Patterns and drivers of Human Visceral Leishmaniasis in Pernambuco (Brazil) from 2007 to 2018.

Visceral leishmaniasis (VL) is the second most common protozoosis that affects people around the world. The aim of this study is to understand how environmental and socioeconomic factors, as well as VL control and surveillance interventions, influence the spread and detection of VL cases in Pernambuco state (Brazil). A novel model was developed to analyze cases of VL between 2007 and 2018, enabling the quantification of the association of these variables with two processes: the probability of "invasion" (emergence of new cases) at municipalities by VL, and the probability of detecting cases not reported in municipalities that have already been invaded. Pernambuco state identified 1,410 cases of VL between 2007 and 2018, with an average of 128 cases per year and average incidence of 1.28/100 thousand people. These cases were distributed in 77.1% (142/184) of the municipalities, and 54.8% (773/1,410) of them were autochthonous. Our model reveals that the proportion of agriculture was positively associated with VL invasion probability. We also find that municipalities that are closer to notification centers and/or that have received technical training and support tend to have higher detection rates of VL cases. Taken together, these results suggest that a municipality with almost no agriculture and that received technical training, located close to a notification center, is unlikely to be invaded if no cases have ever been detected. On the other hand, a municipality that is far from the notification center, with no technical training, with a large agricultural area might have already been invaded but the surveillance system might have routinely failed to detect VL cases due to low detection probability. By disentangling the processes of invasion and detection, we were able to generate insights that are likely to be useful for the strategic allocation of VL prevention and control interventions.

Epidemiological profile and lethality of visceral leishmaniasis/human immunodeficiency virus co-infection in an endemic area in Northeast Brazil.

INTRODUCTION: The association of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection is a concern worldwide, and this co-infection is linked to increased lethality. The Northeast is the region that mostly reports cases of VL in Brazil. The knowledge of risk factors associated with VL/HIV co-infection and its impact on lethality is extremely important. METHODS: The present study analyzed the epidemiologic features of cases with VL/HIV co-infection in the state of Pernambuco, Northeast of Brazil, from 2014 to 2018. RESULTS: There were 858 and 11,514 reported cases of VL and HIV infection, respectively. The average incidences of VL and HIV infection were 1.82 and 24.4/100,000 inhabitants, respectively. Of all reported cases of VL, 4.9% (42/858) also had HIV infection. There was an inverse spatial association between VL and HIV infection incidences. The lethality rates of VL, HIV infection, and co-infection were 9.9%, 26.1%, and 16.6%, respectively. Most of the patients were males and lived in urban areas. The cases of VL mostly occurred in children aged below 10 years, whereas the cases of HIV infection and VL/HIV co-infection were primarily observed in adults between 20 years and 39 years old. CONCLUSIONS: We defined the profile and areas with most cases of co-infection and found that the lethality of VL with co-infection increased in the current period. These findings contribute to applying efforts with a greater focus in these identified populations to prevent future deaths.

Epidemiological profile and lethality of visceral leishmaniasis/human immunodeficiency virus co-infection in an endemic area in Northeast Brazil

Abstract INTRODUCTION: The association of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection is a concern worldwide, and this co-infection is linked to increased lethality. The Northeast is the region that mostly reports cases of VL in Brazil. The knowledge of risk factors associated with VL/HIV co-infection and its impact on lethality is extremely important. METHODS: The present study analyzed the epidemiologic features of cases with VL/HIV co-infection in the state of Pernambuco, Northeast of Brazil, from 2014 to 2018. RESULTS: There were 858 and 11,514 reported cases of VL and HIV infection, respectively. The average incidences of VL and HIV infection were 1.82 and 24.4/100,000 inhabitants, respectively. Of all reported cases of VL, 4.9% (42/858) also had HIV infection. There was an inverse spatial association between VL and HIV infection incidences. The lethality rates of VL, HIV infection, and co-infection were 9.9%, 26.1%, and 16.6%, respectively. Most of the patients were males and lived in urban areas. The cases of VL mostly occurred in children aged below 10 years, whereas the cases of HIV infection and VL/HIV co-infection were primarily observed in adults between 20 years and 39 years old. CONCLUSIONS: We defined the profile and areas with most cases of co-infection and found that the lethality of VL with co-infection increased in the current period. These findings contribute to applying efforts with a greater focus in these identified populations to prevent future deaths.

Spatial analysis and epidemiological profile of visceral leishmaniasis, northeastern Brazil: A cross-sectional study.

Most visceral leishmaniasis (VL) cases reported in Brazil are from the northeast region, where the disease is strongly linked to poverty. In spite of the still existing inequalities, many social improvements were achieved in the past decades in this region, but the possible impact of these improvements on VL remains poorly investigated. We conducted a cross-sectional study coupled with a spatial analysis of VL cases notified in northeastern Brazil from 2007 to 2017. In total, 21,703 cases were reported during this period, with an annual incidence of 3.6 cases per 100,000 inhabitants. Children under 10 years old and males were more affected, and most cases were from urban areas. Living in municipalities situated in the Cerrado, Amazon or, to a lesser extent, in the Caatinga biomes was a risk factor for VL. This study indicates that the epidemiological profile of VL patients remained unchanged in northeastern Brazil, suggesting that social improvements achieved in this region were not enough to mitigate the risk of this disease among the most affected populations.