title: Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012.
abstract: OBJECTIVE
  To describe the spatial patterns of leprosy in the Brazilian state of Tocantins.
  
  
  METHODS
  This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN - Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran's indexes.
  
  
  RESULTS
  A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran's index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins.
  
  
  CONCLUSIONS
  We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Lorena Dias
authors.initials: LD
authors.lastname: Monteiro
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Francisco Rogerlândio
authors.initials: FR
authors.lastname: Martins-Melo
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Aline Lima
authors.initials: AL
authors.lastname: Brito
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D001938:Brazil / Q000453:epidemiology; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D006801:Humans; D007918:Leprosy / Q000453:epidemiology*; D011159:Population Surveillance; D012111:Residence Characteristics; D012307:Risk Factors; D062206:Spatial Analysis