Spatio-temporal distribution of human American visceral leishmaniasis in the Western region of Sao Paulo State, from 2004 to 2018.

Leishmaniasis comprises a group of zoonotic diseases caused by protozoa belonging to the Leishmania genus, noting that the visceral form is the most severe and lethal, if untreated. Nowadays visceral leishmaniasis is widespread in Brazil and the Adamantina microregion, located in the west of Sao Paulo State, has been affected by Human American Visceral Leishmaniasis (HAVL) since 2004. We evaluated the epidemiological profile of HAVL in the Adamantina microregion through a Geographic Information Systems (GIS) and established its incidence rate by location and time. Notified cases were provided by the Sao Paulo State Epidemiological Surveillance Center. Home addresses of patients who tested positive to HAVL were converted into geographic coordinates through the Google Geocoding Application Programming Interface submitted to ArcMap 10.5 System for georeferencing. Kernel spatial analyses were performed to obtain the incidence distribution and the total area involvement rate. From 2004 to 2018, 325 cases of HAVL were diagnosed in 11 of the 12 municipalities belonging to the of Adamantina microregion. The disease has disseminated to the Northwest and East-Southeast directions, taking place along the Comandante Joao Ribeiro de Barros highway, with higher incidences rates in the municipalities where the highway passes. HAVL incidence was higher in children aged between 0 to 9 years and in the elderly; there was no difference in relation to sex and the majority of cases were located in urban areas. The determination of the epidemiological profile and the the spread of disease patterns can indicate possible areas of vulnerability, in order to contribute to the management and prevention of the disease through a strategic resources optimization.