@article{103364,
  keywords = {Brazil, SINAN, Mortality, Relapse, Visceral Leishmaniasis},
  author = {Assefa D and Cota G and Wilson J and Mendes J and Naylor C and Peploe R and Singh-Phulgenda S and Saito M and Guérin P and Dahal P},
  title = {Epidemiological Shifts in Visceral Leishmaniasis Incidence, Relapse, and Mortality in Brazil, 2007-2023: Analysis Using the National Notifiable Diseases Information System.},
  abstract = {<p><strong>BACKGROUND: </strong></p>

<p>Brazil accounts for &gt;90% of visceral leishmaniasis (VL) cases reported in South America. VL is a notifiable disease in Brazil and patient records are captured in the Sistema de Informação de Agravos de Notificação (SINAN) database.</p>

<p><strong>METHODS: </strong></p>

<p>We reviewed 55 723 patient records from the SINAN system (2007-2023) to present temporal trends in patient demographics, drug regimens administered, and treatment outcomes. Disease incidence was modeled using a negative binomial regression, and predictors of mortality were assessed using logistic regression.</p>

<p><strong>RESULTS: </strong></p>

<p>The VL incidence declined 6% annually (incidence rate ratio, 0.94 [95% confidence interval {CI}, 0.92-0.97]), primarily during 2019-2023. The median age at presentation was 10 years (interquartile range [IQR], 2-33 years) in 2007 and 32 years (IQR, 7-48 years) in 2023. The proportion of relapse at presentation also increased over time; compared to 2007-2009, the odds of relapse during 2019-2023 were 2.10-fold higher (95% CI, 1.87-2.37) adjusted for human immunodeficiency virus status. The use of liposomal amphotericin B increased markedly from 6.1% during 2007-2009 to 38.1% during 2019-2023, while antimony use declined from 68.0% to 32.7% over the same period. Following treatment, death from VL was highest among infants (&lt;1y) (425/4125 [10.3%]) and those &gt;50 years of age (1471/7615 [19.3%]), compared to the other age groups (3.5%, 2.2%, and 8.0% among ages ≥1 to &lt;5, ≥5 to &lt;15, and ≥15 to ≤50 years, respectively).</p>

<p><strong>CONCLUSIONS: </strong></p>

<p>The shift toward older patients and increased relapse at presentation indicates a major change in disease epidemiology in Brazil. These findings highlight the need for prioritizing interventions for older and relapsing patients.</p>
},
  year = {2026},
  journal = {Open forum infectious diseases},
  volume = {13},
  pages = {1-11},
  month = {02/2026},
  issn = {2328-8957},
  url = {https://pmc.ncbi.nlm.nih.gov/articles/PMC12910620/pdf/ofag035.pdf},
  doi = {10.1093/ofid/ofag035},
  language = {ENG},
}