Table_1_Biodiversity of Potential Vectors of Rickettsiae and Epidemiological Mosaic of Spotted Fever in the State of Paraná, Brazil.XLSX

Spotted Fever Rickettsioses (SFR) are diseases caused by bacteria of the genus Rickettsia, and are transmitted mainly by ticks. Its eco-epidemiological scenarios vary spatially, and may also vary over time due to environmental changes. It is the main disease transmitted by ticks to humans in Brazil, with the state of Paraná (PR) having the sixth highest number of notified incidences in the country. However, information is lacking regarding the SFR disease cycles at likely infection sites within PR. During case investigations or environmental surveillance in PR for SFR, 28,517 arthropods were collected, including species known or potentially involved in the SFR cycles, such as Amblyomma sculptum, Amblyomma aureolatum, Amblyomma ovale, Amblyomma dubitatum, Amblyomma parkeri, Ctenocephalides felis felis, and Rhipicephalus sanguineus sensu lato. From these Rickettsia asembonensis, Rickettsia bellii, Rickettsia felis, Rickettsia parkeri strain Atlantic Rainforest and Candidatus Rickettsia paranaensis were detected. Ectoparasite abundance was found to be related with specific hosts and collection environments. Rickettsiae circulation was observed for 48 municipalities, encompassing 16 Health Regions (HR). As for socio-demographic and assistance indicators, circulation occurred largely in the most urbanized HR, with a higher per capita Gross Domestic Product, lower Family Health Strategy coverage, and with a higher ratio of beds in the Unified Health System per thousand inhabitants. For environmental variables, circulation occurred predominantly in HR with a climatic classified as “subtropical with hot summers” (Cfa), and with forest type phytogeographic formations. In terms of land use, circulation was commonest in areas with agriculture, pasture and fields and forest cover. Rickettsiae were circulating in almost all hydrographic basins of PR state. The results of this study provide the first descriptive recognition of SFR in PR, as well as outlining its eco-epidemiological dynamics. These proved to be quite heterogeneous, and analyzed scenarios showed characteristics strongly-associated with the outbreaks, with cases presenting clinical variation in space, so illustrating the complexity of scenarios in PR state. Due to the diversity of the circumstances surrounding SFR infections in PR, public health initiatives are necessary to foster a better understanding of the dynamics and factors effecting vulnerability to SFR in this Brazilian state.

斑点热立克次体病（Spotted Fever Rickettsioses, SFR）是由立克次体属（Rickettsia）细菌引发的疾病，主要经蜱虫传播。其生态流行病学场景具有空间异质性，同时可因环境变化随时间发生改变。该病是巴西境内最主要的蜱传人类疾病，其中巴拉那州（Paraná, PR）的报告发病数位居全国第六。然而，目前针对巴拉那州境内潜在感染位点的SFR循环传播机制相关信息仍较为匮乏。在巴拉那州开展SFR病例调查或环境监测期间，研究人员共采集到28517只节肢动物，其中包括已知或潜在参与SFR循环传播的物种，如钝刺花蜱（Amblyomma sculptum）、金泽花蜱（Amblyomma aureolatum）、卵形花蜱（Amblyomma ovale）、疑花蜱（Amblyomma dubitatum）、帕克花蜱（Amblyomma parkeri）、猫栉首蚤指名亚种（Ctenocephalides felis felis）以及血红扇头蜱复合群（Rhipicephalus sanguineus sensu lato）。从上述样本中检出了阿塞邦立克次体（Rickettsia asembonensis）、贝尔立克次体（Rickettsia bellii）、费利斯立克次体（Rickettsia felis）、大西洋雨林型帕克立克次体（Rickettsia parkeri strain Atlantic Rainforest）以及候选帕拉纳立克次体（Candidatus Rickettsia paranaensis）。研究发现体外寄生虫的丰度与特定宿主及采集环境密切相关。研究在48个市镇中检测到立克次体的循环传播，覆盖16个卫生区域（Health Regions, HR）。就社会人口学与卫生服务指标而言，立克次体循环主要发生在城市化程度最高的卫生区域：这些区域的人均国内生产总值更高，家庭健康战略（Family Health Strategy）覆盖率更低，且每千居民拥有的统一卫生系统（Unified Health System）床位占比更高。就环境变量而言，立克次体循环主要发生在气候类型为"夏季炎热型亚热带气候（Cfa）"且植被类型为森林型植物地理区系的卫生区域。就土地利用类型而言，立克次体循环最常见于农业、牧场、原野及森林覆盖区域。巴拉那州几乎所有的水文流域均存在立克次体循环传播现象。本研究结果首次对巴拉那州的SFR疫情进行了描述性认知，并阐明了其生态流行病学动态特征。研究发现该疫情具有显著的异质性，分析场景显示其特征与暴发事件高度相关，且病例存在空间临床差异，由此体现了巴拉那州疫情场景的复杂性。鉴于巴拉那州SFR感染相关环境的多样性，该巴西州亟需开展公共卫生举措，以加深对SFR传播动态及影响易感性的相关因素的理解。