Hyperendemicity, heterogeneity and spatial overlap of leprosy and cutaneous leishmaniasis in the southern Amazon region of Brazil

Abstract

Neglected tropical diseases characterized by skin lesions are highly endemic in the state of Mato Grosso, Brazil. We analyzed the spatial distribution of leprosy and Cutaneous Leishmaniasis (CL) and identified the degree of overlap in their distribution. All new cases of leprosy and CL reported between 2008 and 2017 through the national reporting system were included in the study. Scan statistics together with univariate Global and Local Moran’s I were employed to identify clusters and spatial autocorrelation for each disease, with the spatial correlation between leprosy and CL measured by bivariate Global and Local Moran’s I. Finally, we evaluated the demographic characteristics of the patients. The number of leprosy (N = 28,204) and CL (N = 24,771) cases in Mato Grosso and the highly smoothed detection coefficients indicated hyperendemicity and spatial distribution heterogeneity. Scan statistics demonstrated overlap of high-risk clusters for leprosy (RR = 2.0; p <0.001) and CL (RR = 4.0; p <0.001) in the North and Northeast mesoregions. Global Moran’s I revealed a spatial autocorrelation for leprosy (0.228; p = 0.001) and CL (0.311; p = 0.001) and a correlation between them (0.164; p = 0.001). Both diseases were found to be concentrated in urban areas among men aged 31-60 years, of brown-skinned ethnicity and with a low educational level. Our findings indicate a need for developing integrated and spatially as well as socio-demographically targeted public health policies.

Impact of socioeconomic status on the knowledge, attitudes, and practices about visceral leishmaniasis among dog owners

“…Nonetheless, even representing a relevant VL endemic area, the clinical manifestations of the human disease were largely unknown in Rondonópolis. Moreover, many participants confused human VL with cutaneous leishmaniasis by pointing out skin lesions as a clinical sign, which could be explained by the overlapping of both leishmaniases in the municipality [34]. Poor knowledge of human VL clinical manifestations deserves attention since the early recognition of the disease is highly recommended by the VLSCP [2].…”

Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil

“…From 2008 to 2017, Mato Grosso reached hyperendemic levels of leprosy and CL, with a cumulative incidence of 89.4 and 79.1 cases/100,000 inhabitants, respectively. Both diseases are heterogeneously distributed over the state, with an extensive area of geographical overlap in the North and Northeast mesoregions [ 18 ].…”

“…The central state of Mato Grosso is classified as a hyperendemic area for both leprosy and CL; it ranks first for leprosy and third for CL new cases in the country [ 15 , 17 ]. One third of the population of the state of Mato Grosso lives in municipalities classified as high risk for both diseases [ 18 ]. Despite this situation, no current measures aim at the integrated control of these diseases.…”

Spatio-temporal epidemiology of emergency medical requests in a large urban area. A scan-statistic approach

“…The descriptive maps show the spatial pattern of EMS requests during each time interval, but to identify the high-risk (hotspots) areas of EMS requests by time, we needed to add scan statistics introduced in health sciences by Naus (1965) with spatial and temporal extensions introduced by Kulldorff (1997). These techniques can identify spatial, temporal and space-time clustering as used by (De Carvalho et al, 2020;Punyapornwithaya et al, 2020;Silva et al, 2020). In Kulldorff's scan statistics, the first step is to determine a congruous probability model of the data and compute the likelihood ratio for each scan window.…”