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TJMT – COURT OF JUSTICE OF THE STATE OF MATO GROSSO. Civil Appeal No. 1001086-
96.2021.8.11.0025. Rel. Des. João Ferreira Filho. Judged on 28 Nov. 2023. Available at: https://www.
jusbrasil.com.br. Accessed on: 14 Apr. 2025.
TJSP – COURT OF JUSTICE OF THE STATE OF SÃO PAULO. Interlocutory Appeal – District of
São José dos Campos – Case No. 2259654-63.2022.8.26.0000. Rel. Des. Maria Lúcia Pizzotti. Judged
on: 10 Oct. 2022. Available at: https://www.jusbrasil.com.br. Accessed on: 14 Apr. 2025.
WEN, C. L. Telemedicine: current panorama and perspectives for Brazil. Journal of the Brazilian
Society of Family and Community Medicine, v. 15, n. 1, p. 1-12, 2020.
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EPIDEMIOLOGICAL ANALYSIS OF SCHISTOSOMIASIS IN THE MUNICI-
PALITY OF EUNÁPOLIS (BA): A DESCRIPTIVE STUDY BASED ON SUR-
VEILLANCE DATA FROM 2017 TO 2022
Diana de Lima1
Flaelma Almeida da Silva2
Kaio Henrique Paiva Mezete3
Adma Rita Kirmse Pereira4
Ronnie Walter Lima Monteiro5
Abstract: Schistosomiasis is a parasitic endemic disease caused by the helminth Schistosoma mansoni,
whose transmission cycle involves humans as the denitive host and snails of the Biomphalaria genus
as intermediate hosts. In Brazil, its persistence is directly linked to poor sanitation and frequent
exposure to contaminated freshwater bodies, especially in socioeconomically vulnerable regions.
This study aimed to characterize the epidemiological prole of schistosomiasis in the municipality of
Eunápolis, Bahia, from 2017 to 2021, in order to support targeted surveillance and control strategies.
This is a descriptive, quantitative, and cross-sectional research based on secondary data from the
Notiable Diseases Information System (SINAN) and the Schistosomiasis Control Program (PCE).
Data were analyzed using Microsoft Excel spreadsheets, with calculations of prevalence, incidence,
and relative frequency. A total of 113 conrmed cases of schistosomiasis were recorded during the
study period, predominantly among males (54.9%) aged between 30 and 59 years. The years 2017
and 2018 showed the highest number of cases, followed by a declining trend in subsequent years.
1 PhD in Environmental Engineering Sciences, CETSC Professor at the Pitágoras Faculty of
Medicine in Eunápolis.
2 Master in Education, CETSC Professor at the Pitágoras Faculty of Medicine in Eunápolis.
3 Student of the Medicine Course at the Pitágoras Faculty of Medicine in Eunápolis.
4 Student of the Medicine Course at the Pitágoras Faculty of Medicine in Eunápolis.
5 Student of the Medicine Course at the Pitágoras Faculty of Medicine in Eunápolis.
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The neighborhoods with the highest relative frequencies were Pequi, Juca Rosa, and Alecrim II. The
ndings highlight the continued active transmission of schistosomiasis in the municipality, associated
with structural factors such as lack of basic sanitation and occupational or recreational exposure to
contaminated aquatic environments, emphasizing the need for active surveillance, health education,
and intersectoral vector control actions.
Keywords: Schistosomiasis. Epidemiological Surveillance. Public Health. Eunápolis-BA.
Introduction
Schistosomiasis, also known as bilharziasis, is an infectious and parasitic waterborne disease
caused by the trematode Schistosoma mansoni, whose occurrence still poses an important challenge
to public health in Brazil. Its evolutionary cycle requires the presence of humans as the denitive host
and mollusks of the genus Biomphalaria as intermediate hosts. Infection occurs through the active
penetration of cercariae through human skin during contact with contaminated water collections,
such as dams, rivers and streams (Luz Neto, 2003).
According to data from the Ministry of Health (Brasil, 2019), Brazil remains one of the main
endemic areas in the world, concentrating most cases in the North and Northeast regions. Structural
factors such as the precariousness of basic sanitation, direct contact with natural waters in the daily
lives of vulnerable communities and the absence of health education contribute decisively to the
maintenance of the disease cycle (Silva and Domingues, 2011 apud Jordão et al., 2014). According
to Neves (2005), the spread of schistosomiasis in the Brazilian territory is also related to disordered
internal migratory ows and the wide dispersion of mollusk vectors. Under these conditions, the
simple coexistence between infected snails and contaminated human waste in aquatic environments
becomes sufcient for the sustained spread of the disease.
