Use of soil moisture active passive satellite data and WorldClim 2.0 data to predict the potential distribution of visceral leishmaniasis and its vector Lutzomyia longipalpis in Sao Paulo and Bahia states, Brazil.

Visceral leishmaniasis (VL) is a neglected tropical disease transmitted by Lutzomyia longipalpis, a sand fly widely distributed in Brazil. Despite efforts to strengthen national control programs reduction in incidence and geographical distribution of VL in Brazil has not yet been successful; VL is in fact expanding its range in newly urbanized areas. Ecological niche models (ENM) for use in surveillance and response systems may enable more effective operational VL control by mapping risk areas and elucidation of eco-epidemiologic risk factors. ENMs for VL and Lu. longipalpis were generated using monthly WorldClim 2.0 data (30-year climate normal, 1-km spatial resolution) and monthly soil moisture active passive (SMAP) satellite L4 soil moisture data. SMAP L4 Global 3-hourly 9-km EASE-Grid Surface and Root Zone Soil Moisture Geophysical Data V004 were obtained for the first image of day 1 and day 15 (0:00-3:00 hour) of each month. ENM were developed using MaxEnt software to generate risk maps based on an algorithm for maximum entropy. The jack-knife procedure was used to identify the contribution of each variable to model performance. The three most meaningful components were used to generate ENM distribution maps by ArcGIS 10.6. Similar patterns of VL and vector distribution were observed using SMAP as compared to WorldClim 2.0 models based on temperature and precipitation data or water budget. Results indicate that direct Earth-observing satellite measurement of soil moisture by SMAP can be used in lieu of models calculated from classical temperature and precipitation climate station data to assess VL risk.

The path of canine visceral leishmaniasis versus the path of Center for Zoonoses Control: contributions of spatial analysis to health.

Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city's outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies.

The path of canine visceral leishmaniasis versus the path of Center for Zoonoses Control: contributions of spatial analysis to health / O caminho da leishmaniose visceral canina versus o caminho do Centro de Controle de Zoonoses: contribuições da análise espacial para a saúde / La trayectoria de la leishmaniasis visceral canina versus la trayectoria del Centro para el Control de Zoonoses: contribuciones del análisis espacial a la salud

Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city's outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies.

A leishmaniose visceral (LV) é um problema de saúde pública nas cidades brasileiras. Por mais que haja um planejamento de políticas públicas para LV no Estado de São Paulo, Brasil, novos casos têm sido notificados e se disseminado. O artigo objetiva discutir como o Centro de Controle de Zoonoses realiza suas atividades espacialmente em uma cidade endêmica, Presidente Prudente, no Estado de São Paulo. Os dados são da Secretaria Municipal de Saúde de Presidente Prudente, Instituto Adolfo Lutz e Instituto Brasileiro de Geografia e Estatística. Estimamos espacialmente a população canina por setor censitário e utilizamos ferramentas de geoprocessamento para produzir mapas coropléticos, tendências espaciais e autocorrelação espacial. Encontramos um padrão espacial de maior prevalência na periferia da cidade e uma autocorrelação espacial positiva estatisticamente significativa (I = 0,2; p < 0,000) com clusters de relação alta-alta no noroeste da cidade. Além disso, identificamos uma direção diferente no caminho dos inquéritos sorológicos realizados versus a tendência na LV canina, o que enfatiza a fragilidade das medidas de controle do Centro de Controle de Zoonoses para controlar casos da doença. O Centro de Controle de Zoonoses parece estar sempre correndo atrás da doença. A análise espacial pode ser útil para repensar o funcionamento do serviço e auxiliar as políticas públicas.

