title: Spatial and spatiotemporal occurrence of human visceral leishmaniasis in Adamantina, State of São Paulo, Brazil.
abstract: BACKGROUND
  Several municipalities of the Western region of the State of São Paulo have been affected by human visceral leishmaniasis (HVL), including the City of Adamantina, where the first autochthonous cases occurred in 2004. Therefore, this study aimed to describe the spatial and spatiotemporal occurrence of HVL in Adamantina.
  
  
  METHODS
  Secondary data regarding the occurrence of HVL in Adamantina between 2004 and 2011 were used. Incidence, mortality, and case fatality rates were calculated. We used local empirical Bayesian incidence rates to represent the occurrence of the disease in the census sector of the city. The existence of spatial and spatiotemporal clusters of cases was evaluated using scan statistics. In situ observation was performed to assess the socioeconomic and environmental characteristics of the areas with medium and high incidences.
  
  
  RESULTS
  Adamantina reported cases in 70% of its census sectors. No differences were observed between sexes. The group aged 0-4 years presented the highest incidence and mortality rates, and the group aged 40-59 years presented the highest fatality rate. We detected a spatiotemporal cluster, which coincided with the commencement of the endemic in the city.
  
  
  CONCLUSIONS
  The individuals most affected by the disease were children. The disease was present in areas with better and worse socioeconomic conditions. The use of spatial analysis techniques was important to achieve the study objectives.
authors.affiliation: Faculdades Adamantinenses Integradas, Adamantina, São Paulo, Brazil.
authors.forename: Marisa Furtado Mozini
authors.initials: MF
authors.lastname: Cardim
authors.affiliation: Curso de Graduação em Enfermagem, Escola de Enfermagem, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Carolina Portugal
authors.initials: CP
authors.lastname: Vieira
authors.affiliation: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Chiaravalloti-Neto
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D013029:Space-Time Clustering; D055815:Young Adult