Padrões espaciais, dispersão e fatores associados à febre amarela silvestre no Sudeste do Brasil entre 2016 e 2019

Abstract

Yellow fever is an arbovirus with high epidemic potential and lethality, where the wild cycle has generated epidemic waves that originate in the Amazon region and reach the rest of Brazil, demanding eco-epidemiological aspects need to be better understood. Therefore, this study theorized and analyzed the distribution and dispersion patterns of sylvatic yellow fever (SYF), and determined the spatiotemporal risk and factors associated with the occurrence of human cases in Southeastern Brazil between 2016 and 2019. Search from various sources (Ministry of Health, IBGE, WorldClim, Copernicus, MapBiomas and literature), comparable in tables, graphs and maps, need for statistical tools and spatial and temporal analysis (Global and Local Moran Index, Kernel Density , Directional Distribution, Multivariate Logistic Regression, and Spatiotemporal Relative Risk). A total of 2,178 human cases of SYF were confirmed, mainly in rural worker male brown, whose lethality was greater when its location was remote. 2,911 epizootics were confirmed, mainly Alouatta, the main sentinel. Regions with low vaccination coverage were located, which formed epidemic clusters superimposed space-time over the epidemic regions, with gaps explained by environmental factors. The odds ratio of occurrence of human cases of YFW in the municipalities increased with the increase in gender richness and abundance of epizootics, with low vaccination coverage, with high annual precipitation, with low elevation and average annual temperature, land use dominated by forest formation and low urbanization. The SYF dispersed along two main routes, observed in previous cycles, from the south of Goiás to Paraná and from the north of Goiás to Rio de Janeiro, silently permeating through favorable eco-epidemiological corridors, causing severe epidemics in certain stretches, having its circulation impeded temporarily or definitely, contributing to the existence of the wild cycle regardless of political and administrative boundaries. High vaccination coverage is effective against urbanization, but it does not impede circulation in wild environments, maintaining the permanent risk of urban transmission. The results reinforce the need to study the risk of SYF overflow and dispersion dynamics in the human-animal-environment interface, to support preventive and multisectoral measures, in addition to strengthening the Brazilian Unified Health System.