La leishmaniasis visceral (LV) es un problema de salud pública en las ciudades brasileñas. Aunque hay políticas públicas de planificación relacionadas con la LV en el estado de São Paulo, Brasil, se han informado de nuevos casos, además de su propagación. El objetivo de este trabajo es discutir cómo el Centro de Control de Zoonosis dirige sus acciones espacialmente en una ciudad endémica del estado de São Paulo, Presidente Prudente. Los datos proceden de la Secretaría Municipal de Salud de Presidente Prudente, del Instituto Adolfo Lutz, y del Instituto Brasileño de Geografía y Estadística. Estimamos espacialmente la población de perros por sector censal y utilizamos herramientas de geoprocesamiento para elaborar mapas de coropletas, tendencias espaciales, y autocorrelación espacial. Encontramos un patrón espacial de más alta prevalencia en la periferia de la ciudad, además de una autocorrelación espacial positiva y estadísticamente significativa (I = 0,2; valor de p < 0,000) con clústeres de relaciones alto-alto en la parte noroccidental de la ciudad. Además, identificamos una dirección diferente en la trayectoria de las encuestas serológicas llevadas a cabo, frente a la tendencia de LV canina, que enfatiza la debilidad de acciones del Centro de Control de Zoonosis para controlar casos de la enfermedad. El Centro de Control de Zoonosis parece siempre estar tras la enfermedad. El análisis espacial podría ser útil para repensar cómo está funcionando el servicio, además de ayudar a políticas públicas.

Impact of the dog population and household environment for the maintenance of natural foci of Leishmania infantum transmission to human and animal hosts in endemic areas for visceral leishmaniasis in Sao Paulo state, Brazil.

When it comes to visceral leishmaniasis (VL) in Brazil, one of the main targets of public health policies of surveillance is the control of domestic canine reservoirs of Leishmania infantum. This paper aims to evaluate the effect of the dog population and household environment for the maintenance of natural foci in the transmission to human and animal hosts in an endemic city for VL, Bauru, in Brazil. We collected 6,578 blood samples of dogs living in 3,916 households from Nov.2019 to Mar.2020 and applied geospatial models to predict the disease risk based on the canine population. We used Kernel density estimation, cluster analysis, geostatistics, and Generalized Additive Models (GAM). To validate our models, we used cross-validation and created a receiver operating characteristic (ROC) curve. We found an overall canine VL (CVL) seroprevalence of 5.6% for the sampled dogs, while for the households, the positivity rate was 8.7%. Odds ratios (OR) for CVL increased progressively according to the number of canines for >2 dogs (OR 2.70); households that already had CVL in the past increased the chances for CVL currently (OR 2.73); and the cases of CVL increase the chances for human VL cases (OR 1.16). Our models were statistically significant and demonstrated a spatial association between canine and human disease cases, mainly in VL foci that remain endemic. Although the Kernel density ratio map had the best performance (AUC = 82), all the models showed high risk in the city's northwest area. Canine population dynamics must be considered in public policies, and geospatial methods may help target priority areas and planning VL surveillance in low and middle-income countries.

Seasonality and weather dependance of Acinetobacter baumannii complex bloodstream infections in different climates in Brazil.

Recent studies report seasonality in healthcare-associated infections, especially those caused by Acinetobacter baumannii complex. We conducted an ecologic study aimed at analyzing the impact of seasons, weather parameters and climate control on the incidence and carbapenem-resistance in A. baumannii complex bloodstream infections (ABBSI) in hospitals from regions with different climates in Brazil. We studied monthly incidence rates (years 2006-2015) of ABBSI from hospitals in cities from different macro-regions in Brazil: Fortaleza (Ceará State, Northeast region), Goiânia (Goiás State, Middle-west) and Botucatu (São Paulo State, Southeast). Box-Jenkins models were fitted to assess seasonality, and the impact of weather parameters was analyzed in Poisson Regression models. Separate analyses were performed for carbapenem-resistant versus carbapenem-susceptible isolates, as well as for infections occurring in climate-controlled intensive care units (ICUs) versus non-climate-controlled wards. Seasonality was identified for ABSSI ICUs in the Hospitals from Botucatu and Goiânia. In the Botucatu hospital, where there was overall seasonality for both resistance groups, as well as for wards without climate control. In that hospital, the overall incidence was associated with higher temperature (incidence rate ratio for each Celsius degree, 1.05; 95% Confidence Interval, 1.01-1.09; P = 0.006). Weather parameters were not associated with ABBSI in the hospitals from Goiânia and Fortaleza. In conclusion, seasonality was found in the hospitals with higher ABBSI incidence and located in regions with greater thermal amplitude. Strict temperature control may be a tool for prevention of A. baumanii infections in healthcare settings.

