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A five-year follow-up of the natural history of 924 children exposed to or infected with Leishmania chagasi was conducted in a rural area of northeast Brazil. Seventy-eight percent of the children sought were located. There was no evidence of smoldering disease or long subclinical latency in this population. The overall prevalence of clinical visceral leishmaniasis in this population was 6.1%, with a mortality rate of 10%.