The multiplicity of factors involved in the transmission of American cutaneous leishmaniasis (ACL) make it difficult to formulate an efficient strategy for the control of the disease. On the basis of the number of notified cases per location, the State of São Paulo detemines the application of DDT in houses in those areas where two or more human cases have occurred. This procedure, however, impairs part of the program because 40% of the counties report only one human case each. These and other factors are analyzed in the light of the increase in the incidence of the disease in the State, its advance in the extra-forest environment and the delay in the decision-making process about the efficacy of the program. It is recommended that the control strategy be reviewed.
American cutaneous leishmaniasis; Epidemiology and control strategy