The scientic literature demonstrates that schistosomiasis is profoundly determined by social,
cultural, and occupational factors. According to Coura-Filho et al. (1994), activities such as shing,
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agriculture, washing clothes and bathing in rivers are directly associated with greater exposure to
the infectious agent, especially in low-income areas. In addition, classic studies by Barbosa (1968)
and the World Health Organization (1985), cited by Coura-Filho et al. (1995), already pointed out
that the epidemiological prole of schistosomiasis is not restricted to biological aspects, but is part of
a network of social inuences related to the organization of the territory, leisure, culture and work.
Although old, these authors are considered a founding reference in studies on the disease and remain
current for elucidating the structuring elements of the transmission chain.
The absence of adequate sanitary infrastructure, the dependence on water bodies for
consumption and hygiene, and the discontinuity of public policies to control schistosomiasis are still
persistent realities in many Brazilian municipalities, including Bahia. Recent studies reinforce that,
even with the expansion of control programs, the disease remains active in inland areas, revealing
failures in surveillance and coverage of sanitation services (Chiles et al., 2020). In the state of Bahia,
the endemic presence of schistosomiasis is historically documented, especially in municipalities in the
extreme southern region, such as Eunápolis, which is part of the so-called Discovery Coast. Despite
this, local data on the prevalence, incidence, and sociodemographic prole of the disease remain
limited.
In Eunápolis, a municipality with an estimated population of more than 115 thousand
inhabitants and still decient sanitary sewage coverage, the socio-environmental conditions favor the
maintenance of schistosomiasis transmission. The scarcity of local studies prevents accurate mapping
of critical areas, hindering territorialized interventions and limiting intersectoral planning. In this
context, it is urgent to produce updated epidemiological evidence that supports effective surveillance,
prevention, and control actions.
In view of this scenario, the present study aims to analyze the epidemiological prole of
schistosomiasis in the municipality of Eunápolis (BA), from 2017 to 2022, based on secondary data
from ofcial health information systems. By describing the temporal, spatial and sociodemographic
distribution of reported cases, this research seeks to contribute to the strengthening of local
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epidemiological surveillance, supporting the formulation of public policies oriented to the reality of
the territory.
Methodology
This is a descriptive epidemiological study, with a cross-sectional design and quantitative
approach, based on the analysis of secondary data from ofcial health surveillance systems. The
objective was to describe the behavior of schistosomiasis in the municipality of Eunápolis (BA), based
on the occurrence, distribution, and frequency of cases reported between 2017 and 2022.
The study was carried out in the municipality of Eunápolis, located in the southern region of
the state of Bahia, belonging to the Southern Bahia Mesoregion and the Porto Seguro Microregion.
The municipality has a territorial extension of 1,179.126 km², with an average altitude of 189 meters and
approximate geographic coordinates of 16°22’23’’ south latitude and 39°34’30’’ west longitude (IBGE,
2010; Amaral et al., 2018). It is characterized as an urban regional center with high socioeconomic
heterogeneity and areas with insufcient health coverage, factors known to be associated with the
maintenance of the schistosomiasis cycle.
The data sources used were the records of the Notiable Diseases Information System (SINAN)
and the Schistosomiasis Control Program (PCE), accessed from the Municipal Health Department
of Eunápolis. These databases provided information on the number of conrmed cases, year of
notication, gender, age group, neighborhood of residence, and location of individuals diagnosed with
schistosomiasis. Population data for calculating the rates were obtained from the Brazilian Institute of
Geography and Statistics (IBGE), based on annual estimates of the municipality’s population.
The study population corresponded to the total number of conrmed cases of schistosomiasis
in the municipality in the period between January 1, 2017 and December 31, 2022. Only cases with
conrmed laboratory diagnosis and complete registration as to the location of occurrence were
considered. Imported cases or records with inconsistent or incomplete information were not included.
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The variables analyzed were: absolute number of cases per year, distribution by sex and
age group, frequency by neighborhood/locality, and annual prevalence and incidence of the disease.
