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First noted in the city of Teresina in 1981, the last decades have witnessed a remarkable increase in urban transmission of American visceral leishmaniasis (VL) in many Brazilian cities. Teresina, the site of this study, has faced two large outbreaks of VL. The first occurred from 1981–1985 when almost 1000 new cases were reported. The second started in the 1990s, and between 1993 and 1996 more than...