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Urbanization of Brazilian spotted fever in a municipality of the southeastern region: epidemiology and spatial distribution.

INTRODUCTION
Brazilian spotted fever is an emerging zoonosis notified mainly in the Southeast of Brazil, especially due to its high level of lethality.


OBJECTIVE
To analyze the epidemiological and spatial pattern of the disease in the municipality of Valinhos (106,793 inhabitants), São Paulo, Southeastern region of Brazil, in the period between 2001 and 2012.


METHODS
All laboratory-confirmed cases with likely site of infection in the city (n = 49) notified in the Brazilian Case Registry Database were studied. Sites were geocoded using the cartographic base of the city and Google Earth (geographic coordinates) with correction according to the Brazilian Geodetic System. We used the Kernel estimator to analyze the density of the cases on the map. Land cover and distance to basins of all cases were analyzed. Information about tick species and primary hosts were obtained from reports of the Superintendence of Control of Endemic Diseases.


RESULTS
Seasonality of the disease was observed with the highest incidence from June to November, and in 2005 and 2011. The most affected groups were men (79.6%) aged 20-49 years old (49%). Lethality was found to be 42.9%. Maps showed the progressive registration of cases in the urban area. Capybaras were reported as the main primary host, and Amblyomma cajennense was identified in probable sites of infection during field investigation. The likely sites of infection were mostly located near basins, dirty pastures, and bordering woods.


CONCLUSIONS
The transmission pattern of Brazilian spotted fever in Valinhos is similar to that in other cities in the region, where capybara is the main primary host and an amplifier of R. rickettsii. Over the years, a higher occurrence of cases has been identified in the urban area of the city.