{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:15:55Z","timestamp":1790799355843,"version":"4.1.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T00:00:00Z","timestamp":1583971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Universidad UTE"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Leptospirosis is a zoonotic disease that is considered an important public health problem in tropical regions and the world's poorest countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this ecological study, we included cases of leptospirosis reported in Ecuador from 2013 to 2018. Spatial autocorrelation was evaluated through the global Moran I index and spatial-temporal scan statistics were used to identify high-risk clusters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In Ecuador, the leptospirosis incidence rates decreased from 3.3 cases per 100\u2009000 population in 2013 to 0.8 cases per 100\u2009000 population in 2018. The global Moran I index for the study period showed a positive spatial autocorrelation (0.68; p=0.001). We identified three significant spatial-temporal clusters for a high occurrence of leptospirosis incidence located in cantons of the Coast and Amazon regions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The clusters identified could be targeted by policymakers and stakeholders in order to direct surveillance and understand the dynamics of the distribution of leptospirosis in Ecuador.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trz124","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T20:13:04Z","timestamp":1573503184000},"page":"545-548","source":"Crossref","is-referenced-by-count":9,"title":["Spatial patterns of leptospirosis in Ecuador, 2013\u20132018"],"prefix":"10.1093","volume":"114","author":[{"given":"Solange","family":"N\u00fa\u00f1ez-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n en Salud P\u00fablica y Epidemiolog\u00eda Cl\u00ednica (CISPEC), Universidad UTE, Quito 170129, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gault","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n en Salud P\u00fablica y Epidemiolog\u00eda Cl\u00ednica (CISPEC), Universidad UTE, Quito 170129, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Granja","sequence":"first","affiliation":[{"name":"Instituto de Salud P\u00fablica (ISP), Pontificia Universidad Cat\u00f3lica del Ecuador, Quito 17012184, Ecuador"},{"name":"Posgrado de Medicina Tropical, Facultad de Medicina, Universidad Mayor de San Sim\u00f3n, Cochabamba 4973, Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Simancas-Racines","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n en Salud P\u00fablica y Epidemiolog\u00eda Cl\u00ednica (CISPEC), Universidad UTE, Quito 170129, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"issue":"10","key":"2020070405340181200_ref1","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1038\/nrmicro2208","article-title":"Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen","volume":"7","author":"Ko","year":"2009","journal-title":"Nat Rev Microbiol."},{"key":"2020070405340181200_ref2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global morbidity and mortality of Leptospirosis: a systematic review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"2020070405340181200_ref3","doi-asserted-by":"crossref","first-page":"e0004039","DOI":"10.1371\/journal.pntd.0004039","article-title":"Leptospirosis: updating the global picture of an emerging neglected disease","volume":"9","author":"Pereira","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"2020070405340181200_ref4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004122","article-title":"Global burden of leptospirosis: estimated in terms of disability adjusted life years","volume":"9","author":"Torgerson","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"2020070405340181200_ref5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0138311","article-title":"Epidemiology of Tropical Neglected Diseases in Ecuador in the Last 20 Years","volume":"10","author":"Cartelle Gestal","year":"2015","journal-title":"PLoS One."},{"key":"2020070405340181200_ref6","volume-title":"Direcci\u00f3n Nacional de Vigilancia Epidemiol\u00f3gica, Gaceta Epidemiol\u00f3gica \u2013 Ministerio de Salud P\u00fablica"},{"key":"2020070405340181200_ref7","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1538-4632.1995.tb00338.x","article-title":"Local indicators of spatial association\u2014LISA","volume":"27","author":"Anselin","year":"1995","journal-title":"Geogr Anal."},{"key":"2020070405340181200_ref8","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1371\/journal.pmed.0020059","article-title":"A space\u2013time permutation scan statistic for disease outbreak detection","volume":"2","author":"Kulldorff","year":"2005","journal-title":"PLoS Med"},{"key":"2020070405340181200_ref9","first-page":"41","article-title":"A road map for leptospirosis research and health policies based on country needs in Latin America","volume":"e131","author":"Pereira","year":"2018","journal-title":"Rev Panam Salud Publica."},{"key":"2020070405340181200_ref10","author":"MAE"},{"key":"2020070405340181200_ref11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004990","article-title":"High leptospira diversity in animals and humans complicates the search for common reservoirs of human disease in rural Ecuador","volume":"10","author":"Barragan","year":"2016","journal-title":"PLoS Negl Trop Dis."},{"key":"2020070405340181200_ref12","first-page":"13","article-title":"Cartograf\u00eda de las Amenazas de Origen Natural por Cant\u00f3n en el Ecuador","volume":"66","author":"Demoraes","year":"2001","journal-title":"Hal Arch Ouvert."},{"key":"2020070405340181200_ref13","author":"INEC-Instituto Nacional de Estadistica y Censos"},{"key":"2020070405340181200_ref14","author":"Secretar\u00eda T\u00e9cnica Planifica Ecuador"},{"key":"2020070405340181200_ref15","volume-title":"Instituto Nacional de Estad\u00edstica y Censos y UNICEF (INEC-UNICEF)","author":"Vera"},{"key":"2020070405340181200_ref16","author":"del Agua"},{"key":"2020070405340181200_ref17","volume-title":"Rendici\u00f3n de Cuentas","author":"Ministerio de Salud P\u00fablica de Ecuador","year":"2018"},{"key":"2020070405340181200_ref18","article-title":"Manual de procedimientos del Subsistema alerta acci\u00f3n SIVE \u2013 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