<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1679-4974</journal-id>
<journal-title><![CDATA[Epidemiologia e Serviços de Saúde]]></journal-title>
<abbrev-journal-title><![CDATA[Epidemiol. Serv. Saúde]]></abbrev-journal-title>
<issn>1679-4974</issn>
<publisher>
<publisher-name><![CDATA[Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1679-49742021000400701</article-id>
<article-id pub-id-type="doi">10.1590/s1679-49742021000400014</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Tendências e distribuição espacial da hepatite D no Norte do Brasil, 2009-2018: um estudo ecológico]]></article-title>
<article-title xml:lang="es"><![CDATA[Tendencias y distribución espacial de Hepatitis D en el Norte de Brasil, 2009-2018: un estudio ecológico]]></article-title>
<article-title xml:lang="en"><![CDATA[Trends and spatial distribution of Hepatitis D in the North of Brazil, 2009-2018: an ecological study]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Yamada]]></surname>
<given-names><![CDATA[Adriano Benício Fernandes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Freitas]]></surname>
<given-names><![CDATA[Polyanne Lopes de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Rafael Fernandes da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Souto]]></surname>
<given-names><![CDATA[Francisco José Dutra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Faculdade de Ciências Biomédicas de Cacoal Curso de Medicina ]]></institution>
<addr-line><![CDATA[Cacoal RO]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>31</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>31</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>30</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_arttext&amp;pid=S1679-49742021000400701&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_abstract&amp;pid=S1679-49742021000400701&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iec.gov.br/scielo.php?script=sci_pdf&amp;pid=S1679-49742021000400701&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Objetivo:  Analisar a incidência anual de hepatite D no Brasil e na região Norte, no período 2009-2018.  Métodos:  Estudo ecológico de casos de hepatite D notificados no Sistema de Informação de Agravos de Notificação (Sinan), analisados por sexo, idade e estados do Norte. Realizou-se análise de tendência temporal pelo método de Prais-Winsten, para estimar a variação percentual anual (VPA) das taxas de incidência.  Resultados:  No período, foram reportados 2.710 casos no Brasil, 74,5% na região Norte e 71,5% somente no Amazonas, Acre e Rondônia. Houve tendência de queda da VPA no país (-21,6% - IC95% -3,8;-36,2%), região Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) e Acre (-37,6% - IC95% -18,0;-52,6%). Verificou-se diminuição de casos nos estratos etários abaixo de 40 anos.  Conclusão:  Houve tendência de queda da incidência de hepatite D na Amazônia Ocidental, que impactou na incidência no país. Essa redução foi puxada pelos mais jovens, provavelmente resultado da vacinação para hepatite B.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo:  Evaluar la incidencia anual de casos de hepatitis D en Brasil y en la Región Norte, entre 2009-2018.  Métodos:  En este estudio ecológico, se utilizaron casos notificados al Sistema Nacional de Agravamiento de de Enfermedades (Sinan), analizados por sexo, edad y estados del Norte. Se utilizó la regresión de Prais-Winsten para análisis de la tendencia temporal y el cálculo de la variación porcentual anual (VPA) de tasas de incidencia.  Resultados:  En el periodo, se notificaron 2.710 casos, siendo 74,5% en el Norte e 71,5% en Amazonas, Acre y Rondônia. Hubo tendencia a disminución de la VPA en Brasil (-21,6% - IC95% -3,8;-36,2%), región Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) y Acre (-37,6% - IC95% -18,0;-52,6%). Hubo disminución de casos entre los menores de 40 años.  Conclusión:  Hubo tendencia a la disminución de la incidencia en la Amazonía Occidental, impactando en la incidencia en Brasil. Esta baja está relacionada con los más jóvenes, probablemente debido a la vacunación contra la hepatitis B.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective:  To analyze the annual incidence of hepatitis D cases in both Brazil and the Brazilian Northern region between 2009 and 2018.  Methods:  This was an ecological study of hepatitis cases notified on the Notifiable Health Conditions Information System (SINAN), analyzed by sex, age groups, and Northern region states. Temporal trend analysis was performed using the Prais-Winsten method to estimate incident rate annual percent change (APC).  Results:  In the period studied, 2,710 cases were reported in Brazil, 74.5% of them in the Northern region and 71.5% in Amazonas, Acre and Rondonia alone. APC showed a downward trend in Brazil as a whole (-21.6% - 95%CI -3.8;-36.2%), in the Northern region (-28.5% - 95%CI -5.2;-46.1%,), in Amazonas (-34.1% - 95%CI -0.8;-56.2%) and in Acre (-37.6% - 95%CI -18.0;-52.6%). Cases decreased in age groups below 40 years old.  Conclusion:  There was a downward trend in incidence in the Western Amazon, impacting incidence in Brazil as a whole. This fall was led by younger people, probably due to hepatitis B vaccination.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Hepatite D]]></kwd>
