title: Urbanization of Brazilian spotted fever in a municipality of the southeastern region: epidemiology and spatial distribution.
abstract: BACKGROUND
  Brazilian spotted fever is an emerging zoonosis notified mainly in the Southeast of Brazil, especially due to its high level of lethality.
  
  
  OBJECTIVE
  To analyze the epidemiological and spatial pattern of the disease in the municipality of Valinhos (106,793 inhabitants), São Paulo, Southeastern region of Brazil, in the period between 2001 and 2012.
  
  
  METHODS
  All laboratory-confirmed cases with likely site of infection in the city (n = 49) notified in the Brazilian Case Registry Database were studied. Sites were geocoded using the cartographic base of the city and Google Earth (geographic coordinates) with correction according to the Brazilian Geodetic System. We used the Kernel estimator to analyze the density of the cases on the map. Land cover and distance to basins of all cases were analyzed. Information about tick species and primary hosts were obtained from reports of the Superintendence of Control of Endemic Diseases.
  
  
  RESULTS
  Seasonality of the disease was observed with the highest incidence from June to November, and in 2005 and 2011. The most affected groups were men (79.6%) aged 20-49 years old (49%). Lethality was found to be 42.9%. Maps showed the progressive registration of cases in the urban area. Capybaras were reported as the main primary host, and Amblyomma cajennense was identified in probable sites of infection during field investigation. The likely sites of infection were mostly located near basins, dirty pastures, and bordering woods.
  
  
  CONCLUSIONS
  The transmission pattern of Brazilian spotted fever in Valinhos is similar to that in other cities in the region, where capybara is the main primary host and an amplifier of R. rickettsii. Over the years, a higher occurrence of cases has been identified in the urban area of the city.
authors.affiliation: Laboratory of Spatial Analysis of Epidemiological Data, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Jeanette Trigo
authors.initials: JT
authors.lastname: Nasser
authors.affiliation: Department of Public Health of Valinhos, Secretariat of Health of Valinhos, Valinhos, SP, Brazil.
authors.forename: Rafael César
authors.initials: RC
authors.lastname: Lana
authors.affiliation: Department of Public Health of Valinhos, Secretariat of Health of Valinhos, Valinhos, SP, Brazil.
authors.forename: Claudia Maria dos Santos
authors.initials: CM
authors.lastname: Silva
authors.affiliation: School of Environmental Engineering, Universidade Estadual Paulista Júlio de Mesquita Filho, Sorocaba, SP, Brazil.
authors.forename: Roberto Wagner
authors.initials: RW
authors.lastname: Lourenço
authors.affiliation: School of Environmental Engineering, Universidade Estadual Paulista Júlio de Mesquita Filho, Sorocaba, SP, Brazil.
authors.forename: Darllan Collins
authors.initials: DC
authors.lastname: da Cunha e Silva
authors.affiliation: Laboratory of Spatial Analysis of Epidemiological Data, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Donalísio
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013984:Tick Infestations / Q000453:epidemiology; D014507:Urbanization; D055815:Young Adult