Background:Cutaneous leishmaniasis(CL)is a vector-borne disease classified by the World Health Organization as one ofthe most neglected tropical diseases.Brazil has the highest incidence of CL in America and is one of...Background:Cutaneous leishmaniasis(CL)is a vector-borne disease classified by the World Health Organization as one ofthe most neglected tropical diseases.Brazil has the highest incidence of CL in America and is one of the ten countries in the world with the highest number of cases.Understanding the spatiotemporal dynamics of CL is essential to provide guidelines for public health policies in Brazil.In the present study we used a spatial and temporal statistical approach to evaluate the dynamics ofCL in Brazil.Methods:We used data of cutaneous leishmaniasis cases provided by the Ministry of Health of Brazil from 2001 to 2017.We calculated incidence rates and used the Mann-Kendall trend test to evaluate the temporal trend of CL in each municipality.In addition,we used Kuldorff scan method to identify spatiotemporal clusters and emerging hotspots test to evaluate hotspot areas and their temporal trends.Results:We found a general decrease in the number of CL cases in Brazil(from 15.3 to 8.4 cases per 100000 habitants),although 3.2%of municipalities still have an increasing tendency of CL incidence and 72.5%showed no tendency at all.The scan analysis identified a primary cluster in northern and central regions and 21 secondary clusters located mainly in south and southeast regions.The emerging hotspots analysis detected a high spatial and temporal variability of hotspots inside the main cluster area,diminishing hotspots in eastern Amazon and permanent,emerging,and new hotspots in the states of Amapa and parts of Para,Roraima,Acre and Mato Grosso.The central coast the state of Bahia is one of the most critical areas due to the detection of a cluster of the highest rank in a secondary cluster,and because it is the only area identified as an intensifying hotspot.Conclusions:Using a combination of statistical methods we were able to detect areas of higher incidence of CL and understand how it changed over time.We suggest that these areas,especially those identified as permanent,new,emerging and intensifying hotspots,should be targeted for future research,surveillance,and implementation of vector control measures.展开更多
基金supported by the Coordena Co de Aperfeigoamento de Pessoal de Nivel Superior-Brazil(Finance Code 001 toTPP)Conselho Nacional de Desenvolvimento Cientifico elecnologico-Brazil(Grant Number:311832/2017-2 to RAK)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo-Brazil(contract number:2016/01343-7 to RAK).
文摘Background:Cutaneous leishmaniasis(CL)is a vector-borne disease classified by the World Health Organization as one ofthe most neglected tropical diseases.Brazil has the highest incidence of CL in America and is one of the ten countries in the world with the highest number of cases.Understanding the spatiotemporal dynamics of CL is essential to provide guidelines for public health policies in Brazil.In the present study we used a spatial and temporal statistical approach to evaluate the dynamics ofCL in Brazil.Methods:We used data of cutaneous leishmaniasis cases provided by the Ministry of Health of Brazil from 2001 to 2017.We calculated incidence rates and used the Mann-Kendall trend test to evaluate the temporal trend of CL in each municipality.In addition,we used Kuldorff scan method to identify spatiotemporal clusters and emerging hotspots test to evaluate hotspot areas and their temporal trends.Results:We found a general decrease in the number of CL cases in Brazil(from 15.3 to 8.4 cases per 100000 habitants),although 3.2%of municipalities still have an increasing tendency of CL incidence and 72.5%showed no tendency at all.The scan analysis identified a primary cluster in northern and central regions and 21 secondary clusters located mainly in south and southeast regions.The emerging hotspots analysis detected a high spatial and temporal variability of hotspots inside the main cluster area,diminishing hotspots in eastern Amazon and permanent,emerging,and new hotspots in the states of Amapa and parts of Para,Roraima,Acre and Mato Grosso.The central coast the state of Bahia is one of the most critical areas due to the detection of a cluster of the highest rank in a secondary cluster,and because it is the only area identified as an intensifying hotspot.Conclusions:Using a combination of statistical methods we were able to detect areas of higher incidence of CL and understand how it changed over time.We suggest that these areas,especially those identified as permanent,new,emerging and intensifying hotspots,should be targeted for future research,surveillance,and implementation of vector control measures.