<kwd lng="pt"><![CDATA[Doenças Negligenciadas]]></kwd>
<kwd lng="pt"><![CDATA[Estudos de Séries Temporais]]></kwd>
<kwd lng="pt"><![CDATA[Monitoramento Epidemiológico]]></kwd>
<kwd lng="pt"><![CDATA[Incidência]]></kwd>
<kwd lng="pt"><![CDATA[Ecossistema Amazônico.]]></kwd>
<kwd lng="es"><![CDATA[Hepatitis D]]></kwd>
<kwd lng="es"><![CDATA[Enfermedades Desatendidas]]></kwd>
<kwd lng="es"><![CDATA[Estudios de Series Temporales]]></kwd>
<kwd lng="es"><![CDATA[Monitoreo Epidemiológico]]></kwd>
<kwd lng="es"><![CDATA[Incidencia]]></kwd>
<kwd lng="es"><![CDATA[Ecosistema Amazónico.]]></kwd>
<kwd lng="en"><![CDATA[Hepatitis D]]></kwd>
<kwd lng="en"><![CDATA[Neglected Diseases]]></kwd>
<kwd lng="en"><![CDATA[Time Series Studies]]></kwd>
<kwd lng="en"><![CDATA[Epidemiological Monitoring]]></kwd>
<kwd lng="en"><![CDATA[Incidence]]></kwd>
<kwd lng="en"><![CDATA[Amozonian Ecosystem.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Scarponi]]></surname>
<given-names><![CDATA[CFO]]></given-names>
</name>
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[RDN]]></given-names>
</name>
<name>
<surname><![CDATA[Souza-Filho]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Guerra]]></surname>
<given-names><![CDATA[MRL]]></given-names>
</name>
<name>
<surname><![CDATA[Pedrosa]]></surname>
<given-names><![CDATA[MAF]]></given-names>
</name>
<name>
<surname><![CDATA[Mol]]></surname>
<given-names><![CDATA[MPG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatitis D prevalence in South America: a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Rev Soc Bras Med Trop]]></source>
<year>2018</year>
<volume>52</volume>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lempp]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Urban]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatitis delta virus: replication strategy and upcoming therapeutic options for a neglected human pathogen]]></article-title>
<source><![CDATA[Viruses]]></source>
<year>2017</year>
<volume>9</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>172</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goyal]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Romero-Severson]]></surname>
<given-names><![CDATA[EO]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Screening for hepatitis D and PEG-interferon over tenofovir enhance general hepatitis control efforts in Brazil]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2018</year>
<volume>13</volume>
<numero>9</numero>
<issue>9</issue>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Viana]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Paraná]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Moreira]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Compri]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Macedo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[High prevalence of hepatitis B vírus and hepatitis D vírus in the western Brazilian Amazon]]></article-title>
<source><![CDATA[Am J Trop Med Hyg]]></source>
<year>2005</year>
<volume>73</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>808-14</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cicero]]></surname>
<given-names><![CDATA[MF]]></given-names>
</name>
<name>
<surname><![CDATA[Pena]]></surname>
<given-names><![CDATA[NM]]></given-names>
</name>
<name>
<surname><![CDATA[Santana]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Arnold]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Azevedo]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
<name>
<surname><![CDATA[Leal]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is hepatitis D infections important in Brazil]]></article-title>
<source><![CDATA[BMC Infect Dis]]></source>
<year>2016</year>
<volume>16</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>525</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nunes]]></surname>
<given-names><![CDATA[JDC]]></given-names>
</name>
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[DLF]]></given-names>
</name>
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[LMB]]></given-names>
</name>
<name>
<surname><![CDATA[Felipe]]></surname>
<given-names><![CDATA[IMA]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[BR]]></given-names>
</name>
<name>
<surname><![CDATA[Santana]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Unexpected findings of hepatitis B and delta infection in northeastern Brazil: a public health alert]]></article-title>
<source><![CDATA[Ann Hepatol]]></source>
<year>2021</year>
<volume>22</volume>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ferreira-Junior]]></surname>
<given-names><![CDATA[PA]]></given-names>
</name>
<name>
<surname><![CDATA[de-Oliveira]]></surname>
<given-names><![CDATA[EC]]></given-names>
</name>
<name>
<surname><![CDATA[Martin]]></surname>
<given-names><![CDATA[TOG]]></given-names>
