Spatio-temporal analysis of leptospirosis in Brazil and its relationship with flooding.

Leptospirosis is a serious public health problem in Brazil, which can be observed after flooding events. Using an exploratory mixed clustering method, this ecological study analyzes whether spatial-temporal clustering patterns of leptospirosis occur in Brazil. Data from the Brazilian Unified Health System (SUS) were used to calculate the prevalence of leptospirosis between 2007 and 2017 in all counties of the country. Clustering techniques, including spatial association indicators, were used for analysis and evaluation of disease yearly spatial distribution. Based on Local Indicators of Spatial Association (LISA) with Empirical Bayesian rates detected spatial patterns of leptospirosis ranging from 0.137 (p = 0.001 in 2009) to 0.293 (p = 0.001 in 2008). Over the whole period, the rate was 0.388 (p = 0.001). The main pattern showed permanence of leptospirosis clusters in the South and emergence and permanence of such clusters in northern Brazil. The municipalities with leptospirosis cases and at least one flood occurrence registered in the Brazilian Integrated Disaster Information System were incorporated into the LISA cluster map with Empirical Bayesian rates. These counties were expected to exhibit clustering, not all did. The results of the cluster analysis suggest allocation of health resources in areas with leptospirosis clustering.