To calculate the prevalence, the ratio between the number of existing cases in a given year and the
estimated population for the same period, multiplied by 100,000 inhabitants, was used. The incidence
was calculated by the ratio between the number of new cases diagnosed and the exposed population,
also multiplied by 100,000 inhabitants (Wagner, 1998). All indicators were organized by year of
notication.
The organization and descriptive analysis of the data was carried out using Microsoft Excel
spreadsheets, using simple tabulation and graph construction resources. The results were presented in
absolute and relative frequencies and rates per 100,000 inhabitants. The interpretation of the ndings
was complemented based on a narrative review of the scientic literature, in order to contextualize the
local data to the regional and national trends already documented on schistosomiasis.
As this is a study based exclusively on secondary data, in the public domain and without
individual identication of the subjects, it was not necessary to submit the project to the ethics
committee, according to Resolution No. 510/2016 of the National Health Council.
Analysis and Discussion of Results
The epidemiological analysis of schistosomiasis in the municipality of Eunápolis (BA),
between 2017 and 2022, revealed a total of 113 conrmed cases, evidencing the persistence of the
disease as a public health problem in the region. The data indicate a higher concentration of cases
in 2017 and 2018, with a downward trend in subsequent years, which may be related to both control
actions and possible underreporting.
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Graph 1. Conrmed cases of schistosomiasis in the Municipality of Eunápolis-BA, from 1975 to 2017
Source: Study Data, 2024.
In 2017, 43 cases were reported, a number that was repeated in 2018, representing, together,
76% of all records in the period. From 2019 onwards, there was a signicant reduction: 17 cases in
2019, 5 in 2020, 9 in 2021 and only 1 case in 2022. This oscillation may reect the variability in the
effectiveness of surveillance and vector control actions, as well as uctuations in the notication
processes, as also observed by Pereira (2019) in a study conducted in the state of Pará.
The peak of notications between 2017 and 2018 coincides with periods in which the Health
Surveillance of Eunápolis intensied eld actions, which suggests that the increase in numbers may
be partially linked to greater detection capacity and not necessarily to an outbreak. This hypothesis is
compatible with the ndings of Oliveira et al. (2024), who point to the discontinuity of notications as
one of the main challenges to accurately measure the real burden of schistosomiasis in Brazil.
The distribution of cases according to sex showed a predominance of men, with 62 records
(54.9%) among men and 51 (45.1%) among women. This proportion contrasts with the regional
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panorama described by Chiles et al. (2020), who identied a higher prevalence of the disease in women
with low education in the Discovery Coast region, to which Eunápolis belongs. Such divergence
points to possible territorial and occupational singularities specic to the municipality.
The national literature presents different ndings in relation to the most affected sex. While
Jordão et al. (2014) observed a male predominance between 2001 and 2011 in the state of Alagoas,
attributed to the greater occupational exposure of men in activities such as shing and agriculture,
Chiles et al. (2020) indicate that, in certain urban contexts, the greater vulnerability of women may
be related to the overload of domestic tasks performed in unhealthy environments. Both patterns
illustrate how social determinants shape local disease dynamics.
The distribution by age group revealed a concentration of cases among adults aged 30 to 59
years, both in males and females. In the case of men, the highest frequency was observed between 30
and 39 years old (25.81%), while among women, the cases were concentrated in the 40 to 49 years and
60 to 69 years old groups (both with 22.45%).
Graph 2. Absolute frequency of conrmed cases of schistosomiasis by age group in the municipality
of Eunápolis-BA, in the period 2017-2021
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Source: Study Data, 2024.
This age concentration is compatible with the occupational exposure prole pointed out by
Coura-Filho et al. (1994), who identied as the main risk factors the involvement with agricultural,
shing and leisure activities in rivers, common practices among adults of economically active age.
The frequency of cases in more advanced age groups, such as 60 to 69 years of age, may also be
associated with accumulated chronic exposure and recurrence of infections in populations with a
history of prolonged contact with contaminated environments.
Regarding the spatial distribution of cases, the neighborhoods with the highest relative
frequencies were Pequi (13.27%), Juca Rosa (10.62%) and Alecrim II (10.62%), followed by Rosa
Neto, Urbis III and Iris Lopes, all with percentages above 6%.
