Technological innovations in health for the diagnosis and control of Visceral Leishmaniosis in the municipality of Bauru, State of São Paulo, Brazil

Abstract

Brazil is among the six countries that together account for 90% of the cases of the global incidence of Visceral Leishmaniasis (VL). In the last three decades LV stands out as one of the main problems of Public Health, present in the 5 Brazilian regions. The geographic dispersion of the disease takes place in jumps or continuously throughout the Brazilian territory, accompanying the highways and railroads through the traffic of people, major engineering works, moving through medium-sized cities and even large cities, producing new circuits of the disease, contrary to the delimitation of diseases of rural areas, with a much larger number of people currently exposed to the risk of becoming infected and sick than in any other time. Surveillance and control actions have resulted in successive failures, and the endemic progresses through new areas with impressive speed, morbidity and lethality. In the Americas, the dog is the main reservoir of L. infantum for transmission to insects that, once infected, may transmit the parasite through the bite. The LV Surveillance and Control Program (PVCLV) prioritizes actions for the diagnosis and early treatment of human cases; monitoring and reduction of sandfly abundance and control of domestic reservoirs that are infected dogs, as well as actions related to environmental management to reduce favorable conditions for colonization of L. longipalpis. LV is the main parasitic endemic in the State of São Paulo, and since 1998 there have been known natural outbreaks of transmission in Araçatuba, following almost all other regions. There are 193 municipalities with vector presence, of which 157 with human and / or canine transmission, since 1999 there are 2,917 human LV cases distributed in 92 municipalities; with a lethality rate of 8.5%, higher than the lethality in Brazil, around 7.0. Since 2002, Bauru is the main producer of human LV in the state, with 21.7% of the total indigenous LV cases. Canine prevalence exceeds 25% in certain localities. Identification, recollection and euthanasia of infected dogs aimed at reducing the sources of infection is the action of greater visibility and increasingly challenged by different segments of society, including the scientific community. Alternatives to control and reduce the incidence of canine LV include the use of insecticide collars, vaccination to prevent transmission and treatment of infected dogs to reduce parasitic load. Health Ministry does not recommend vaccination and treatment as measures in public health, due to insufficient scientific evidence of its effectiveness. The actions directed at the vectors are insufficient since indicators related to their ecology and the rates of natural infection in the outbreaks of transmission are unknown. The systematization of field information in digital storage structures, the relationship of these data with other systems (climatic and environmental, socioeconomic vulnerability) as well as the automation of the collection, validation, comparison and analysis processes can help to identify trends and patterns in the data series. With the construction of databases for the spatial location of the canine and human incidence rates; of the indices of abundance and vectorial infection, the environmental diagnosis, it will be possible to know in the areas and foci of transmission the spaces of convergence of two or more components of this chain (vector, dog, human and environment) allowing to plan and prioritize action strategies in responses for the surveillance and control of LV. Having as indicators of success the reduction of these rates and indexes will be able to carry out evaluations on the effectiveness of the territorial base in the surveillance and control of the LV and consequent revision of this public policy of surveillance and control of the LV with the incorporation of new strategies in the field technological innovation. (AU)