Visceral leishmaniasis in Brazil: scenarios and challenges for the surveillance and control

Adaptation of the vector and displacement of infected dogs to previously disease-free areas challenges visceral leishmaniasis (VL) control, and leads to geographic dispersion and occurrence in urban and peri-urban areas. Continuous VL control measures over time must be applied with a wide geographic reach, along with better diagnosis practices and timely treatment. The high case-fatality of human VL in areas of recent introduction and its growing association with HIV impose the need for an early diagnosis, treatment and the adoption of active search for human and canine cases incorporated into the routine of periodic home visits by health professionals. The increasing on public rejection of canine euthanasia as a control measure, the limitations of canine therapy with the current available drugs, and the controversies regarding available vaccines for canine protection are discussed. Good prospects on the insecticide-impregnated collars as an effective control measure are emphasized.

Prevalence of tungiasis in humans in Brazil and in its federative units: a systematic review

Tungiasis is a neglected parasitic disease caused by penetration of female Tunga penetrans under the skin, causing important health outcomes in humans. Therefore, the aim of this study was to describe the prevalence of tungiasis in Brazil and in its federative units. In November 2019, an investigation was carried out to find studies published from 1980 onwards in MEDLINE, LILACS, Cochrane, CINAHL, Scopus, Web of Science and Embase databases, and in the gray literature, using descriptors related to the prevalence of tungiasis caused by T. penetrans in Brazil. Of the 542 studies found, only 16 published between 2002 and 2010 met the eligibility criteria to be included in this systematic review. Of the 16 selected publications, 14 addressed the prevalence of tungiasis in communities in the Northeast region of the country, one in the South and one in the Southeast. The general prevalence of the parasitosis in the studies ranged from 1.6% to 54.8%, predominantly in the five to nine age group. Eight studies considered the prevalence by gender, ranging from 2.2% to 62.2% for females and 1.1% to 62.5% for males. This systematic review presents an unprecedented survey of the prevalence of tungiasis, a parasitic disease whose dissemination is facilitated by several factors, occuring mainly in low-income communities. Considering the regionalization of the findings, the scarcity of publications, as well as disease neglect, more studies are required.

Epidemiological aspects and spatial analysis of chikungunya fever cases from 2017 to 2021, in a state in the northeast region of Brazil

This study aimed to characterize the epidemiological aspects and perform a spatial analysis of Chikungunya fever cases from 2017 to 2021, in the State of Maranhão, Brazil. This is an ecological, descriptive, observational, and retrospective study, conducted by collecting data on Chikungunya fever's confirmed cases in the State of Maranhão, available on the platform of the Department of Informatics of the Unified Health System. Most cases of Chikungunya fever occurred in the year 2017 (p<0.0001), in females (p=0.54), in people between 20 and 39 years old (p=0.04), and with a high school degree (p=0.25). Regarding the evolution of the disease, most cases were cured (p=0.006). The municipalities that obtained a High/High pattern of spatial correlation for the incidence rates of Chikungunya fever per 100,000 inhabitants in the State of Maranhão were located in the West and South Mesoregions in 2017; North and East in 2018; Central, North and East in 2019; North in 2020; and North, East and South in 2021. The epidemiological situation of Chikungunya fever in the State of Maranhão needs attention from public health agencies. Greater efforts towards vector and outbreaks prevention, as well as the improvement on health education programs that educate the population about the disease are necessary. Mainly in the most affected municipalities in order to effectively involve the population in reducing domestic mosquito breeder sites

Perfil epidemiológico da Hanseníase entre os anos 2015 e 2020, no município de Lago da Pedra, estado do Maranhão / Epidemiological profile of Leprosy between the years of 2015 and 2020, in the municipality of Lago da Pedra, state of Maranhão

A alta morbidade da Hanseníase tem sido associada ao acometimento neural, que pode levar a incapacidades físicas permanentes e deformidades que geram, muitas vezes, comportamentos de rejeição e discriminação da sociedade em relação ao doente. No município de Lago da Pedra, localizado no estado do Maranhão, a doença se manifesta de forma representativa. O objetivo do presente estudo foi descrever as características epidemiológicas da Hanseníase no município de Lago da Pedra, estado do Maranhão, no período de 2015 a 2020. Trata-se de um estudo descritivo, observacional e retrospectivo, em que foram analisadas as Fichas de Notificação de Hanseníase, que compõem o banco de dados oficial do Sistema de Informação de Agravos de Notificação (SINAN), fornecidas pela Secretaria Municipal de Saúde. Foram confirmados 395 casos de Hanseníase no município, com predominância do gênero masculino (55,0%), faixa etária dos 30 a 39 anos (19,7%) e forma clínica Dimorfa (74,4%). A incidência por 1.000 habitantes variou de 0,95 a 2,21. Houve diferença estatisticamente significativa na comparação das medianas de casos de Hanseníase entre os anos (H = 11,37; p = 0,04), entre as faixas etárias (H = 10,88; p = 0,0043), entre as formas clínicas da doença (H = 21,67; p = 0,0002), mas não entre os gêneros (U = 11,50; p = 0,33). Ressalta-se que o Maranhão, estado nordestino, é considerado endêmico para a Hanseníase, tendo em vista o contexto socioeconômico da população, que é marcado por desigualdades sociais, inclusive na saúde, influenciando no alto número de casos diagnosticados da doença

The high morbidity of leprosy has been associated with neural involvement, which can lead to permanent physical disabilities and deformities, which often generate society's rejection and discrimination towards the patient. In the municipality of Lago da Pedra, located in the state of Maranhão, the disease manifests itself in a representative way. The aim of this study was to describe the epidemiological characteristics of leprosy in the municipality of Lago da Pedra, state of Maranhão, from 2015 to 2020. This is a descriptive, observational and retrospective study that analyzed the Notification Sheets of Leprosy, which make up the official database of the Notifiable Diseases Information System (SINAN), provided by the Municipal Health Department. A total of 395 cases of leprosy were confirmed in the city, with a predominance of males (55.0%), age group from 30 to 39 years old (19.7%) and borderline clinical form (74.4%). The incidence rate per 1,000 in-habitants ranged from 0.95 to 2.21. There was a statistically significant difference in the com-parison of medians of leprosy cases between years (H = 11.37; p = 0.04), between age groups (H = 10.88; p = 0.0043), between forms disease clinics (H = 21.67; p = 0.0002), but not between genders (U = 11.50; p = 0.33). It is noteworthy that Maranhão, northeastern state, is considered endemic for leprosy, given the socioeconomic context of the population, which is marked by social inequalities, health access included, influencing the high number of cases of the disease.