Graph 3: Relative frequency (%) by neighborhood/locality – 2017 to 2022
Source: Study Data, 2024.
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These locations concentrate populations with lower urban development rates, high population
density and precarious coverage of sanitary infrastructure.
Gonçalves et al. (2016), when studying the urban expansion of Eunápolis, identied that only
20.4% of the families in the municipality are served by a sanitary sewage network, which forces most
of the population to resort to rudimentary cesspools or the direct disposal of waste in open areas.
This reality directly contributes to the contamination of water collections and the perpetuation of the
schistosomiasis cycle, as also observed by Souza et al. (2011) in an analysis of the health determinants
of the disease.
The persistence of cases in specic neighborhoods, even with the general reduction in
notications, indicates the existence of local foci of active transmission. This pattern reinforces
the importance of territorializing surveillance and control strategies, with actions directed to
areas with greater health and socio-environmental vulnerability. This approach is in line with the
recommendations of Paiva et al. (2025), who advocate the adoption of measures focused on regions
with a higher burden of hospitalizations and less access to structuring policies.
When evaluating the annual distribution of incidence rates, a decreasing pattern was observed
in the municipality of Eunápolis over the period analyzed. In 2017, the rate was approximately 37.29
cases per 100,000 population; in 2018, 38.29; in 2019, 14.99; in 2020, 4.37; and in 2021, 7.8. In 2022,
there was no information on the number of cases for calculation.
Table 1: Schistosomiasis incidence rates by year – 2017 to 2021
Source: Study Data, 2024.
Yea r Estimated population Conrmed cases Incidence rate (per 100,000 inhabitants)
2017 115.290 43 37,29
2018 112.318 43 38,29
2019 113.380 17 14,99
2020 114.396 54,37
2021 115.360 97,80
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The downward trend, although positive, should be interpreted with caution, considering the
limitations of coverage of notication systems, as highlighted by Oliveira et al. (2024) and Dutra et
al. (2024), who point to underreporting as a recurrent obstacle in the monitoring of schistosomiasis.
The abrupt drop in cases after 2018 may reect not only the impact of control actions, but also
the possible interruption of sustained epidemiological surveillance and health education strategies.
Vira Júnior et al. (2024) showed that the discontinuation of the Schistosomiasis Control Program
is directly associated with the subsequent increase in the incidence of the disease in municipalities
that previously showed a downward trend. Such a relationship signals that the maintenance of low
indicators requires continuity of actions and not just punctual responses.
The spatial heterogeneity of the cases in Eunápolis reveals important patterns. The
neighborhoods with the highest number of conrmed cases, such as Pequi, Juca Rosa, Alecrim II and
Rosa Neto, coincide with areas with higher population density and less sanitary sewage infrastructure,
as described by Gonçalves et al. (2016). This association reinforces the socio-spatial character of
schistosomiasis and the need for territorialized interventions.
The literature indicates that the absence of adequate basic sanitation is one of the main
determining factors for the persistence of the schistosomiasis transmission cycle. Souza et al. (2011)
point out that the lack of sewage collection and treatment allows the contamination of surface water
with parasite eggs, which favors the infection of snails of the genus Biomphalaria and, later, of humans.
This dynamic is aggravated in contexts of disorderly urbanization, as occurs in several peripheral
regions of Eunápolis.
In 2017, it was possible to observe a wide dispersion of cases among different neighborhoods,
with emphasis on Juca Rosa (7 cases), Pequi (5 cases) and Urbis III (3 cases).
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Graph 4: Conrmed cases by neighborhood – 2017
Source: Study Data, 2024.
This dispersion suggests the existence of multiple sources of transmission, possibly related
to the use of different water bodies by the population, whether for leisure, hygiene or work. In 2018,
the spatial distribution remained wide, with the Pequi neighborhood registering 9 cases, followed by
Rosa Neto (5 cases), Iris Lopes (4 cases), Juca Rosa (4 cases) and SAE/CTA (2 cases).
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Graph 5: Conrmed cases by neighborhood – 2018
Source: Study Data, 2024.
The presence of cases in different urban neighborhoods, including health units, points to the
need for environmental investigations and updated mapping of the presence of Biomphalaria sp. in
the municipality.
In 2019, the total number of cases dropped to 17, but even so, the concentration in neighborhoods
such as Alecrim II (6 cases) and Dinah Borges I (3 cases) demonstrates that transmission persisted in
specic areas.