Predicted distribution of sand fly (Diptera: Psychodidae) species involved in the transmission of Leishmaniasis in São Paulo state, Brazil, utilizing maximum entropy ecological niche modeling.

Leishmaniasis is a public health problem worldwide. We aimed to predict ecological niche models (ENMs) for visceral (VL) and cutaneous (CL) leishmaniasis and the sand flies involved in the transmission of leishmaniasis in São Paulo, Brazil. Phlebotomine sand flies were collected between 1985 and 2015. ENMs were created for each sand fly species using Maximum Entropy Species Distribution Modeling software, and 20 climatic variables were determined. Nyssomyia intermedia (Lutz & Neiva, 1912) and Lutzomyia longipalpis (Lutz & Neiva, 1912), the primary vectors involved in CL and VL, displayed the highest suitability across the various regions, climates, and topographies. L. longipalpis was found in the border of Paraná an area currently free of VL. The variables with the greatest impact were temperature seasonality, precipitation, and altitude. Co-presence of multiple sand fly species was observed in the cuestas and coastal areas along the border of Paraná and in the western basalt areas along the border of Mato Grosso do Sul. Human CL and VL were found in 475 of 546 (86.7%) and 106 of 645 (16.4%) of municipalities, respectively. Niche overlap between N. intermedia and L. longipalpis was found with 9208 human cases of CL and 2952 cases of VL. ENMs demonstrated that each phlebotomine sand fly species has a unique geographic distribution pattern, and the occurrence of the primary vectors of CL and VL overlapped. These data can be used by public authorities to monitor the dispersion and expansion of CL and VL vectors in São Paulo state.

The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil.

Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.

Pandemia de covid-19: uma análise geopolítica / Covid-19 pandemic: a geopolitical analysis

Resumo A partir de uma reelaboração crítica das categorias analíticas gramscianas de guerra de posição e de guerra de movimento, em uma perspectiva interescalar, analisam-se as diversas estruturas de poder e como elas se posicionam diante da crise mundial e busca de hegemonia. Tais perspectivas apontam a crise sanitária como uma questão geopolítica e evidenciam as estratégias de instâncias supraestatais (como a Organização Mundial do Comércio, a Organização Mundial da Saúde e a Organização Internacional do Trabalho), de Estados e de grupos econômicos setoriais que expressam as relações de poder, assim como as determinações territoriais que se desenvolvem sobre uma fragmentada sociedade civil, particularmente as camadas mais vulneráveis (povos originários, camponeses e comunidades negras), tendo como centralidade a produção da forma de valor.

Abstract From a critical re-elaboration of the Gramsci's analytical categories of war of position and war of movement, in an inter-scale perspective, the different power structures and how they position themselves in the face of the global health crisis in search of hegemony are analyzed. Such perspectives point to the covid-19 pandemic as a geopolitical issue and highlight how the strategies of supra-state bodies (WTO, WHO, ILO), States and sectoral economic groups materialize as territorial determinations developed over a fragmented civil society, particularly in the most vulnerable strata (indigenous peoples, peasants and black communities). These territorial determinations express a set of power relations for the realization of the form of value.

Two hundred days of COVID-19 in São Paulo State, Brazil.

Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analysed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission.

Increasing molecular diagnostic capacity and COVID-19 incidence in Brazil.

Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo.

Avaliação da efetividade do uso de coleiras impregnadas com deltametrina no controle da leishmaniose visceral no município de Votuporanga, Estado de São Paulo, Brasil, 2014 ­ 2016 / Evaluation of the effectiveness of using deltamethrinimpregnated collars to control visceral leishmaniasis in the municipality of Votuporanga, State of São Paulo, Brazil, 2014 ­ 2016

