title: Vulnerability of Brazilian municipalities to hantavirus infections based on multi-criteria decision analysis.
abstract: BACKGROUND
  Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease.
  
  
  METHODS
  Incidence of hantavirus infections in Brazil (1993-2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities' vulnerability to disease by means of multi-criteria decision analysis (MCDA).
  
  
  RESULTS
  From 1993 to 2013, 1752 cases of hantavirus were registered in 16 Brazilian states. The highest incidence of hantavirus was observed in the states of Mato Grosso (0.57/100,000) and Santa Catarina (0.13/100,000). Based on MCDA analysis, municipalities in the southern, southeastern, and midwestern regions of Brazil can be classified as highly vulnerable. Most municipalities in northern and northeastern Brazil were classified as having low vulnerability to hantavirus cardiopulmonary syndrome.
  
  
  CONCLUSIONS
  Although most human infections by hantavirus registered in Brazil occurred in the southern region of the country, a greater vulnerability to hantavirus was found in the Brazilian Midwest. This result reflects the need to strengthen surveillance where the disease has thus far gone unreported.
authors.affiliation: Programa de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil ; Coordenação Geral de Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Stefan Vilges
authors.initials: SV
authors.lastname: de Oliveira
authors.affiliation: Coordenação Geral de Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Lidsy Ximenes
authors.initials: LX
authors.lastname: Fonseca
authors.affiliation: Programa de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
authors.forename: Keline Medeiros
authors.initials: KM
authors.lastname: de Araújo Vilges
authors.affiliation: Coordenação Geral de Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Fernanda Voietta Pinna
authors.initials: FV
authors.lastname: Maniglia
authors.affiliation: Coordenação Geral de Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Simone Valéria Costa
authors.initials: SV
authors.lastname: Pereira
authors.affiliation: Coordenação Geral de Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Eduardo Pacheco
authors.initials: EP
authors.lastname: de Caldas
authors.affiliation: Programa de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
authors.forename: Pedro Luiz
authors.initials: PL
authors.lastname: Tauil
authors.affiliation: Laboratório de Parasitologia Médica e Biologia de Vetores, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Gurgel-Gonçalves
keywords: Epidemiology; Hantavirus; Projections and predictions