Analysis of epidemiological scenarios and the relationship with surveillance and control of visceral leishmaniasis transmission in the state of São Paulo

Abstract

Regional characteristics influence the patterns of transmission of visceral leishmaniasis revealing over time different scenarios for the control of the disease in the state of São Paulo. Between 1999 and 2016, Lutzomyia longipalpis was detected in 95.8% (137/143) of the municipalities with human, canine or both transmissions. However, the occurrence of human cases in a new municipality and an increase in canine cases in the metropolitan region of São Paulo without detection of the vector suggest new challenges to surveillance and control of the disease. In the western part of the state, the classic form of transmission prevails with 19.70% (13/66) of the priority municipalities, accumulating 63.8% (245/384) of cases in the triennium 2015-2016-2017. This epidemiological pattern is compatible with the 80/20 empirical rule. Some of these municipalities had remission of the transmission with a subsequent increase in the number of cases over the years. Thus, it is concluded that the surveillance and control system of visceral leishmaniasis should seek new tools for coping with transmission in the various scenarios and for effective control of the disease.