Epidemiologia da leishmaniose visceral em Belo Horizonte, Minas Gerais, Brasil, 2006 a 2018: análise espacial e temporal

Abstract

Visceral leishmaniasis (VL) is considered a neglected tropical disease of public and animal health importance with wide global distribution. Belo Horizonte, capital of the state of Minas Gerais (MG), is the fourth city with the highest number of confirmed VL cases in Brazil. In this context, the aim of this study was to describe the health indicators [incidence rate (IR), lethality rate (LR) and potential years of life lost (PYLL)] and the sociodemographic factors associated with cases and deaths from VL and VL-HIV co-infection in Belo Horizonte, from 2006 to 2018. Furthermore, to evaluate the temporal relationship between cases of human visceral leishmaniasis (HVL) and canine (CVL) and the spatial distribution of VL cases over time. During the study period, a total of 1,115 new cases of HVL were confirmed, corresponding to a median IR of 2.6 cases/100,000 inhabitants. Regarding VL-HIV co-infection cases, 119 new cases were confirmed. The median IR for this group was 0.3 cases/100,000 inhabitants. There were 148 deaths in individuals with VL and 25 in those with VL-HIV co-infection. Median TL for VL and VL-HIV co-infection were similar (14.6% and 14.3%, respectively). During the study period, a total of 2,843.5 PYLL was verified, which represented an average of 19.2 years lost for each death due to VL. The variables sex, age, and ethnicity were significant predictors of VL and VL-HIV co-infection throughout the period. The study confirmed the endemicity and decrease of VL cases in Belo Horizonte. Regarding the time series analyses, the IR and PCP (proportion of canine seroprevalence) showed a decreasing trend over the first study period (January/2006 to August/2013). According to the ARIMAX model adjusted for this period, a temporal relationship was observed between the IR and PCP, with the IR being influenced by the IR of the last two and five months and by the PCP of the third previous month. For the second study period (September/2013 to December/2018) it was not possible to adjust an ARIMAX model. Spatial analysis showed that HVL cases were concentrated mainly in the Administrative Regions (AR) Northwest (15.1%), Northeastern (14.6%) and Venda Nova (12.2%). On the other hand, the smallest number of cases were found in the AR Central-South (6.7%) and West (8.1%). Kernel density maps indicated concentration of HVL cases in different locations throughout the study period. A total of 1,258,389 diagnostic tests for CVL performed were characterized, of these tests 103,358 were positive (8.2%). Positive spatial autocorrelation and spatial dependence were verified between PCP. Finally, studies like this are important sources of information and can lead to better decision-making in Public Health, in addition to improving the effectiveness of VL surveillance and control measures.