Mortality due to visceral leishmaniasis in Brazil by municipalities, 2001-2018: a spatial-temporal analysis of estimates from the Global Burden of Disease study.

OBJECTIVES: In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies. STUDY DESIGN: This was an ecological study that analysed the spatial-temporal patterns of VL mortality in Brazilian municipalities. METHODS: Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial-temporal risks. RESULTS: The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality. CONCLUSION: Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals.

Freqüência de aglutininas anti-Leptospira interrogans em soros sangüíneos de bovinos, em Minas Gerais, de 1980 a 2002 / Frequency of anti-Leptospira interrogans agglutinins in bovine serum samples in Minas Gerais, Brazil, 1980 to 2002

Foram analisados os resultados de exames de microaglutinação rápida, para pesquisa de aglutininas anti-Leptospira interrogans, em 39.012 soros sangüíneos de bovinos provenientes de 398 (47 por cento) municípios de Minas Gerais de 1980 a 2002. As sorovariedades mais freqüentes foram: hardjo (amostra Norma), 23,7 por cento, hardjo (OMS), 19,7 por cento, hardjo (hardjobovis), 13,8 por cento, e wolffi, 13,2 por cento. Os resultados mostraram relevância da hardjo como problema prioritário nas leptospiroses em bovinos em Minas Gerais. A baixa porcentagem de soros reagentes à pomona (2,8 por cento) e a mini (amostra Neguita) (3,0 por cento) indica que essas sorovariedades devem ser consideradas para esclarecer casos clínicos em bovinos quando a hardjo (OMS), hardjo (Norma) e hardjo (hardjobovis) não forem detectadas nos testes sorológicos. As porcentagens de reagentes para as sorovariedades canicola e icterohaemorrhagiae foram inferiores a 1 por cento. A infecção por Leptospira interrogans é endêmica em bovinos em Minas Gerais.