8;-17,6) la letalidad se mantuvo estable (APC=-13,5 - IC95% -38,7; 3,8). Los barrios con alta incidencia se agruparon en la región oeste de la ciudad, pero, la mortalidad y la letalidad no fueron definidos espacialmente. Conclusión: La LV es endémica en Fortaleza, aunque ha habido una disminución en el último trienio estudiado.

Objective: To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017. Methods: This was an ecological study using segmented temporal regression and thematic mapping. Results: Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The overall incidence rate showed a rising trend (Annual Percent Change - APC=8.7% - 95%CI -3.3;34.1), while the mortality rate (APC=-25.9 - 95%CI -48.5;-10.6) and lethality (APC=-33.0 - 95%CI -53.7;-17.6) showed a falling trend. From 2010-2015 the incidence rate fell (APC=-15.8 - 95%CI -25.1;-4.0), but mortality (APC=18.7 - 95%CI 9.4;50.6) and lethality (APC=40.1 - 95%CI 22.5;72.0) had an upward trend. In 2015-2017, incidence (APC=-24.6 - 95%CI -36.2;-10.3), and mortality (APC=-44.6 - 95%CI -58.8;-17,6) fell, while lethality remained stable (APC=-13.5 - 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region of the city, however, mortality and lethality did not present defined spatial patterns. Conclusion: VL is endemic in Fortaleza, although there was a reduction in the last three years studied.

Post-exposure human rabies prophylaxis: spatial patterns of inadequate procedures in Ceará - Brazil, 2007 to 2015

Abstract INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures.

Atendimentos antirrábicos humanos pós-exposição: tendência temporal de sua prevalência no Ceará, de 2007 a 2015 / Post-exposure human anti-rabies care: temporal trend of its prevalence in Ceará, from 2007 to 2015

Resumo Introdução A principal recomendação para o controle da raiva em humanos é a vacinação profilática. Objetivo Considerando-se a endemicidade da raiva no Brasil e o direcionamento das ações de controle, buscou-se caracterizar a tendência temporal dos atendimentos antirrábicos humanos pós-exposição no Ceará, de 2007 a 2015. Método O estudo é ecológico de tendência temporal e analítico. Os dados das fichas de atendimento antirrábico foram organizados em planilhas e calculados os coeficientes anuais de prevalência. Resultados Houve 231.694 atendimentos antirrábicos, com coeficientes de prevalência crescentes de 2007 a 2011 (35,09 por 10.000 habitantes; APC=13,5; p<0,001) e ápice em 2015 (40,35 por 10.000 habitantes; APC=5,5; p=0,005). Houve um aumento na faixa etária de 20 a 59 anos (APC=14,0; p<0,001), e residentes da zona urbana (APC=7,0; p<0,001). A espécie canina teve tendência crescente de 2007 a 2011 (APC=14,3; p<0,001). Das notificações, 95,8% apresentaram condutas inadequadas, com crescimento nos coeficientes de prevalência de 2007 a 2011 (APC=13,6; p<0,001). Conclusão As condutas profiláticas inadequadas aconteceram mais de 2007 a 2011. A análise temporal, com tendência crescente no período analisado, deve ser utilizada como componente contínuo das ações de vigilância da raiva no Ceará, para assistência adequada e segura aos pacientes vítimas de agressão animal.

Abstract Background The main recommendation for the control of rabies in humans is the prophylactic vaccination. Objective Considering the endemicity of rabies in Brazil and the direction of control actions, it was aimed to characterize the temporal trend of post-exposure human anti-rabies in Ceará from 2007 to 2015. Method The study is ecological with a temporal trend and analytical. The data of the anti-rabies data sheets were organized into spreadsheets and the annual prevalence coefficients were calculated. Results There were 231,694 rabies treatments, with prevalence coefficients increasing from 2007 to 2011 (35.09 per 10,000 inhabitants, APC = 13.5, p <0.001) and apex in 2015 (40.35 per 10,000 inhabitants, APC = 5, 5, p = 0.005). There was an increase in the age group of 20 to 59 years old (APC = 14.0, p <0.001), and urban residents (APC = 7.0, p <0.001). The canine species showed an increasing trend from 2007 to 2011 (APC = 14.3, p <0.001). Of the notifications, 95.8% presented inadequate behaviors, with an increase in the prevalence coefficients from 2007 to 2011 (APC = 13.6, p <0.001). Conclusion Inadequate prophylactic behaviors occurred more than 2007 to 2011. The temporal analysis, with an increasing trend in the analyzed period, should be used as a continuous component of the rabies surveillance actions in Ceará, for adequate and safe assistance to the patients who are victims of animal aggression.

