Dispersion of Lutzomyia longipalpis and expansion of visceral leishmaniasis in São Paulo State, Brazil: identification of associated factors through survival analysis

Background In Brazil, visceral leishmaniasis (VL) is a serious public health problem because of its magnitude, geographical expansion and potential harms caused by illnesses, including death. However, VL is largely ignored in discussions of tropical disease priorities. Thus, this study aimed to identify factors associated with the expansion of VL and the dispersion of its vector, Lutzomyia longipalpis , in the municipalities of the State of São Paulo, Brazil. Methods Information about the date of vector detection and the confirmation of autochthonous VL occurrence in humans and canines in São Paulo were obtained between 1997 and 2014. Survival curves were calculated by the Kaplan-Meier and the Cox multiple regression models was used. Results The presence of the Marechal Rondon highway showed the highest positive association with vector dispersion and canine and human VL expansion. The monthly maximum and minimum temperature averages recorded in the municipalities during the study period were also positively associated with these events. The presence of transverse highways was positively associated with the presence of the vector; the border with the State of Mato Grosso do Sul, the presence of a prison, microregion headquarters, and the presence of the Tietê River were positively associated with the occurrence of canine cases, while only the presence of prison was positively associated with the occurrence of human cases. The construction of the Bolivia-Brazil gas pipeline was not associated with any events. Conclusions Survival analysis enabled the identification of factors associated with vector dispersion and VL expansion, thus the results of this study may be useful to the improvement of VL surveillance and control activities in the State of São Paulo and throughout Brazil.