O objetivo deste artigo é apresentar os principais resultados do Projeto de Inovação Tecnológica em Saúde realizado entre 2014 e 2015, destacando-se o uso de coleiras impregnadas com deltametrina a 4% em cães em uma região endêmica para leishmaniose visceral (LV), o município de Votuporanga, São Paulo, Brasil. Neste município, anterior à realização do projeto, eram registrados muitos casos caninos e humanos da doença, com elevada taxa de letalidade. Durante o projeto, foram monitorados cerca de 16,5 mil cães, examinadas 25.700 amostras de sangue, considerando-se as perdas e as entradas de novos animais durante os quatro inquéritos sorológicos. Após sua finalização, verificou-se uma diminuição da prevalência e incidência de LV canina, assim como do número de casos humanos. A diminuição dos casos caninos foi correlacionada positivamente aos casos humanos no período de 2011 a 2016 (Correlação de Pearson de 0.914, p-valor<0.05). Além disso, a análise espacial dos resultados corrobora a diminuição ou desaparecimento da concentração de casos caninos e, consequentemente, de fontes e de infecção nas áreas endêmicas à medida que avançaram no tempo e espaço as diferentes etapas de desenvolvimento do projeto. Apesar da drástica redução na incidência da LV canina, ainda permaneceram algumas áreas críticas. Os resultados delineados sugerem a revisão de protocolos e manuais demonstrando a efetividade do uso das coleiras como medida preventiva e potencial no controle da LV. (AU)

This paper aims to present the main results of the Health Technology Innovation Project carried out between 2014 and 2015, which evaluates the use of 4% deltamethrin-impregnated collars in dogs, in an endemic region for visceral leishmaniasis (VL), the municipality of Votuporanga, São Paulo, Brazil. Before this project, Votuporanga had notified canine and human cases of the disease, with a high case fatality rate. We monitored approximately 16.5 thousand dogs, 25,700 blood samples analyzed, considering losses and entrances of new animals during the four serological surveys. After the project, the prevalence and incidence of canine VL decreased as well as the number of human cases. We found a positive correlation between the decrease of infected dogs and human cases from 2011 to 2016 (Pearson correlation of 0.914, p-value <0.05). Furthermore, the spatial analysis of the results indicated areas with canine cases concentration that decreased its intensity or disappeared concomitantly to the project levels in the space-time. Despite the drastic reduction in the incidence of canine VL, some critical areas remain. The current results suggest the review of protocols and manuals demonstrating the effectiveness of the use of collars as a preventive measure and potential in the control of VL. (AU)

Geospatial and modeling tools for leishmaniasis studies: a review of publication between 2008-2018

Aspects of how geospatial technologies can be used on visceral leishmaniasis (VL) control programs are discussed. We reviewed a number of papers discussing the usage of those technologies, through a PubMed literature review. Additionally, we provided conceptual elements for a development of a hierarchical scale framework on VL for decision making in São Paulo State, using Geographical Information Systems. Supported by Geospatial Techniques, we developed a view of some instruments for helping communities to better manage their risk areas. We used a classification called Strengths of GIS and Spatial Analysis in Epidemiology (SGISSAE). This review identified 50 papers published in the PubMed. With respect to developing the theoretical perspective, this paper can help to identify points of deficiency in shortage in discussions and leishmaniasis control programs, which led us to recommend future to delimitation studies to at community-based level and to define local actions to identify and manage the disease. In the conceptual framework data at community-based level will allow us to understand more broadly the changing spatial distribution of the disease.(AU)

Aspectos sobre como as tecnologias geoespaciais podem ser usadas nos programas de controle da leishmaniose visceral (LV) são discutidos. Nós confrontamos uma série de artigos discutindo o uso dessas tecnologias, através de uma revisão da literatura no PudMed. Adicionalmente, fornecemos elementos conceituais para o desenvolvimento de uma estrutura hierárquica sobre a escala na tomada de decisão sobre a leishmaniose no Estado de São Paulo, utilizando Sistemas de Informação Geográfica. Com o apoio das técnicas geoespaciais, desenvolvemos alguns instrumentos para ajudar as comunidades a gerenciar melhor suas áreas de risco. Usamos uma classificação chamada Forças do SIG e da análise espacial em Epidemiologia (SGISSAE). A revisão nos permitiu selecionar 50 artigos publicados no PubMed. Com relação ao desenvolvimento da perspectiva teórica, este artigo pode ajudar a identificar pontos de deficiência em discussões e programas de controle da leishmaniose, o que nos levou a recomendar futuros estudos de delimitação a nível comunitário e a definir ações locais para identificar e gerenciar a doença. No quadro conceptual, os dados ao nível da comunidade permitirão compreender mais amplamente a evolução da distribuição espacial da doença. (AU)