Raiva humana: avaliação da prevalência das condutas profiláticas pós-exposição no Ceará, Brasil, 2007-2015 / La rabia humana: evaluación de la prevalencia de las conductas profilácticas post-exposición en Ceará, Brasil, 2007-2015 / Human rabies: evaluation of post-exposure prophylaxis prevalence in Ceará, Brazil, 2007-2015

Objetivo: analisar a prevalência da profilaxia antirrábica humana pós-exposição inadequada em pacientes vítimas de agressão por animal no Ceará, Brasil, 2007 a 2015. Métodos: estudo de prevalência de condutas profiláticas inadequadas, com dados das notificações dos acidentes por animais potencialmente transmissores da raiva registrados no Sistema de Informação de Agravos de Notificação (Sinan), de janeiro de 2007 a dezembro de 2015. Resultados: de 231.694 notificações, 95,8% apresentaram inadequações, principalmente em menores de 19 anos (37,6%), sem diferença entre os sexos (p=0,04); maiores prevalências de condutas inadequadas aconteceram na exposição por mordedura (RP=1,03 - IC95% 1,02;1,03), nos ferimentos múltiplos (RP=1,07 - IC95% 1,06;1,07), nos acidentes com animais mortos/desaparecidos (RP=1,05 - IC95% 1,05;1,06) e nos tratamentos com vacinas (RP=1,03 - IC95% 1,02;1,03). Conclusão: a alta prevalência de condutas inadequadas aponta a necessidade de melhor avaliação epidemiológica dos casos e o atendimento às Normas Técnicas de Profilaxia da Raiva Humana, para a condução adequada da profilaxia antirrábica.

Objetivo: analizar la prevalencia de la profilaxis antirrábica humana post-exposición inadecuada en pacientes víctimas de agresión por animal en Ceará, Brasil, 2007 a 2015. Métodos: estudio de prevalencia de conductas profilácticas inadecuadas, con datos de notificaciones de los accidentes por animales potencialmente transmisores de la rabia registrados en el Sistema de Información de Agravamientos de Notificación (Sinan), 2007 a 2015. Resultados: de 231.694 notificaciones, el 95,8% presentó inadecuaciones, principalmente en menores de 19 años (37,6%), sin diferencia entre sexos (p=0,04); la prevalencia de conductas inadecuadas ocurrió en la exposición por mordedura (RP=1,03 - IC95% 1,02;1,03), en lesiones múltiples (RP=1,07 - IC95% 1,06;1,07), en animales muertos/desaparecidos (RP=1,05 - IC95% 1,05;1,06) y en tratamientos con vacunas (RP=1,03 - IC95% 1,02;1,03). Conclusión: la importante prevalencia de conductas inadecuadas apunta a la necesidad de una mejor evaluación epidemiológica de los casos y atención a las Normas Técnicas de Profilaxis de la Rabia Humana, para la conducción adecuada de la profilaxis antirrábica.

Objective: to analyze the prevalence of inadequate human anti-rabies post-exposure prophylaxis in patients attacked by animals in the state of Ceará, Brazil, 2007-2015. Methods: this was a study of the prevalence of inadequate prophylaxis procedures, using data on reported cases of accidents involving animals potentially capable of transmitting rabies registered on the Notifiable Diseases Information System (SINAN) from January 2007 to December 2015. Results: of the 231,694 reported cases, 95.8% were found to have inadequate procedures, especially in young people aged under 19 (37.6%), with no difference between the sexes (p=0.04); higher prevalence rate of inadequate procedures occurred with regard to exposure to bites (PR=1.03 - 95%CI 1.02;1.03), multiple injuries (PR=1.07 - 95%CI 1.06;1.07), accidents involving dead/missing animals (RP=1.05 - 95%CI 1.05;1.06), and vaccine treatments (RP=1.03 - 95%CI 1.02;1.03). Conclusion: high prevalence of inadequate procedures indicates the need for a better epidemiological evaluation of cases and compliance with the Human Rabies Prophylaxis Technical Standards, in order to ensure adequate anti-rabies prophylaxis procedures.