{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:43:30Z","timestamp":1788219810205,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust grant","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000769","name":"Infectious Diseases Data Observatory, Oxford University, UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000769","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization\/","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Clinical Research Leadership fellow"},{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Brazil accounts for &amp;gt;90% of visceral leishmaniasis (VL) cases reported in South America. VL is a notifiable disease in Brazil and patient records are captured in the Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o (SINAN) database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed 55 723 patient records from the SINAN system (2007\u20132023) to present temporal trends in patient demographics, drug regimens administered, and treatment outcomes. Disease incidence was modeled using a negative binomial regression, and predictors of mortality were assessed using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The VL incidence declined 6% annually (incidence rate ratio, 0.94 [95% confidence interval {CI}, 0.92\u20130.97]), primarily during 2019\u20132023. The median age at presentation was 10 years (interquartile range [IQR], 2\u201333 years) in 2007 and 32 years (IQR, 7\u201348 years) in 2023. The proportion of relapse at presentation also increased over time; compared to 2007\u20132009, the odds of relapse during 2019\u20132023 were 2.10-fold higher (95% CI, 1.87\u20132.37) adjusted for human immunodeficiency virus status. The use of liposomal amphotericin B increased markedly from 6.1% during 2007\u20132009 to 38.1% during 2019\u20132023, while antimony use declined from 68.0% to 32.7% over the same period. Following treatment, death from VL was highest among infants (&amp;lt;1y) (425\/4125 [10.3%]) and those &amp;gt;50 years of age (1471\/7615 [19.3%]), compared to the other age groups (3.5%, 2.2%, and 8.0% among ages \u22651 to &amp;lt;5, \u22655 to &amp;lt;15, and \u226515 to \u226450 years, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The shift toward older patients and increased relapse at presentation indicates a major change in disease epidemiology in Brazil. These findings highlight the need for prioritizing interventions for older and relapsing patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag035","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:42:13Z","timestamp":1769172133000},"source":"Crossref","is-referenced-by-count":2,"title":["Epidemiological Shifts in Visceral Leishmaniasis Incidence, Relapse, and Mortality in Brazil, 2007\u20132023: Analysis Using the National Notifiable Diseases Information System"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9951-5762","authenticated-orcid":false,"given":"Dawit Getachew","family":"Assefa","sequence":"first","affiliation":[{"name":"Infectious Diseases Data Observatory, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United 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Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5922-7539","authenticated-orcid":false,"given":"Caitlin","family":"Naylor","sequence":"additional","affiliation":[{"name":"Infectious Diseases Data Observatory, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1669-3716","authenticated-orcid":false,"given":"Rhys","family":"Peploe","sequence":"additional","affiliation":[{"name":"Infectious Diseases Data Observatory, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2892-3053","authenticated-orcid":false,"given":"Sauman","family":"Singh-Phulgenda","sequence":"additional","affiliation":[{"name":"Infectious Diseases Data Observatory, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1667-9287","authenticated-orcid":false,"given":"Makoto","family":"Saito","sequence":"additional","affiliation":[{"name":"Infectious Diseases Data Observatory, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United 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