Volume 84, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



This study used spatial analysis to identify areas at greatest risk of visceral leishmaniasis (VL) in the urban area of Teresina, Brazil during 2001–2006. The results from kernel ratios showed that peripheral census tracts were the most heavily affected. Local spatial analysis showed that in the beginning of the study period local clusters of high incidence of VL were mostly located in the southern and northeastern parts of the city, but in subsequent years those clusters also appeared in the northern region of the city, suggesting that the pattern of VL is not static, and the disease may occasionally spread to other areas of the municipality. We also observed a spatial correlation between VL rates and all socioeconomic and demographic indicators evaluated ( < 0.01). The concentration of interventions in high-risk areas could be an effective strategy to control the disease in the urban setting.


Article metrics loading...

Loading full text...

Full text loading...



  1. Mendes WS, Silva AA, Trovão JR, Silva AR, Costa JM, , 2000. Expansão espacial da leishmaniose visceral americana em São Luis, Maranhão, Brasil. Rev Soc Bras Med Trop 35: 227231.[Crossref]
  2. Werneck GL, Rodrigues L, Jr Santos MV, Araújo IB, Moura LS, Lima SS, Gomes RB, Maguire JH, Costa CH, , 2002. The burden of Leishmania chagasi infection during an urban outbreak of visceral leishmaniasis in Brazil. Acta Trop 83: 1318.[Crossref]
  3. Werneck GL, Costa CH, , 2005. Utilização de dados censitários em substituição a informações socioeconômicas obtidas no nível individual: uma avaliação empírica. Epidemiol Serv Saúde 14: 143150.
  4. Oliveira AL, Paniago AM, Dorval ME, Oshiro ET, Leal CR, Sanches M, Cunha RV, Bóia MN, , 2006. Foco emergente de leishmaniose visceral em Mato Grosso do Sul. Rev Soc Bras Med Trop 39: 446450.[Crossref]
  5. Dantas-Torres F, Brandão-Filho SP, , 2006. Expansão geográfica da leishmaniose visceral no Estado de Pernambuco. Rev Soc Bras Med Trop 39: 352356.[Crossref]
  6. Costa CH, , 2008. Characterization and speculations on the urbanization of visceral leishmaniasis in Brazil. Cad Saude Publica 24: 29592963.[Crossref]
  7. Gontijo CM, Melo MN, , 2004. Leishmaniose visceral no Brasil: quadro atual, desafios e perspectivas. Rev Bras Epidemiol 7: 338349.[Crossref]
  8. Costa CH, Pereira HF, Araújo MV, , 1990. Epidemia de leishmaniose visceral no estado do Piauí, Brasil, 1980–1986. Rev Saude Publica 24: 361372.[Crossref]
  9. Teresina Prefeitura Municipal de, , 1993. Teresina: Aspectos e Características. Teresina: Brasil.
  10. Spielman A, James AA, Warren KS, Mahmoud AA, , 1990. Transmission of Vector-Borne Disease. , eds. Tropical and Geographical Medicine. Second edition. New York: McGraw-Hill, 146159.
  11. Rangel EF, Vilela ML, , 2008. Lutzomyia longipalpis (Diptera, Psychodidae, Phlebotominae) and urbanization of visceral leishmaniasis in Brazil. Cad Saude Publica 24: 29482952.[Crossref]
  12. Werneck GL, , 2008. Forum: geographic spread and urbanization of visceral leishmaniasis in Brazil. Introduction. Cad Saude Publica 24: 29372940.[Crossref]
  13. Nascimento EL, Martins DR, Monteiro GR, Barbosa JD, Ximenes MF, Maciel BL, Duarte I, Jerônimo SM, , 2008. Forum: geographic spread and urbanization of visceral leishmaniasis in Brazil. Postscript: new challenges in the epidemiology of Leishmania chagasi infection. Cad Saude Publica 24: 29642967.[Crossref]
  14. Ministério da Saúde do Brasil Série A, , 2005. Guia de Vigilância Epidemiológica. 6a edição, , Brasília: Secretaria de Vigilância em Saúde.
  15. Tesh RB, , 1995. Control of zoonotic visceral leishmaniasis: is it time to change strategies? Am J Trop Med Hyg 52: 287292.
  16. Costa CH, Vieira JB, , 2001. Mudanças no controle da leishmaniose visceral no Brasil. Rev Soc Bras Med Trop 34: 223228.[Crossref]
  17. Courtenay O, Quinnell RJ, Garcez LM, Shaw JJ, Dye C, , 2002. Infectiousness in a cohort of Brazilian dogs: why culling fails to control visceral leishmaniasis in areas of high transmission. J Infect Dis 186: 13141320.[Crossref]
  18. Desjeux P, , 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305318.[Crossref]
  19. Maia-Elkhoury AN, Alves WA, Sousa-Gomes ML, Sena JM, Luna EA, , 2008. Visceral leishmaniasis in Brazil: trends and challenges. Cad Saude Publica 24: 29412947.[Crossref]
  20. Instituto Brasileiro de Geografia e Estatística, 2001. Tendências Demográficas: uma Análise dos Resultados da Sinopse Preliminar do Censo Demográfico 2000. Available at: http://www.ibge.gov.br/home/estatistica/populacao/tendencia_demografica/analise_resultados/sinopse_censo2000.pdf. Acessed June 4, 2010.
