Geospatial technologies for targeting priority areas on surveillance and response of visceral leishmaniasis in São Paulo state, Brazil: embracing a One Health integrative approach.

Background: In 2023, Brazil accounted for 93.5% of the reported cases of visceral leishmaniasis (VL) in Latin America. This study, employing a One Health approach aims: i) to analyse the spatial distribution of VL using integrated geospatial methods, ii) the temporal trend of VL to assess the impact of the COVID-19 pandemic on the occurrence of cases, and iii) identify spatial clusters of municipalities with heightened environmental vulnerability to prioritise surveillance and control efforts for VL in São Paulo state, Brazil. Methods: Archival databases from 1999 to 2022 were analysed. High-risk clusters of human VL (HVL) were identified using the Local Moran Index. Incidence and mortality rates were modelled with the Generalized Additive Model. Data on the distribution of Lutzomyia longipalpis vectors were obtained from São Paulo's Supervision in Control of Endemics, while the spatial distribution of canine visceral leishmaniasis (CVL) was based on survey data from the Adolfo Lutz Institute. Environmental factors, including normalized difference vegetation index (NDVI), land surface temperature (LST), and geomorphology, were derived from Moderate Resolution Imaging Spectroradiometer (MODIS) data and Environmental Information Database (BDiA) platform. Results: Lutzomyia longipalpis was detected in 32.4% of municipalities, CVL in 29.0%, and HVL in 18.0%. The western region, characterised by plateau geomorphology, elevated deforestation, and higher temperatures, accounted for 30.6% of high-risk clusters, underscoring its priority status for control and surveillance. While VL cases remain stable during the COVID-19 pandemic, lethality rates increased. Conclusions: Addressing VL and reducing lethality rates will pose a significant challenge for public health authorities in São Paulo in the coming years.