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Identifying spatiotemporal clusters of transmission is crucial for targeting surveillance and control efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify the spatial and temporal variation of high\u2010risk clusters for leprosy detection in Brazil (2001\u20132023) and priority areas for intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a nationwide, population\u2010based ecological study using Brazilian municipalities (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095570) as units of analysis. Frequencies, crude detection rates and age\u2010 and sex\u2010adjusted detection rates of newly recorded leprosy cases were calculated, based on the national Notifiable Diseases Information System (SINAN). Kulldorff's spatial scan statistic (Poisson model) was applied to overlapping three\u2010year periods to identify statistically significant high\u2010risk clusters. Neighbouring categories and changes between consecutive triennia were compared to classify municipalities into clusters based on persistence, entry, or exit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the study period, a total of 795,802 cases were reported (age\u2010 and sex\u2010adjusted detection rate: 17.58\/100,000 population; 95% CI: 17.54\u201317.62), with higher occurrence among males and residents of the Northeast region. Significantly high\u2010risk clusters were concentrated in the North, Northeast, and Central\u2010West regions; approximately 23% of municipalities were part of significant clusters in each triennium. The proportion of municipalities newly entering clusters increased from 10.7% (2003\u20132005 vs. 2001\u20132003) to 36.0% (2021\u20132023 vs. 2019\u20132021). In the most recent triennium (2021\u20132023), 16.9% of municipalities remained within significant clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The persistence and (re)emergence of high\u2010risk leprosy clusters in historically hyperendemic and socially vulnerable territories indicate sustained operational failures and demand programmatic prioritisation, with intensified surveillance, timely diagnosis and adequate treatment, particularly in the North, Northeast and Central\u2010West regions of Brazil.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70104","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:25:04Z","timestamp":1771251904000},"page":"532-546","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Persistent and Emerging 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