[Visceral Leishmaniasis Epidemic in the State of Piauí, Brazil, 1980-1986]

The kala-azar epidemic in the State of Piauí 1980-1986 is analyzed on the basis of the data collected by SUCAM Piauí. The outbreak began in towns of central and northern Piauí in 1980. In contrast what has happened in endemic periods in which the disease occurred in areas of higher altitude and semi-arid climate, the epidemic developed in humid tropical river valleys in rural zones. The epidemic was worst in the towns. The state capital, Teresina, hit in 1981, reached the epidemic peak in 1984 and accounted, for more than 60% of the 1,509 cases in the state. The epidemic was not substantial in those regions sprayed to combat malaria and Chagas' disease. While control in Teresina was attempted through intensive use of insecticides, the outbreak gave way spontaneously in rural areas. Neither the number of cases nor the phlebotomine population of Teresina presented significant seasonal variations but were moderately correlated. There was greater prevalence in children of 5 years of age or less, especially during the peak epidemic years, and much lesser prevalence in adults over 40 years of age. The geographical distribution of the epidemic process and its beginning, concomitant with a prolonged drought with its accompanying migration of people and domestic animals from endemic to epidemic regions, suggests that migration unleashed the epidemic. The fact that the epidemic process spontaneously relinquished its hold in areas where no control was attempted, indicates that the end of the epidemic cannot be attributed solely to measures of control. An analysis of the coefficients of specific incidence within age groups sparks the discussion about the possibility that progressive reduction of susceptibility (determined by the great number of asymptomatic infections as well as by long-lasting immunity) contributed to the extinction of the epidemic.