Acute Chagas disease in Brazil from 2001 to 2018: A nationwide spatiotemporal analysis
Open Access
- 3 August 2020
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLoS Neglected Tropical Diseases
- Vol. 14 (8), e0008445
- https://doi.org/10.1371/journal.pntd.0008445
Abstract
In Brazil, acute Chagas disease (ACD) surveillance involves mandatory notification, which allows for population-based epidemiological studies. We conducted a nationwide population-based ecological analysis of the spatiotemporal patterns of ACD notifications in Brazil using secondary surveillance data obtained from the Notifiable Diseases Information System (SINAN) maintained by Brazilian Ministry of Health. In this nationwide population-based ecological all cases of ACD reported in Brazil between 2001 and 2018 were included. Epidemiological characteristics and time trends were analyzed through joinpoint regression models and spatial distribution using microregions as the unit of analysis. A total of 5,184 cases of ACD were recorded during the period under study. The annual incidence rate in Brazil was 0.16 per 100,000 inhabitants/year. Three statistically significant changes in time trends were identified: a rapid increase prior to 2005 (Period 1), a stable drop from 2005 to 2009 (Period 2), followed by another increasing trend after 2009 (Period 3). Higher frequencies were noted in males and females in the North (all three periods) and in females in Northeast (Periods 1 and 2) macroregions, as well as in individuals aged between 20–64 years in the Northeast, and children, adolescents and the elderly in the North macroregion. Vectorial transmission was the main route reported during Period 1, while oral transmission was found to increase significantly in the North during the other periods. Spatiotemporal distribution was heterogeneous in Brazil over time. Despite regional differences, over time cases of ACD decreased significantly nationwide. An increasing trend was noted in the North (especially after 2007), and significant decreases occurred after 2008 among all microregions other than those in the North, especially those in the Northeast and Central-West macroregions. In light of the newly identified epidemiological profile of CD transmission in Brazil, we emphasize the need for strategically integrated entomological and health surveillance actions. Chagas disease (CD) infection is a debilitating and neglected disease that occurs in 21 Latin America countries. CD has two distinct phases: acute and chronic. The generally asymptomatic acute phase begins shortly after infection and can last up to four months. When symptoms do appear, they are typically mild and unspecific. Following this phase, infected individuals evolve to a long-lasting chronic phase, which can be either symptomatic or asymptomatic. In Brazil, only acute cases are mandatorily notifiable in the Brazilian Notifiable Diseases Information System (Brazilian Ministry of Health). Most chronic cases are unknown and untreated. Considering that epidemiological data related to ACD is publicly available, we have analyzed the spatiotemporal distribution of notified cases of ACD and evaluated relevant epidemiological indicators throughout Brazil from 2001 to 2018. The data present here may contribute to surveillance actions designed at preventing new CD cases. We observed 5,184 cases of ACD during the period under study. The annual incidence rate in Brazil was 0.16 per 100,000 inhabitants/year. Three distinct epidemiological periods were identified: a rapid increase prior to 2005 (Period 1), a stable drop from 2005 to 2009 (Period 2), followed by another increasing trend after 2009 (Period 3). Vectorial transmission was the main route reported during Period 1, while oral transmission was found to increase significantly in the North during the other periods. Despite regional differences, over time cases of ACD decreased significantly nationwide. An increasing trend was noted in the North (especially after 2007). In light of the newly identified epidemiological profile of CD transmission in Brazil, we emphasize the need for strategically integrated entomological and health surveillance actions.Keywords
Funding Information
- Coordination of Superior Level Staff Improvement-Brazil (Finance Code 001)
- Brazilian National Council for Scientific and Technological Development (306222/2013-2)
- Gonçalo Moniz Institute
- Research Support Foundation of the State of Bahia
This publication has 44 references indexed in Scilit:
- Epidemiology of Mortality Related to Chagas' Disease in Brazil, 1999–2007PLoS Neglected Tropical Diseases, 2012
- O controle da transmissão vetorialRevista da Sociedade Brasileira de Medicina Tropical, 2011
- Chagas disease: A Latin American health problem becoming a world health problemActa Tropica, 2010
- Clinical Outcomes of Thirteen Patients with Acute Chagas Disease Acquired through Oral Transmission from Two Urban Outbreaks in Northeastern BrazilPLoS Neglected Tropical Diseases, 2010
- Oral Transmission of Chagas Disease by Consumption of Açaí Palm Fruit, BrazilEmerging Infectious Diseases, 2009
- Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005Revista da Sociedade Brasileira de Medicina Tropical, 2008
- Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studiesBMJ, 2007
- Soroprevalência da infecção chagásica em moradores de municípios da região de Botucatu, Estado de São PauloRevista da Sociedade Brasileira de Medicina Tropical, 2007
- Transmissão vetorial da doença de Chagas em Mulungu do Morro, Nordeste do BrasilRevista da Sociedade Brasileira de Medicina Tropical, 2003
- Sudden death in Chagas' diseaseArquivos Brasileiros de Cardiologia, 2001