title: Temporal, spatial and spatiotemporal analysis of the occurrence of visceral leishmaniasis in humans in the City of Birigui, State of São Paulo, from 1999 to 2012.
abstract: BACKGROUND
  In 1999, Birigui and Araçatuba were the first municipalities in the State of São Paulo to present autochthonous cases of visceral leishmaniasis in humans (VLH). The aim of this study was to describe the temporal, spatial and spatiotemporal behaviors of VLH in Birigui.
  
  
  METHODS
  Secondary data were obtained from the Notifiable Diseases Information System from 1999 to 2012. The incidence, mortality and case fatality rates by sex and age were calculated. The cases of VLH were geocoded and grouped according to census tracts. Local empirical Bayesian incidence rates were calculated. The existence of spatial and spatiotemporal clusters was investigated using SaTScan software.
  
  
  RESULTS
  There were 156 confirmed cases of autochthonous VLH. The incidence rate was higher in the 0-4-year-old children, and the mortality and case fatality rates were higher in people aged 60 years and older. The peaks of incidence occurred in 2006 and 2011. The Bayesian rates identified the presence of VLH in all of the census tracts in the municipality; however, spatial and spatiotemporal clusters were found in the central area of the municipality.
  
  
  CONCLUSIONS
  Birigui, located in the Araçatuba region, has recently experienced increasing numbers of VLH cases; this increase is contrary to the behavior observed over the entire region, which has shown a decreasing trend in the number of VLH cases. The observations that the highest incidence is in children 0-4 years old and the highest mortality is in people 60 years and older are in agreement with the expected patterns of VLH.
authors: Curso de Graduação em Enfermagem, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Carolina Portugal
authors: CP
authors: Vieira
authors: Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Agda Maria
authors: AM
authors: Oliveira
authors: Programa de Pós-Graduação em Ciência Animal, Universidade Estadual Paulista Júlio de Mesquita Filho, Araçatuba, SP, Brazil.
authors: Lilian Aparecida Colebrusco
authors: LA
authors: Rodas
authors: Laboratório de Vetores de São José do Rio Preto, Superintendência de Controle de Endemias, Secretaria de Estado de Saúde de São Paulo, São José do Rio Preto, SP.
authors: Margareth Regina
authors: MR
authors: Dibo
authors: Laboratório de Vetores de São José do Rio Preto, Superintendência de Controle de Endemias, Secretaria de Estado de Saúde de São Paulo, São José do Rio Preto, SP.
authors: Marluci Monteiro
authors: MM
authors: Guirado
authors: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Francisco
authors: F
authors: Chiaravalloti Neto
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D062211:Spatio-Temporal Analysis; D055815:Young Adult