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      Epidemiological Aspects and High Magnitude of Human Visceral Leishmaniasis in Ceará, Northeast of Brazil, 2007-2021

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          ABSTRACT

          Background:

          Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021.

          Methods:

          This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization.

          Results:

          There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL.

          Conclusions:

          HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.

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          Most cited references27

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          Male predominance in reported Visceral Leishmaniasis cases: Nature or nurture? A comparison of population-based with health facility-reported data

          Background Bangladesh, India, and Nepal aim for the elimination of Visceral Leishmaniasis (VL), a systemic parasitic infectious disease, as a public health problem by 2020. For decades, male patients have comprised the majority of reported VL cases in this region. By comparing this reported VL sex ratio to the one observed in population-based studies conducted in the Indian subcontinent, we tested the working hypothesis that mainly socio-cultural gender differences in healthcare-seeking behavior explain this gender imbalance. Methodology/Principal findings We compared the observed sex ratio of male versus female among all VL cases reported by the health system in Nepal and in the two most endemic states in India with that observed in population-based cohort studies in India and Nepal. Also, we assessed male sex as a potential risk factor for seroprevalence at baseline, seroconversion, and VL incidence in the same population-based data. The male/female ratio among VL cases reported by the health systems was 1.40 (95% CI 1.37–1.43). In the population cohort data, the age- and study site-adjusted male to female risk ratio was 1.27 (95% CI 1.08–1.51). Also, males had a 19% higher chance of being seropositive at baseline in the population surveys (RR 1.19; 95% CI 1.11–1.27), while we observed no significant difference in seroconversion rate between both sexes at the DAT cut-off titer defined as the primary endpoint. Conclusions/Significance Our population-based data show that male sex is a risk factor for VL, and not only as a socio-cultural determinant. Biological sex-related differences likely play an important role in the pathogenesis of this disease.
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            Série temporal da leishmaniose visceral em Aracaju, estado de Sergipe, Brasil (1999 a 2008): aspectos humanos e caninos

            INTRODUÇÃO: Considerada doença negligenciada pela OMS, a Leishmaniose visceral (LV) tem se expandido e urbanizado, sendo sua transmissão e expansão associadas a diversos fatores. OBJETIVO: Avaliar aspectos epidemiológicos da LV no município de Aracaju/SE, por meio de estudo retrospectivo da série histórica de LV humana e canina no período de 1999-2008. MÉTODOS: Foram utilizados dados secundários do SINAN para os casos humanos, e o resultado dos inquéritos caninos e atendimentos da demanda passiva do Centro de Controle de Zoonoses (CCZ). RESULTADOS: Foram notificados 192 casos autóctones de LV humana, sendo 63,5% do gênero masculino. Crianças entre 1 e 4 anos foram mais acometidas (29,2%), seguidas de adultos entre 20-29 anos (15,6%) e de crianças entre 5-9 anos (15,1%). A letalidade geral foi de 8,9%, sendo mais acentuada em pessoas entre 60 a 69 anos (60%); 32,3% dos casos autóctones realizaram sorologia para HIV, com positividade de 6,9%. A confirmação laboratorial foi realizada principalmente mediante a imunofluorescência indireta isolada (71,1%). Dos 58.161 cães que realizaram sorologia a positividade foi de 5,4%, sendo 87,0% dos inquéritos realizados anualmente pelo CCZ, com uma positividade de 4,4%. Dos 7.501 cães trazidos ao CCZ por diversas queixas, o exame sorológico foi reagente em 12,0%. CONCLUSÃO: Os dados denotam o caráter endêmico da LV no município, mostrando a necessidade de ações que permitam a diminuição do risco para a população, principalmente aquela onde a incidência e a letalidade são maiores, como melhorias no diagnóstico da LV, assim como na co-infecção com HIV e no monitoramento da população canina, entre outros.
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              Epidemiological aspects of human and canine visceral leishmaniasis in State of Alagoas, Northeast, Brazil

              Abstract Zoonotic visceral leishmaniasis (ZVL), caused by protozoans of the genus Leishmania, it is a worldwide of great importance disease. In the northeast region of Brazil, the state of Alagoas has an endemic status for ZVL. Thus, this work aimed to analyze the epidemiological situation of human and canine visceral leishmaniasis in Alagoas, Northeast, Brazil, from 2007 to 2013. We conducted a descriptive, observational, retrospective study using secondary data from the Notifiable Diseases Information System, the Center of Zoonosis Control of Maceió, and the Central Laboratory of Public Health of Alagoas. During the studied period, it was observed that the highest incidence of human visceral leishmaniasis was in 2011 and the lowest in 2013. On the other hand, canine visceral leishmaniasis had its highest incidence in 2007 and its lowest in 2012. Of the 55 municipalities in the State of Alagoas that showed human visceral leishmaniasis (HVL), São José da Tapera presented an average of 4.4 cases over the past five years, being classified as of intense transmission. Regarding canine visceral leishmaniasis, in the same studied period, 45,112 dogs were examined in the State, of which 4,466 were positive. It resulted, thus, in a 9.9% positivity rate. Conclusions: Our data are important because canine infection is an important risk factor for the human disease.
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                Author and article information

                Journal
                Rev Soc Bras Med Trop
                Rev Soc Bras Med Trop
                rsbmt
                Revista da Sociedade Brasileira de Medicina Tropical
                Sociedade Brasileira de Medicina Tropical - SBMT
                0037-8682
                1678-9849
                20 May 2022
                2022
                : 55
                : e0684-2021
                Affiliations
                [1 ] Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil.
                [2 ] Secretaria de Saúde do Estado do Ceará, Coordenadoria de Vigilância e Prevenção em Saúde, Fortaleza, CE, Brasil.
                [3 ] Colégio Militar de Manaus, Sistema Colégio Militar do Brasil, Manaus, AM, Brasil.
                Author notes
                Corresponding author: Carlos Henrique Alencar. e-mail: carllosalencar@ 123456ufc.br

                Authors' contribution: KKSC and CHA were responsible for writing the proposal and analyzing and interpreting the data; KKSC was responsible for reviewing the literature and writing the article; KKSC, CHA, KMOB, FRAC, FGSC and CMGDF drafting the paper and substantially revising.

                Conflict of Interest: The authors declare that there is no conflict of interest.

                Author information
                http://orcid.org/0000-0002-7501-3995
                http://orcid.org/0000-0003-3554-1918
                http://orcid.org/0000-0003-1299-9133
                http://orcid.org/0000-0002-5043-6393
                http://orcid.org/0000-0002-9297-2856
                http://orcid.org/0000-0003-2967-532X
                Article
                00315
                10.1590/0037-8682-0684-2021
                9131778
                35613225
                f6b311e2-f9ca-4b93-97bc-6818df724387

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 04 December 2021
                : 25 March 2022
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 28
                Categories
                Major Article

                visceral leishmaniasis,morbidity and mortality indicators,epidemiological surveillance,epidemiological monitoring

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