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Graph 6: Conrmed cases by neighborhood – 2019
Source: Study Data, 2024.
Persistence in certain territories may indicate failures in vector control processes and in the
articulation between epidemiological surveillance and environmental surveillance.
In the years 2020, 2021 and 2022, the records were less expressive, but reveal continuity of
the territorial pattern. In 2020, for example, 3 of the 5 cases occurred in the Antares neighborhood.
In 2021, there were notications in the Center, Dinah Borges I and Urbis III, and in 2022 1 case was
registered in Dinah Borges I.
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Graph 7: Conrmed cases by neighborhood – 2020 to 2022
Source: Study Data, 2024.
The repetition of these locations suggests that the foci have not been completely eliminated,
but rather reduced, which requires permanent active surveillance actions.
Analysis by relative frequency between men and women also revealed relevant distinctions.
While men concentrated cases between 30 and 39 years old (25.81%), women had higher relative
frequencies in the 40 to 49 and 60 to 69 age groups (both 22.45%).
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Graph 8: Relative frequency by sex and age group
Source: Study Data, 2024.
These differences may be associated with the type of exposure in each group, with men more
exposed to external economic activities and women to domestic tasks that involve contact with water,
such as washing clothes and utensils in unhealthy places.
The predominance of cases in the middle-aged adult population reinforces the understanding
that schistosomiasis is a disease strongly linked to lifestyle and working conditions. As pointed out
by Coura-Filho et al. (1994), work activities developed in rural and riverine areas, such as shing and
agriculture, signicantly increase exposure to Biomphalaria breeding sites, conguring important
risk factors. This pattern of occupational exposure seems to be maintained over time and in different
regions of the country.
However, local data also indicate that older age groups, such as 60 to 69 years old, continue
to have cases in considerable numbers. Such a nding may reect not only continued exposure but
also the absence of regular access to diagnosis, which contributes to chronic untreated infections.
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This situation was also observed by Jordão et al. (2014) when analyzing the epidemiological prole
of schistosomiasis in Alagoas, reinforcing the relevance of active screening even among older
populations.
The frequency of cases among women over 60 years of age may also be related to the
domestic use of untreated water, since in communities without formal supply, contact with rivers,
wells and streams to carry out daily activities remains frequent. As observed by Silva and Domingues
(2011) apud Jordão et al. (2014), sanitary precariousness, added to structural poverty, imposes risks of
infection even within the home environment.
The Eunápolis scenario conrms the classic notes of Neves (2005), for whom schistosomiasis
represents not only a parasitic endemic, but a socially determined phenomenon. The author points
out that the distribution of the disease follows internal migratory trajectories, absence of public
infrastructure and low health coverage, all elements present in the regions with the highest incidence
in the municipality studied.
The presence of cases in health units, such as the Regional Hospital and the SAE/CTA, as
recorded in 2018, may be associated with active search or late notication of cases diagnosed during
hospitalizations or routine laboratory tests. This data draws attention to the importance of sensitizing
health care professionals regarding mandatory notication and the inclusion of schistosomiasis in the
differential diagnosis of nonspecic symptoms.
In studies conducted by Oliveira et al. (2024) and Dutra et al. (2024), underreporting is
pointed out as one of the main obstacles to effective surveillance of schistosomiasis, aggravated by
the disarticulation between municipalities and the discontinuity of eld actions. This reality seems
to be reected in Eunápolis, where the years with the lowest number of cases coincide with periods
without records of joint efforts, educational campaigns or intersectoral mobilizations documented in
the article.
The data also allow us to infer that the intermittent records may be the result of structural
failures in the surveillance system. According to Paiva et al. (2025), many Brazilian municipalities
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lack teams trained for the early detection and interruption of outbreaks, which compromises local
control of the endemic. The nding of only one case in 2022, for example, requires interpretative
caution, as it does not necessarily indicate eradication, but may signal the absence of active search
and investigation.
The analysis of the data allows us to afrm that schistosomiasis persists as a neglected problem
in the municipality of Eunápolis, especially in the urban peripheries and areas with low sanitation
coverage. As demonstrated by Souza (2024), the disease remains active in several municipalities
in the interior of Brazil, where high rates of poverty, absence of treated water, and discontinuity of
preventive actions are concentrated.
