title: An update on the epidemiological situation of spotted fever in Brazil.
abstract: BACKGROUND
  Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs.
  
  
  METHODS
  This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015.
  
  
  RESULTS
  In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed.
  
  
  CONCLUSIONS
  The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil ; Graduate Program in Tropical Medicine, University of Brasília, Brasília, DF Brazil ; National Reference Laboratory of Vectors of Rickettsioses, Oswaldo Cruz foundation, Rio de Janeiro, RJ Brazil.
authors.forename: Stefan Vilges
authors.initials: SV
authors.lastname: de Oliveira
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Jessica Noronha
authors.initials: JN
authors.lastname: Guimarães
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Guilherme Carneiro
authors.initials: GC
authors.lastname: Reckziegel
authors.affiliation: Graduate Program in Infectious and Parasitic Diseases, School of Veterinary Medicine, University of Brasília, Brasília, DF Brazil.
authors.forename: Bidiah Mariano da Costa
authors.initials: BM
authors.lastname: Neves
authors.affiliation: Graduate Program in Tropical Medicine, University of Brasília, Brasília, DF Brazil.
authors.forename: Keline Medeiros de
authors.initials: KM
authors.lastname: Araújo-Vilges
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Lidsy Ximenes
authors.initials: LX
authors.lastname: Fonseca
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Fernanda Voietta
authors.initials: FV
authors.lastname: Pinna
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Simone Valéria Costa
authors.initials: SV
authors.lastname: Pereira
authors.affiliation: Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasília, DF Brazil.
authors.forename: Eduardo Pacheco
authors.initials: EP
authors.lastname: de Caldas
authors.affiliation: National Reference Laboratory of Vectors of Rickettsioses, Oswaldo Cruz foundation, Rio de Janeiro, RJ Brazil.
authors.forename: Gilberto Salles
authors.initials: GS
authors.lastname: Gazeta
authors.affiliation: Laboratory of Medical Parasitology and Vector Biology, School of Medicine, University of Brasília, Brasília, DF Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Gurgel-Gonçalves
keywords: Epidemiology; Information system; Rickettsial diseases; Tick-borne disease