Geohealth: biology based mapping of vector borne disease in the Americas using NASA satellite data / Geosaúde: mapeamento da biologia das doenças vetoriais nas Américas utilizando dados de satélites da NASA

Implementation of a geospatial surveillance and response system data resource for vector borne disease in the Americas (GeoHealth) will be tested using NASA satellite data, geographic information systems and ecological niche modeling to characterize the environmental suitability and potential for spread of endemic and epizootic vector borne diseases. The initial focus is on developing prototype geospatial models for visceral leishmaniasis, an expanding endemic disease in Latin America, and geospatial models for dengue and other Aedes aegypti borne arboviruses (zika, chikungunya), emerging arboviruses with potential for epizootic spread from Latin America and the Caribbean and establishment in North America. Geospatial surveillance and response system open resource data bases and models will be made available, with training courses, to other investigators interested in mapping and modeling other vector borne diseases in the western hemisphere and contributing brokered data to an expanding GeoHealth data resource as part of the NASA AmeriGEOSS initiative.(AU)

A implementação de uma fonte de dados de vigilância e um sistema de resposta geoespacial para doenças transmitidas por vetores nas Américas (GeoHealth) será testada utilizando dados provenientes de satélites da NASA, sistemas de informações geográficas e modelagem do nicho ecológico, para caracterizar a suceptibilidade ambiental e o potencial de dispersão de doenças endêmicas e epizooticas transmitidas por vetores vetores. O foco inicial será o desenvolvimento de protótipos de modelos geoespaciais para a leishmaniose visceral, uma doença endêmica e em expansão na América Latina, e modelos geoespaciais para dengue e outros transmitidos pelo Aedes aegypti (zika, chikungunya), arbovírus emergentes com potencial para disseminação epizoótica pela América Latina e Caribe e estabelecimento na América do Norte. Sistemas de vigilância e resposta geoespacial e modelos de recursos em bases de dados abertas serão diponibilizados, com cursos de treinamento, para outros pesquisadores interessados em mapear e modelar outras doenças transmitidas por vetores no hemisfério ocidental e contribuir intermediando dados para uma fonte de dados GeoHealth em expansão, como parte da Iniciativa AmeriGEOSS, da NASA. (AU)

Geospatial and modeling tools for leishmaniasis studies: a review of publication between 2008-2018 / Ferramentas geoespaciais e de modelagem para estudos de leishmaniose: uma revisão de publicação entre 2008-2018

Aspects of how geospatial technologies can be used on visceral leishmaniasis (VL) control programs are discussed. We reviewed a number of papers discussing the usage of those technologies, through a PubMed literature review. Additionally, we provided conceptual elements for a development of a hierarchical scale framework on VL for decision making in São Paulo State, using Geographical Information Systems. Supported by Geospatial Techniques, we developed a view of some instruments for helping communities to better manage their risk areas. We used a classification called Strengths of GIS and Spatial Analysis in Epidemiology (SGISSAE). This review identified 50 papers published in the PubMed. With respect to developing the theoretical perspective, this paper can help to identify points of deficiency in shortage in discussions and leishmaniasis control programs, which led us to recommend future to delimitation studies to at community-based level and to define local actions to identify and manage the disease. In the conceptual framework data at community-based level will allow us to understand more broadly the changing spatial distribution of the disease.

