Changes in the epidemiology of visceral leishmaniasis in Brazil from 2001 to 2014

Abstract INTRODUCTION Visceral leishmaniasis (VL) is a neglected disease, with territorial expansion and regional differences in Brazil that require explanation. This study aimed to describe changes in the epidemiology of VL in Brazil from 2001 to 2014. METHODS The incidence rates, sociodemographic and clinical data, and case evolution were subgrouped from 2001 to 2006 and from 2007 to 2014 and presented descriptively. Spatial distribution of disease incidence rates and changes in the spatial and temporal pattern were examined. RESULTS: In total, 47,859 VL cases were reported in Brazil between 2001 and 2014, with predominance in the Northeast macroregion (55%), though the incidence rate in this region declined between the two study periods. The State of Tocantins had the highest crude rate (26.2/100,000 inhabitants), which was responsible for VL increasing in the North macroregion. VL predominated in the urban zone (70%), in children under 4 years (34%); however, an increase in the incidence of VL in adults older than 40 years was identified, with 12.3% and 31% in the first and second period, respectively. The mapping of crude rates and autochthonous canine cases showed territorial expansion. The temporal distribution of VL was consistent in Brazil in general, with no pattern observed, but regional differences were found. CONCLUSIONS: The incidence of VL is increasing in Brazil. In addition to the State of Tocantins, which had the highest rate, new outbreaks of VL have occurred in the South macroregion of Brazil with small decreases identified in the incidence rate in the Northeast.

【摘要】引言：内脏利什曼病（Visceral leishmaniasis, VL）是一种被忽视的疾病，在巴西呈现地域扩张态势且存在区域差异，亟待阐释。本研究旨在描述2001年至2014年巴西内脏利什曼病的流行病学变化。方法：将2001-2006年及2007-2014年两个研究时段的发病率、社会人口学与临床数据及病例转归进行分组，并予以描述性呈现；同时分析疾病发病率的空间分布及时空模式变化。结果：2001年至2014年间，巴西累计报告内脏利什曼病病例47859例，病例以东北部大区为主（占比55%），但该区域的发病率在两个研究时段间呈下降趋势。托坎廷斯州的粗发病率最高（26.2/10万人口），是北部大区内脏利什曼病发病率上升的主要原因。内脏利什曼病高发于城市地区（占比70%）及4岁以下儿童群体（占比34%）；但研究发现40岁以上成人的发病率有所上升，两个研究时段的该群体占比分别为12.3%与31%。粗发病率与本土犬类病例的分布图谱显示疾病存在地域扩张。整体而言，巴西内脏利什曼病的时间分布无显著特征，但存在区域差异。结论：巴西内脏利什曼病的发病率呈上升趋势。除发病率最高的托坎廷斯州外，巴西南部大区亦出现新的暴发疫情，而东北部大区的发病率则小幅下降。