Dengue no Ceará: 19 anos sob perspectiva espacial e temporal

Abstract

The Northeast has always been one of the regions with high coefficients of dengue incidence and epidemics. In Ceará, dengue has a historical series with more than 30 years. The objective of this study was to identify the pattern of temporal and spatial distribution of dengue during the past 19 years. An exploratory ecological study of multiple groups, temporal and mixed, was carried out. The time trend analysis was performed using the Joinpoint Regression version 4.0.4. The other analyzes were carried out in four blocks of years: 2001 to 2019; 2001 to 2007; 2008 to 2013; 2014 to 2019. Purely spatial and spatio temporal analyzes were performed using the SatScan program version 9.6. Clusters with low and high relative risk were identified. Thematic maps were prepared using the ArcMap software. Clusters with only one city were excluded from the thematic maps. From 2001 to 2019, 539. 653 cases were confirmed across the state.The average annual percentage change revealed a significant reduction in cases over time (AAPC = -9.5; 95% CI = - 18.3 to -0.3). From 2001 to 2004, there was a decrease in the incidence rate, although not significant (APC = -20.9; 95% CI: - 65.1 to 44.8). From 2005 to 2015 the upward trend was also not significant (APC = 7.9; 95% CI: - 6.0 to 98.9). From 2016 to 2019 there was a significant reduction in incidence (APC = -48.8; 95% CI: - 83.0 to -6.1). In the purely temporal distribution, from 2001 to 2019, 9 clusters were identified, 2 of them with high relative risk, one to the south (RR = 2.41) and one to the east (RR = 1.64); from 2001 to 2007, 10 clusters, 3 of high risk, one to the south (RR = 3.12), one to the west (RR = 2.62), and one to the northwest (RR = 1.84); 2008 to 2013, 9 clusters, 1 of high risk in western Ceará (RR = 2.02); 2014 to 2019, 10 clusters, 4 high risk: one to the south (RR = 3.85), one to the west (RR = 3.13) and two to the east (RR = 2.80; RR = 2.43) . In the spatio temporal distribution, from 2001 to 2019, 7 clusters were identified, 3 being of high risk, one to the south (RR = 12.91), one to the east (RR = 8.40), one to the west (RR = 5, 12); from 2001 to 2007, 10 clusters, 4 were of high risk, two to the south (RR = 14.38; RR = 5.14), one to the west (RR = 4.72), one to the northwest (RR = 3 , 57); from 2008 to 2013, 5 clusters, 1 of high risk in the western region (RR = 3.40); from 2014 to 2019, 8 clusters, where 5 were of high risk: one in the east (RR = 9.24), one in the west (RR = 7.57), one in the central region (RR = 7.22), one to the south (RR = 3.81), one to the southeast (RR = 2.95). In Ceará, dengue presented a reduction in the incidence coefficient. During the epidemic years, the southern, eastern and western regions were the ones that most presented clusters with areas of high risk for dengue infection. Even in years of epidemic, some cities in the north, northwest, central and central-south regions were areas of low relative risk for dengue. The introduction of the virus in an area with low relative risk may cause explosive outbreaks, therefore, this makes them areas of great susceptibility to dengue epidemics.