Aspectos sobre como as tecnologias geoespaciais podem ser usadas nos programas de controle da leishmaniose visceral (LV) são discutidos. Nós confrontamos uma série de artigos discutindo o uso dessas tecnologias, através de uma revisão da literatura no PudMed. Adicionalmente, fornecemos elementos conceituais para o desenvolvimento de uma estrutura hierárquica sobre a escala na tomada de decisão sobre a leishmaniose no Estado de São Paulo, utilizando Sistemas de Informação Geográfica. Com o apoio das técnicas geoespaciais, desenvolvemos alguns instrumentos para ajudar as comunidades a gerenciar melhor suas áreas de risco. Usamos uma classificação chamada Forças do SIG e da análise espacial em Epidemiologia (SGISSAE). A revisão nos permitiu selecionar 50 artigos publicados no PubMed. Com relação ao desenvolvimento da perspectiva teórica, este artigo pode ajudar a identificar pontos de deficiência em discussões e programas de controle da leishmaniose, o que nos levou a recomendar futuros estudos de delimitação a nível comunitário e a definir ações locais para identificar e gerenciar a doença. No quadro conceptual, os dados ao nível da comunidade permitirão compreender mais amplamente a evolução da distribuição espacial da doença.

Avaliação da efetividade do uso de coleiras impregnadas com deltametrina no controle da leishmaniose visceral no município de Votuporanga, Estado de São Paulo, Brasil, 2014 – 2016 / Evaluation of the effectiveness of using deltamethrinimpregnated collars to control visceral leishmaniasis in the municipality of Votuporanga, State of São Paulo, Brazil, 2014 – 2016

O objetivo deste artigo é apresentar os principais resultados do Projeto de Inovação Tecnológica em Saúde realizado entre 2014 e 2015, destacando-se o uso de coleiras impregnadas com deltametrina a 4% em cães em uma região endêmica para leishmaniose visceral (LV), o município de Votuporanga, São Paulo, Brasil. Neste município, anterior à realização do projeto, eram registrados muitos casos caninos e humanos da doença, com elevada taxa de letalidade. Durante o projeto, foram monitorados cerca de 16,5 mil cães, examinadas 25.700 amostras de sangue, considerando-se as perdas e as entradas de novos animais durante os quatro inquéritos sorológicos. Após sua finalização, verificou-se uma diminuição da prevalência e incidência de LV canina, assim como do número de casos humanos. A diminuição dos casos caninos foi correlacionada positivamente aos casos humanos no período de 2011 a 2016 (Correlação de Pearson de 0.914, p-valor<0.05). Além disso, a análise espacial dos resultados corrobora a diminuição ou desaparecimento da concentração de casos caninos e, consequentemente, de fontes e de infecção nas áreas endêmicas à medida que avançaram no tempo e espaço as diferentes etapas de desenvolvimento do projeto. Apesar da drástica redução na incidência da LV canina, ainda permaneceram algumas áreas críticas. Os resultados delineados sugerem a revisão de protocolos e manuais demonstrando a efetividade do uso das coleiras como medida preventiva e potencial no controle da LV.

This paper aims to present the main results of the Health Technology Innovation Project carried out between 2014 and 2015, which evaluates the use of 4% deltamethrin-impregnated collars in dogs, in an endemic region for visceral leishmaniasis (VL), the municipality of Votuporanga, São Paulo, Brazil. Before this project, Votuporanga had notified canine and human cases of the disease, with a high case fatality rate. We monitored approximately 16.5 thousand dogs, 25,700 blood samples analyzed, considering losses and entrances of new animals during the four serological surveys. After the project, the prevalence and incidence of canine VL decreased as well as the number of human cases. We found a positive correlation between the decrease of infected dogs and human cases from 2011 to 2016 (Pearson correlation of 0.914, p-value <0.05). Furthermore, the spatial analysis of the results indicated areas with canine cases concentration that decreased its intensity or disappeared concomitantly to the project levels in the space-time. Despite the drastic reduction in the incidence of canine VL, some critical areas remain. The current results suggest the review of protocols and manuals demonstrating the effectiveness of the use of collars as a preventive measure and potential in the control of VL.

