Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study.

BACKGROUND: Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. OBJECTIVE: To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. METHODS: We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. RESULTS: Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. CONCLUSIONS: VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.

Spatial analysis of the prevalence of schistosomiasis in an endemic coastal area in north-eastern Brazil.

Due to contact and misuse of water drainage channels, schistosomiasis has spread and become a constant concern in northeastern Brazil. The aim of this study was to monitor human cases of Schistosomiasis mansoni and the breeding areas of the snail intermediate host Biomphalaria glabrata through spatial analysis in a community named Invasão do Canal do Guaxinim, located in Barra dos Coqueiros City in an endemic coastal part of the state of Sergipe, Brazil. This research was performed as a cross-sectional epidemiological study conducted with parasitological and malacological surveys. To verify the spatial analysis, a two-year spatial point pattern analysis was performed by means of Kernel intensity estimation using TerraView software 4.2.2. A schistosomiasis prevalence reduction from 8.1% (2013) to 4.9% (2014) was observed but mild infection prevailed in adolescents and/or young adults during the two-year study. In malacological research, 387 specimens of snails of the genus B. glabrata were collected and all were negative with regard to schistosomiasis. Spatial analysis showed a strong, spatial trend of increased transmission risk areas north and south of the community, both in 2013 and 2014. In Invasão do Canal do Guaxinim itself, the increased risk was only seen in the northern part. When combined, the human and the malacological spatial analyses constituted an important methodological approach for monitoring and controlling this parasitic disease.

Study of the snail intermediate hosts for Schistosoma mansoni on Itamaracá Island in northeast Brazil: spatial displacement of Biomphalaria glabrata by Biomphalaria straminea.

In 2012 a malacological survey of the breeding sites of Biomphalaria glabrata and B. straminea , the two intermediate host snails of Schistosoma mansoni , was carried out on Itamaraca Island in Pernambuco, Brazil. This study has now been extended by studying the competition between the two species. Snails were collected and dissected to identify the species and tests were performed to verify S. mansoni infection. Student's t test was used to compare the proportion between the two species and their breeding sites and a parasitological survey was conducted among local residents, using the Kato-Katz method. The spatial distribution of the two snail species was determined using TerraView, while a snail density map was constructed by Kernel estimate. The survey identified two breeding sites for B. glabrata with 17 specimens and 19 breeding sites for B. straminea with 459 snails, all of them negative for S. mansoni infection. The statistical analysis revealed that the proportion of the numbers of specimens and breeding sites of B. straminea (37.84 ± 9.01) were significantly greater than those of B. glabrata (8.50 ± 6.50). Parasitological examinations from 41 residents diagnosed two cases of schistosomiasis with parasite loads of 60 and 84 eggs per 1 g of stool, respectively. This indiction of a competitive process between the two snail species requires monitoring of schistosomiasis in the resident and travelling human populations occupying this environment, which could potentially result in social and economic changes on the island risking its attraction as a centre for eco-tourism.