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Leishmaniasis represents a major neglected public health problem and the control measures have not been successful in Brazil. Recent studies have shown leishmaniasis importance to Brazilian border zones which reinforces the need to investigate its spread in those regions. This study aimed to analyze epidemiologic profile and its spatial distribution or aggregation process in both tegumentary and visceral leishmaniasis in the Brazilian border strip from 2009 to 2017. This is an ecological study of the epidemiological profile and spatial patterns encompassing municipalities in the Brazilian border strip. The presence of spatial autocorrelation and determination of priority areas for disease control were performed using global (Moran I) and local (LISA) Moran spatial techniques. The annual mean coefficients of tegumentary and visceral leishmaniasis were 29.8 and 0.6 by 100,000 inhabitants in the border strip, respectively. The indigenous population rates of leishmaniasis in the border zone appears to be higher than in the rest of the country (cutaneous changed from 33.2% to 6.6% and visceral rising from 1.0% to 17.5%) in the period. The most affected municipalities were located in the North and Central arches of the border zone. The results can subsidize the development of more targeted and effective strategies that can contribute to the surveillance and control of leishmaniasis in border zones, as the provision of epidemiological and spatial data on the disease. For better control of the disease, we recommend and emphasize the need to integrate public health policies of neighboring countries.

As leishmanioses representam dois milhões de novos casos anualmente e possuem transmissão endêmica em 98 países. Nas Américas, o Brasil apresenta o maior número de ocorrências da doença. Para além da conhecida relevância do estudo das leishmanioses neste país, os dados da situação na faixa de fronteira brasileira têm despertado interesse como problema de saúde pública. Assim, o principal objetivo do trabalho foi analisar o perfil epidemiológico e os processos de difusão/agregação espacial das leishmanioses tegumentar e visceral na região da faixa de fronteira do Brasil no período de 2009 a 2017. Para isso realizamos um estudo ecológico com os casos confirmados de LTA e LV notificados ao Ministério da Saúde (Brasil). O perfil epidemiológico foi descrito utilizando-se as variáveis: sexo, cor da pele/etnia, faixa etária e escolaridade. Foram realizadas análises espaciais dividindo-se o período de estudo em triênios: 2009-2011, 2012-2014 e 2015-2017. Para verificar a presença de autocorrelação espacial e determinar as áreas prioritárias para vigilância e controle da doença foram calculados os índices Moran global e local (LISA). Mapas foram elaborados com os softwares Terraview e Geoda. No período os casos confirmados de LTA no Brasil foram 176.132 dos quais 29.920 (17%) ocorreram na faixa de fronteira, com os respectivos coeficientes de detecção: 9,76/100.000 habitantes e 29,83 /100.000. Para LV, 33.684 casos ocorreram no Brasil dos quais 628 (1.8%) pertenceram à faixa de fronteira com os coeficientes de incidência de 1,85/100.000 e 0.61/100.000 habitantes, respectivamente. Para as duas formas de leishmanioses, o maior número de casos foi descrito em homens, raça parda e baixa escolaridade semelhante ao observado para todo o Brasil. A faixa etária prevalente na tegumentar foi 20 aos 39 anos (42,21%), enquanto na visceral em menores de 10 anos (48,09%). Em indígenas há uma elevada proporção de casos na faixa de fronteira para a forma tegumentar (6,66%) e visceral (17,52%), quando comparados com dados para todo o país, temos 3,22% e 1,05% respectivamente. A análise dos casos e incidência bruta demonstrou que os municípios mais afetados se distribuíram na região Norte e Central (principalmente na região Amazônica). Alguns municípios com maior incidência de LTA foram Serra do Navio (AP), Pedra Branca do Amapari (AP), Xapuri (AC) e Sena Madureira (AC) e para LV foram Uiramutã (RR), Pacaraima (RR) e Normandia (RR). Os índices de Moran global indicaram autocorrelação espacial positiva. As áreas definidas como maior prioridade para controle, nos três períodos avaliados, foram 69 para LTA e para LV identificamos quatro distribuídas nos arcos Norte e Central da faixa de fronteira. Esse trabalho pode proporcionar o desenvolvimento de estratégias mais direcionadas e eficazes que possam contribuir para a vigilância e controle das leishmanioses nas áreas de fronteira. Ressaltamos ainda a importância da integração entre os países de fronteira para melhor controle da doença. Leishmaniasis accounts for two million new cases annually with endemic transmission in 98 countries. In the Americas, Brazil has the highest number of cases of the disease. In addition to the recognized relevance of the study of leishmaniasis in this country, data from the Brazilian border strip have generated interest as a public health problem. This reinforces the relevance of the study of leishmaniasis in this country, especially in the Brazilian border area. Thus, the main objective of this study was to analyze the epidemiological profile and spatial diffusion/clustering processes of tegumentary and visceral leishmaniasis in the border region of Brazil from 2009 to 2017. We performed an ecological study with the confirmed cases of LTA and LV notified to the Ministry of Health (Brazil). The epidemiological profile was described considering the following variables: gender, skin color/ethnicity, age range and years of schooling. Spatial analyzes were carried out dividing the study period in triennium: 2009 to 2011, 2012 to 2014 and 2015 to 2017. In order to verify the presence of spatial autocorrelation and determine the priority areas for surveillance and control of the disease, the global and local(LISA) Moran indices were calculated. Maps were developed with Terraview and Geoda softwares. In the period, the confirmed cases of LTA in Brazil were 176,132 of which 29,920 (17%) occurred in the border strip, with the respective detection coefficients: 9.76 / 100,000 inhabitants and 29.83 / 100.000. For LV, 33,684 cases occurred in Brazil, of which 6.28 (1.8%) belonged to the border with the incidence coefficients of 1.85 / 100.000 inhabitants and 0.61 / 100.000 inhabitants respectively. For the two clinical forms of leishmaniasis the largest number of cases were observed in males, skin color brown and low years of schooling similar to the data observed for Brazil. The prevalent age group for patients with the tegumentary form was 20 to 39 years old (42.21%) while in the visceral we observed younger than 10 years (48.09%). In indigenous, we found a high proportion of cases in the border strip for tegumentary form (6.66%) and visceral (17.52%) when compared with data for the whole country (3.22% and 1.05%, respectively). The analysis of the cases and incidence showed that the municipalities most affected were distributed in the North and Central regions (mainly in Amazon Region). Some municipalities with higher incidence of LTA were Serra do Navio (AP), Pedra Branca do Amapari (AP), Xapuri (AC) and Sena Madureira (AC) and for LV were Uiramutã (RR), Pacaraima (RR) and Normandia (RR). The Global Moran indices indicated positive spatial autocorrelation. The areas defined as highest priority for control in the three evaluated periods were 69 for LTA and for LV we found 4 areas distributed in the North and Central arcs of the border strip. This work may guide the development of more targeted and effective strategies that may contribute to the surveillance and control of leishmaniasis in the areas of Brazilian border strip. We also emphasize the importance of integration between border countries for better control of the disease.