American visceral leishmaniasis: disease control strategies in Dracena microregion in Alta Paulista, SP, Brazil

Despite measures adopted to control American visceral leishmaniasis (AVL), the disease is spreading in a fast and worrying way throughout western São Paulo state. The aim of this work was to study the variables involved in the disease cycle as well as the effectiveness of controlling measures. The study was carried out in the microregion of Dracena, which is composed of twelve cities and belongs to Alta Paulista, a region of western São Paulo. The necessary data were provided by the Superintendence for Endemic Disease Control and Adolfo Lutz Institute, Regional Laboratory of Presidente Prudente. From August 2005 to January 2008, the following factors were observed: detection of phlebotomine sandflies in the cities and periods in which dogs or humans were diagnosed; number of human deaths; prevalence of suspected dogs tested by serology; percentage of euthanasia in suspected dogs; a possible correlation between positive dogs and cases of the disease in humans; and the disease prevalence among municipalities from the studied region. It was verified that, despite the strategies adopted in Dracena microregion to control AVL, the disease continues to rise. Thus, some procedures of the AVL Monitoring and Control Program should be reviewed, to grant the initiative more credibility and effectiveness.

[Use of spatial analysis tools in the epidemiological surveillance of American visceral leishmaniasis, Araçatuba, São Paulo, Brazil, 1998-1999]. / Utilização de ferramentas de análise espacial na vigilância epidemiológica de leishmaniose visceral americana - Araçatuba, São Paulo, Brasil, 1998-1999.

The control of American visceral leishmaniasis (AVL) is based on combating the vector and eliminating the domestic reservoir of the focus area - defined as 200 meters around human or canine cases. This paper discusses the use of spatial analysis techniques in the epidemiological surveillance of AVL in Araçatuba, São Paulo State, in order to propose a model for territorial epidemiological surveillance, reformulating current control strategies. The results showed that AVL transmission was not homogeneous; human cases were more frequent in areas with higher canine prevalence rates. Vector dispersion appeared to be restricted to a few houses, although it was not possible to model the vector density. In order to study the vector distribution and correlated covariates, a field study based on house sampling is being conducted. The results will aid the development of new spatial analysis tools and possibly redefine protocols and routines for the control of this endemic disease in urban areas.

[Strategy and perspectives for the control of cutaneous leishmaniasis in the state of São Paulo]. / Estratégia e perspectivas de controle da leishmaniose tegumentar no estado de São Paulo.

The multiplicity of factors involved in the transmission of American cutaneous leishmaniasis (ACL) make it difficult to formulate an efficient strategy for the control of the disease. On the basis of the number of notified cases per location, the State of São Paulo determines the application of DDT in houses in those areas where two or more human cases have occurred. This procedure, however, impairs part of the program because 40% of the counties report only one human case each. These and other factors are analyzed in the light of the increase in the incidence of the disease in the State, its advance in the extra-forest environment and the delay in the decision-making process about the efficacy of the program. It is recommended that the control strategy be reviewed.

Estratégia e perspectivas de controle da leishmaniose tegumentar no estado de São Paulo / Strategy and perspectives for the control of cutaneous leishmaniasis in the state of São Paulo

The multiplicity of factors involved in the transmission of American cutaneous leishmaniasis (ACL) make it difficult to formulate an efficient strategy for the control of the disease. On the basis of the number of notified cases per location, the State of São Paulo determines the application of DDT in houses in those areas where two or more human cases have occurred. This procedure, however, impairs part of the program because 40% of the counties report only one human case each. These and other factors are analyzed in the light of the increase in the incidence of the disease in the State, its advance in the extra-forest environment and the delay in the decision-making process about the efficacy of the program. It is recommended that the control strategy be reviewed.

A multiplicidade de fatores que envolve a transmissão da leishmaniose tegumentar americana resulta em dificuldades para se formular estratégia eficiente de controle da doença. O Estado de São Paulo, considerando o número de casos notificados por localidade, estabelece aplicação de DDT em área com ocorrência de dois ou mais casos. Com isto, parte do programa fica afetado, pois em 40% dos municípios tem-se registrado apenas um caso humano. Esses e outros fatores são analisados diante de um crescimento de distribuição da incidência no Estado e da evolução da doença em ambiente extraflorestal. Procedimentos administrativos com retardamento na tomada de decisão afetam a eficácia do programa. Daí, a necessidade de uma revisão na estratégia.

IgM antibodies to Schistosoma mansoni gut-associated antigens for the study of schistosomiasis transmission in Ribeirão Pires, São Paulo.

The potential of an immunofluorescence test for detection of IgM antibodies against Schistosoma mansoni gut-associated antigens (IgM-IFT) was evaluated as a tool for studying aspects related to the schistosomiasis transmission in Ribeirão Pires, in the metropolitan area of the capital of the State of São Paulo, Brazil. Children from a school with about 400 students, 6 to 18 years, were followed-up for two years. In the five surveys, carried out at 6-month intervals, from October 92 to October 94, serological (IgM-IFT) prevalence indices of 5.3%, 5.8%, 6.2%, 2.9% and 3.3% were obtained. These indices were 7 to 10 times higher than the parasitological prevalence indices of 0.5%, 0.5%, 0.7%, 0.4% and 0% determined by the Kato-Katz method. Seroconversion from IFT negative to positive was indicating possible newly acquired S. mansoni infection in three children. But confirmation of infection by fecal examination was possible in only one child. The IgM-IFT can constitute a valuable tool for the improvement of the vigilance program in low endemic areas for schistosomiasis, better characterizing the S. mansoni transmission in such areas.

Avaliaçäo da resposta do Plasmodium falciparum à cloroquina, quinino e mefloquina / Evaluation of Plasmodium falciparum response to chloroquine, quinine and mefloquine

Nosso estudo envolveu a análise de cepas de Plasmodium falciparum provenientes da Regiäo Amazônica Brasileira, coletadas no Laboratório de Malária da SUCEN. Os estudos "in vitro" foram efetuados com a cloroquina (46 ensaios), quinino (42 ensaios) e mefloquina (51 ensaios). Os resultados mostraram resistência de 100% en relaçäo à cloroquina, 2,4% ao quinino e 31,4% à mefloquina, na análise "in vitro". Sete pacientes foram tratados com quinino isolado e nove com a associaçäo mefloquina + pirimetamina-sulfadoxina, näo mostrando correlaçäo com os testes "in vitro"