Leishmaniasis is a public health problem worldwide. We aimed to predict ecological niche models (ENMs) for visceral (VL) and cutaneous (CL) leishmaniasis and the sand flies involved in the transmission of leishmaniasis in São Paulo, Brazil. Phlebotomine sand flies were collected between 1985 and 2015. ENMs were created for each sand fly species using Maximum Entropy Species Distribution Modeling software, and 20 climatic variables were determined. Nyssomyia intermedia (Lutz & Neiva, 1912) and Lutzomyia longipalpis (Lutz & Neiva, 1912), the primary vectors involved in CL and VL, displayed the highest suitability across the various regions, climates, and topographies. L. longipalpis was found in the border of Paraná an area currently free of VL. The variables with the greatest impact were temperature seasonality, precipitation, and altitude. Co-presence of multiple sand fly species was observed in the cuestas and coastal areas along the border of Paraná and in the western basalt areas along the border of Mato Grosso do Sul. Human CL and VL were found in 475 of 546 (86.7%) and 106 of 645 (16.4%) of municipalities, respectively. Niche overlap between N. intermedia and L. longipalpis was found with 9208 human cases of CL and 2952 cases of VL. ENMs demonstrated that each phlebotomine sand fly species has a unique geographic distribution pattern, and the occurrence of the primary vectors of CL and VL overlapped. These data can be used by public authorities to monitor the dispersion and expansion of CL and VL vectors in São Paulo state.

Background: Visceral leishmaniasis (VL) is an emerging zoonosis, and Brazil harbors about 90% of those infected in Latin America. Since 1998, the disease has been spreading quickly in São Paulo state, and the western region is considered an emerging focus of VL in Brazil. Our aim was to evaluate the clinical characteristics and spatial distribution of VL in children referred to a public tertiary hospital located in the western region of São Paulo state, Brazil. Methods: Medical records of children up to 18 years of age who were diagnosed with VL between January 2006 and December 2010 were reviewed. Geospatial analysis was performed using the ArcGIS 10.2 platform. Results: Sixty-three patients were enrolled in the study; the median age was 3.3 ± 3.3 years. The median time interval between the onset of clinical symptoms and diagnosis was 16.1 ± 11.1 days, and the median time in the pediatric ward was 18.0 ± 9.4 days. Liposomal amphotericin B was the first-line treatment in 90.5% of the patients and 9.6% relapsed. One patient died (1.6%), and 19% were submitted to the pediatric intensive care unit. Conclusion: The short interval between the onset of symptoms, diagnosis, and treatment and the reduced number of days of hospitalization certainly influenced the small number of deaths, relapses, and severity among the children infected with VL. However, the disease is spreading fast in the western region of São Paulo state. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices.

Visceral leishmaniasis is an emerging zoonosis and its geographic distribution is restricted to tropical and temperate regions. Most of the individuals infected in Latin America are in Brazil. Despite the control measures that have been adopted, the disease is spreading throughout new regions of the country. Domestic dogs are involved in the transmission cycle and are considered to be the main epidemiologic reservoir of Leishmania infantum (syn. L. chagasi). Our aim was to determine the prevalence of canine leishmaniasis (CL) and Ehrlichiosis infection in Presidente Prudente as well as the spatial dispersion of the disease in the western region of São Paulo state. Dogs underwent clinical examination and symptoms related to CL were recorded. Anti- Leishmania antibodies were detected using ELISA, rK39-immunocromatographic tests (DPP), and an indirect fluorescent antibody test (IFAT). Anti-E. canis antibodies were detected by IFAT. A follow-up was conducted in dogs that were positive in the ELISA at the baseline study. Data on the spatial distribution of L. longipalpis and CL in São Paulo state were obtained from Brazilian public health agencies. Serum samples from 4547 dogs were analyzed. The seroprevalence of CL was 11.2 % by ELISA and 4.5 % by IFAT. In the follow-up, seroprevalence was 32.9 % by ELISA, 15.3 % by IFAT, 11.8 % by DPP test, and 66.5 % for E. canis. There was a significant positive association between Leishmania and E. canis infection (P < 0.0001). In the follow-up, clinical examinations revealed symptoms compatible with CL in 33.5 % of the dogs. L. longipalpis was found in 24 and CL in 15 counties of the Presidente Prudente mesoregion. The dispersion route followed the west frontier of São Paulo state toward Paraná state. Low CL and high ehrlichiosis prevalence rates were found in Presidente Prudente city. This emerging focus of CL is moving through the western region of São Paulo state toward the border of Paraná state. Integrated actions to fight the vector, parasites, infected dogs, and humans are needed to monitor the disease and implement strategies for epidemiologic control.