Geografia e saúde coletiva no Brasil / Geography and public health in Brazil

Resumo Este artigo faz uma reflexão a respeito da importância da geografia para a pesquisa em saúde coletiva no Brasil. Por meio de uma revisão bibliográfica narrativa, o autor descreve os principais temas abordados, agrupando os artigos selecionados de três das principais revistas brasileiras da área - Revista de Saúde Pública, Cadernos de Saúde Pública e Saúde e Sociedade - por escolas do pensamento geográfico. Discute também os avanços alcançados, assim como os desafios teóricos e metodológicos da saúde coletiva com base nos conhecimentos geográficos. Observou-se a importância do geoprocessamento em saúde para estudos de distribuição espacial, principalmente de doenças infectocontagiosas e parasitárias. Da mesma forma, foi possível identificar o crescimento da produção científica em estudos com base no pensamento crítico, com destaque para as publicações recentes na revista Saúde e Sociedade. A comparação dos trabalhos publicados também proporcionou a identificação de desafios metodológicos a serem enfrentados para o estudo da saúde coletiva com embasamento ainda maior de conhecimentos geográficos, como o uso de modelos preditivos e análise de superfícies de tendências, assim como o desenvolvimento de novas ferramentas cartográficas para a compreensão da realidade social em transformação e movimento.

Abstract This article analyzes the importance of Geography for research in Public Health in Brazil. Through a bibliographical narrative review, the author describes the key topics addressed, grouping the selected articles of the most important Brazilian journals in Public Health - Revista de Saúde Pública, Cadernos de Saúde Pública e Saúde e Sociedade - by geographical approaches. It also discusses the progress achieved, as well as the theoretical and methodological challenges of Public Health based on geographical knowledge. The importance of health geoprocessing for spatial distribution studies was observed, especially those on infectious and parasitic diseases. Similarly, it was possible to identify the growth of the scientific production in studies based on critical thinking, especially recent publications in Saúde e Sociedade. The comparison of published works also provided the identification of methodological challenges to be faced for the study of Public Health with an even better basis of geographical knowledge, such as the use of predictive models and trend surface analysis, as well as the development of new cartographic tools to understand social reality in transformation and movement.

The shadows of a ghost: a survey of canine leishmaniasis in Presidente Prudente and its spatial dispersion in the western region of São Paulo state, an emerging focus of visceral leishmaniasis in Brazil.

BACKGROUND: Visceral leishmaniasis is an emerging zoonosis and its geographic distribution is restricted to tropical and temperate regions. Most of the individuals infected in Latin America are in Brazil. Despite the control measures that have been adopted, the disease is spreading throughout new regions of the country. Domestic dogs are involved in the transmission cycle and are considered to be the main epidemiologic reservoir of Leishmania infantum (syn. L. chagasi). Our aim was to determine the prevalence of canine leishmaniasis (CL) and Ehrlichiosis infection in Presidente Prudente as well as the spatial dispersion of the disease in the western region of São Paulo state. METHODS: Dogs underwent clinical examination and symptoms related to CL were recorded. Anti- Leishmania antibodies were detected using ELISA, rK39-immunocromatographic tests (DPP), and an indirect fluorescent antibody test (IFAT). Anti-E. canis antibodies were detected by IFAT. A follow-up was conducted in dogs that were positive in the ELISA at the baseline study. Data on the spatial distribution of L. longipalpis and CL in São Paulo state were obtained from Brazilian public health agencies. RESULTS: Serum samples from 4547 dogs were analyzed. The seroprevalence of CL was 11.2% by ELISA and 4.5 % by IFAT. In the follow-up, seroprevalence was 32.9% by ELISA, 15.3% by IFAT, 11.8 % by DPP test, and 66.5% for E. canis. There was a significant positive association between Leishmania and E. canis infection (P < 0.0001). In the follow-up, clinical examinations revealed symptoms compatible with CL in 33.5% of the dogs. L. longipalpis was found in 24 and CL in 15 counties of the Presidente Prudente mesoregion. The dispersion route followed the west frontier of São Paulo state toward Paraná state. CONCLUSIONS: Low CL and high ehrlichiosis prevalence rates were found in Presidente Prudente city. This emerging focus of CL is moving through the western region of São Paulo state toward the border of Paraná state. Integrated actions to fight the vector, parasites, infected dogs, and humans are needed to monitor the disease and implement strategies for epidemiologic control.