The results obtained in this study reinforce the need for epidemiological surveillance
strategies articulated with intersectoral actions, which involve not only the health sector, but also
public policies for sanitation, housing, education, and the environment. This approach is compatible
with what Santos Pereira et al. (2018) propose, when they argue that environmental health education
should be integrated into territorial planning as a tool to cope with schistosomiasis.
Another critical point identied is the absence of updated studies on the presence and
geographic distribution of vector snails in the municipality of Eunápolis. Although the risk of
transmission is directly associated with the presence of Biomphalaria sp., no recent surveys were
found in the material analyzed that indicate the active foci. This gap compromises the development
of effective control actions aimed at risk environments, requiring the resumption of malacological
investigations.
The absence of updated georeferenced data on the foci of Biomphalaria sp. It compromises not
only the control of transmission, but also the construction of risk maps that guide health surveillance
in a territorialized way. Chiles et al. (2020), when studying the Discovery Coast, pointed out the
importance of the spatialization of cases and the integration between entomological surveillance and
community actions. In Eunápolis, this absence is congured as a point of institutional vulnerability,
especially in neighborhoods with recurrence of cases over the years analyzed.
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In summary, the results demonstrate that, despite the general trend of reduction in
schistosomiasis notications in Eunápolis (BA) between 2017 and 2022, foci of active transmission
persist in specic areas, with a sociodemographic pattern characterized by young and middle-aged
adults, predominantly male. The permanence of these cases in neighborhoods marked by health
vulnerability and the absence of structural interventions conrms the multifactorial nature of the
disease, requiring that coping be based on integrated, continuous strategies adapted to local realities,
as guided by the reference studies included in this study.
Final Thoughts
The municipality of Eunápolis (BA) remains an area of epidemiological relevance for
schistosomiasis, as evidenced by records documented since 1971 and by the occurrence of signicant
peaks, such as that of 2007. In the most recent cut, corresponding to the period from 2017 to 2022,
113 cases of the disease were conrmed, including one death in 2020. In 2022, although only one new
case was ofcially reported, the data cannot be interpreted as eradication of the disease, but rather as
a possible reection of underreporting or reduced active surveillance. The set of evidence reinforces
the permanence of schistosomiasis as a public health problem that is still active and worrying in the
territory.
The ndings of the study indicated an epidemiological prole markedly associated with the
male gender, predominantly in the age groups between 30 and 59 years, which is in line with the
occupational risk identied in previous studies. The higher incidence in economically active adults
suggests that work practices and daily activities related to contact with contaminated water are
still determining factors in the transmission chain. The temporal analysis showed a trend towards
a reduction in the absolute number of cases from 2019 onwards; however, this drop cannot be
interpreted as an interruption of the cycle, in view of the continuity of notications in historically
vulnerable neighborhoods and the absence of a recent survey on the outbreaks of Biomphalaria sp. in
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the municipality.
The geographical distribution of cases reinforces the need for territorialization of coping
actions. Neighborhoods such as Pequi, Juca Rosa, Alecrim II, Rosa Neto, and Dinah Borges I
concentrated recurrent notications over the years studied, indicating the maintenance of active foci
of transmission. The lack of georeferenced data on vector mollusks constitutes a critical gap that
prevents the formulation of more precise and effective malacological strategies, compromising the
local control of the endemic.
In addition to the issues directly related to surveillance, the study evidenced the contribution
of structural and social factors to the maintenance of schistosomiasis in Eunápolis. Precarious
conditions of basic sanitation, low level of education of the affected population, absence of continuous
health education actions and discontinuity of vector control campaigns make up a scenario that favors
the permanence of the disease. The frequent use of water bodies for bathing, recreation, and domestic
activities intensies the risks of infection, especially in underserved communities.
Given this scenario, it is essential to strengthen the articulation between epidemiological
surveillance, the environmental health sector, and other structuring public policies, such as housing,
education, and sanitary infrastructure. The intersectoral approach should be prioritized, with permanent
investments in educational actions, vector control, early diagnosis, and active monitoring. Only with
integrated and territorialized strategies will it be possible to interrupt the cycle of schistosomiasis
transmission and ensure better health conditions for the population of Eunápolis, respecting local
specicities and the social determinants that sustain the permanence of this neglected endemic.
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