  21. Shryock HS, Siegel JS, , 1976. The Methods and Materials of Demography. San Diego, CA: Academic Press.
  22. Kleinbaum DG, Kupper LL, Morgenstern H, , 1982. Epidemiologic Research: Principles and Quantitative Methods. New York: Van Nostrand Reinhold.
  23. Bernardenelli L, Montomolli C, , 1992. Empirical Bayes versus fully Bayesian analysis of geographical variation in disease risk. Stat Med 11: 9831007.[Crossref]
  24. Assunção RM, Barreto S, Guerra LH, Sakurai E, , 1998. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saude Publica 14: 713723.[Crossref]
  25. Marshall R, , 1991. Mapping disease and mortality rates using empirical Bayes estimators. Appl Stat 40: 283294.[Crossref]
  26. Anselin L, Longley PA, Goodchild MF, Maguire DJ, Wind DW, , 1998. Interactive techniques and exploratory spatial data analisys. , eds. Geographical Information System: Principles, Techniques, Management and Applications. New York: Wiley, 253365.
  27. Anselin L, Syabri I, Smirnov O, , 2003. Visualizing Multivariate Spatial Correlation with Dynamically Linked Windows. Urbana, IL: University of Illinois, 2003.
  28. Bailey TC, Gatrell AC, , 1995. Interactive Spatial Data Analysis. Essex, United Kingdom: Longman Scientific & Technical.
  29. Gatrell AC, Bailey TC, Diggle PJ, Rowlingson BS, , 1996. Spatial point pattern analysis and its application in geographical epidemiology. Trans Inst Br Geogr 21: 256274.[Crossref]
  30. Werneck GL, Costa CH, Walker AM, David JR, Wand M, Maguire JH, , 2007. Multilevel modelling of the incidence of visceral leishmaniasis in Teresina, Brazil. Epidemiol Infect 135: 195201.[Crossref]
  31. Cerbino Neto J, Werneck GL, Costa CH, , 2009. Factors associated with the incidence of urban visceral leishmaniasis: an ecological study in Teresina, Piauí State, Brazil. Cad Saude Publica 25: 15431551.[Crossref]
  32. Werneck GL, Costa CH, Walker AM, David JR, Wand M, Maguire JH, , 2002. The urban spread of visceral leishmaniasis: clues from spatial analysis. Epidemiology 13: 364367.[Crossref]
  33. Woolhouse ME, Dye C, Etard JF, Smith T, Charlwood JD, Garnett GP, Hagan P, Hii JL, Ndhlovu PD, Quinnell RJ, Watts CH, Chandiwana SK, Anderson RM, , 1997. Heterogeneities in the transmission of infectious agents: implications for the design of control programs. Proc Natl Acad Sci USA 94: 338342.[Crossref]
  34. Koopman JS, Simon CP, Riolo CP, , 2005. When to control endemic infections by focusing on high-risk groups. Epidemiology 16: 621627.[Crossref]
  35. Badaró R, Jones TC, Carvalho EM, Sampaio D, Reed SG, Barral A Teixeira R, Johnson WD, Jr, 1986. New perspectives on a subclinical form of visceral leishmaniasis. J Infect Dis 154: 10031011.[Crossref]
  36. Evans TG, Teixeira MJ, McAulife IT, Vasconcelos I, Vasconcelos AW, Sousa Ade A, Lima JW, Pearson RD, , 1992. Epidemiology of visceral leishmaniasis in northeast Brazil. J Infect Dis 166: 11241132.[Crossref]
  37. Jerônimo SM, Oliveira RM, Mcckay S, Costa RM, Sweet J, Nascimento ET, Luz KG, Fernandes MZ, Jernigan J, Pearson RD, , 1994. An urban outbreak of visceral leishmaniasis in Natal, Brazil. Trans R Soc Trop Med Hyg 88: 386388.[Crossref]
  38. Costa CH, Stewart JM, Gomes RB, Garcez LM, Ramos PK, Bozza M, Satoskar A, Dissanayake S, Santos RS, Silva MR, Shaw JJ, David JR, Maguire JH, , 2002. Asymptomatic human carriers of Leishmania chagasi . Am J Trop Med Hyg 66: 334337.
  39. Karplus TM, Jeronimo SM, Chang H, Helms BK, Burns TL, Murray JC, Mitchell AA, Pugh EW, Braz RF, Bezerra FL, Wilson ME, , 2002. Association between the tumor necrosis factor locus and the clinical outcome of Leishmania chagasi infection. Infect Immun 70: 69196925.[Crossref]
  40. Alonso DP, Ferreira AF, Ribolla PE, de Miranda Santos IK, do Socorro Pires e Cruz M, Aécio de Carvalho F, Abatepaulo AR, Lamounier Costa D, Werneck GL, Farias TJ, Soares MJ, Costa CH, , 2007. Genotypes of the mannan-binding lectin gene and susceptibility to visceral leishmaniasis and clinical complications. J Infect Dis 195: 12121217.[Crossref]
  41. Maciel BL, Lacerda HG, Queiroz JW, Galvão J, Pontes NN, Dimenstein R, McGowan SE, Pedrosa LF, Jerônimo SM, , 2008. Association of nutritional status with the response to infection with Leishmania chagasi . Am J Trop Med Hyg 79: 591598.

Data & Media loading...

  • Received : 04 Jun 2010
  • Accepted : 08 Feb 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error