</name>
<name>
<surname><![CDATA[Alves-Junior]]></surname>
<given-names><![CDATA[ER]]></given-names>
</name>
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
<name>
<surname><![CDATA[Mello]]></surname>
<given-names><![CDATA[FCA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of hepatitis B and D virus infection in a district of Mato Grosso, bordering Amazonas and Rondônia states]]></article-title>
<source><![CDATA[Rev Soc Bras Med Trop]]></source>
<year>2020</year>
<volume>53</volume>
<numero>e20190559</numero>
<issue>e20190559</issue>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Braga]]></surname>
<given-names><![CDATA[WSM]]></given-names>
</name>
<name>
<surname><![CDATA[Castilho]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Borges]]></surname>
<given-names><![CDATA[FG]]></given-names>
</name>
<name>
<surname><![CDATA[Leão]]></surname>
<given-names><![CDATA[JRT]]></given-names>
</name>
<name>
<surname><![CDATA[Martinho]]></surname>
<given-names><![CDATA[ACS]]></given-names>
</name>
<name>
<surname><![CDATA[Rodrigues]]></surname>
<given-names><![CDATA[IS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatitis D virus infection in the Western Brazilian Amazon: far from a vanishing disease]]></article-title>
<source><![CDATA[Rev Soc Bras Med Trop]]></source>
<year>2012</year>
<volume>45</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>691-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Souto]]></surname>
<given-names><![CDATA[FJD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[of hepatitis B infection in Brazil: the epidemiological situation at the beginning of the 21st century]]></article-title>
<source><![CDATA[Rev Soc Bras Med Trop]]></source>
<year>2016</year>
<volume>49</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>11-23</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[LMM]]></given-names>
</name>
<name>
<surname><![CDATA[Martelli]]></surname>
<given-names><![CDATA[CMT]]></given-names>
</name>
<name>
<surname><![CDATA[Mérchan-Hamann]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Montarroyos]]></surname>
<given-names><![CDATA[UR]]></given-names>
</name>
<name>
<surname><![CDATA[Braga]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Lima]]></surname>
<given-names><![CDATA[MLC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Population-based multicentric survey of hepatitis B infection and risk factor differences among three regions in Brazil]]></article-title>
<source><![CDATA[Am J Trop Med Hyg]]></source>
<year>2009</year>
<volume>81</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>240-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<collab>Ministério da Saúde (BR), Secretaria de Vigilância em Saúde</collab>
<source><![CDATA[Sistema de Informação de Agravos de Notificação]]></source>
<year>2008</year>
<publisher-loc><![CDATA[Brasília, DF ]]></publisher-loc>
<publisher-name><![CDATA[MS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<collab>Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Doenças Crônicas e Infecções Sexualmente Transmissíveis</collab>
<source><![CDATA[Indicadores e dados básicos das hepatites nos municípios brasileiros]]></source>
<year>2008</year>
<publisher-loc><![CDATA[Brasília, DF ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<collab>Instituto Brasileiro de Geografia e Estatística</collab>
<source><![CDATA[População residente: estimativas para o TCU 2017]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Brasília, DF ]]></publisher-loc>
<publisher-name><![CDATA[IBGE]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Antunes]]></surname>
<given-names><![CDATA[JLF]]></given-names>
</name>
<name>
<surname><![CDATA[Cardoso]]></surname>
<given-names><![CDATA[MRA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Uso da análise de séries temporais em estudos epidemiológicos]]></article-title>
<source><![CDATA[Epidemiol Serv Saude]]></source>
<year>2015</year>
<volume>24</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>565-76</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Simonetti]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Schatzmayr]]></surname>
<given-names><![CDATA[HG]]></given-names>
</name>
<name>
<surname><![CDATA[Castejón]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Cesário]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Simonetti]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of infection with hepatitis D virus (HDV) among carriers of hepatitis B surface antigen in Amazonas State, Brazil]]></article-title>
<source><![CDATA[Trans R Soc Trop Med Hyg]]></source>
<year>1988</year>
<volume>82</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>469-71</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Cruz]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sistema de vigilância em saúde no Brasil: avanços e desafios]]></article-title>
<source><![CDATA[Saude Debate]]></source>
<year>2015</year>
<volume>39</volume>
<numero>104</numero>
<issue>104</issue>
<page-range>255-67</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