Visceral leishmaniasis (VL) is one of the most prevalent parasitic diseases worldwide. In 2019, 97% of the total numbers of cases in Latin America were reported in Brazil. In São Paulo state, currently 17.6% of infected individuals live in the western region. To study this neglected disease on a regional scale, we describe the spread of VL in 45 municipalities of the Regional Network for Health Assistance11(RNHA11). Environmental, human VL (HVL), and canine VL (CVL) cases, Human Development Index, andLutzomyia longipalpisdatabases were obtained from public agencies. Global Moran’s I index and local indicators of spatial association (LISA) statistics were used to identify spatial autocorrelation and to generate maps for the identification of VL clusters. On a local scale, we determined the spread of VL in the city of Teodoro Sampaio, part of the Pontal of Paranapanema. In Teodoro Sampaio, monthly peri-domicile sand fly collection; ELISA, IFAT and Rapid Test serological CVL; and ELISA HVL serum surveys were carried out. In RNHA11 from 2000 to 2018,Lu.longipalpiswas found in 77.8%, CVL in 69%, and HVL in 42.2% of the 45 municipalities, and 537 individuals were notified with HVL. Dispersion occurred from the epicenter in the north to Teodoro Sampaio, in the south, whereLu.longipalpisand CVL were found in 2010, HVL in 2018, and critical hotspots of CVL were found in the periphery. Moran’s Global Index showed a weak but statistically significant spatial autocorrelation related to cases of CVL (I = 0.2572), and 11 municipalities were identified as priority areas for implementing surveillance and control actions. In RNHA11, a complex array of socioeconomic and environmental factors may be fueling the epidemic and sustaining endemic transmission of VL, adding to the study of a neglected disease in a region of São Paulo, Brazil.

In the last decade, in the state of São Paulo, 5898 cases of cutaneous leishmaniasis (CL) were reported. This study was undertaken to analyze the epidemiology of CL in the municipality of Teodoro Sampaio, in São Paulo State, Brazil, based on a geographic approach, as very little is known of the relationship between CL and the spatial transformation process. This is a population-based quantitative, descriptive and cross-sectional case study. Surveys of the official notifications in the healthcare center and official sources from 1998 to 2011 were analysed. The data were described based on statistics and the Kernel method to detect hotspots of transmission. The age group between 21 and 40 yr was most affected, with 24 cases (57.9%). Of the 41 cases reported between 1998 and 2011, 33 cases were having low education status and 31 cases (75.6%) were males. The spatial and temporal distribution was aggregated in three-year periods which permitted the identification of two microfoci, in periods I (1998-2000) and III (2005-2007). The disease has presented, in recent years, a pattern of sporadic transmission or microfoci, and continues to maintain enzootic cycles of Leishmania in a sylvatic environment, ensuring the perpetuation of the pathogen in nature, and the risk of emergence of new cases of CL in domestic animals and humans.

Malaria in Bhutan has fallen significantly over the last decade. As Bhutan attempts to eliminate malaria in 2022, this study aimed to characterize the space–time clustering of malaria from 2010 to 2019. Malaria data were obtained from the Bhutan Vector-Borne Disease Control Program data repository. Spatial and space–time cluster analyses of Plasmodium falciparum and Plasmodium vivax cases were conducted at the sub-district level from 2010 to 2019 using Kulldorff’s space–time scan statistic. A total of 768 confirmed malaria cases, including 454 (59%) P. vivax cases, were reported in Bhutan during the study period. Significant temporal clusters of cases caused by both species were identified between April and September. The most likely spatial clusters were detected in the central part of Bhutan throughout the study period. The most likely space–time cluster was in Sarpang District and neighboring districts between January 2010 to June 2012 for cases of infection with both species. The most likely cluster for P. falciparum infection had a radius of 50.4 km and included 26 sub-districts with a relative risk (RR) of 32.7. The most likely cluster for P. vivax infection had a radius of 33.6 km with 11 sub-districts and RR of 27.7. Three secondary space–time clusters were detected in other parts of Bhutan. Spatial and space–time cluster analysis identified high-risk areas and periods for both P. vivax and P. falciparum malaria. Both malaria types showed significant spatial and spatiotemporal variations. Operational research to understand the drivers of residual transmission in hotspot sub-districts will help to overcome the final challenges of malaria elimination in Bhutan.