A total of 48 neighborhoods are characterized by lower rates and those are highlighted in red in Fig. 1. The population in region 4 is characterized by a low income status while a lack of supply of health facilities reduces proper and timely access to care. The combination of these two factors may contribute to underreporting. Low rates in region 5 were also attributed to intensified spraying campaigns conducted by the Health Municipality.1 In comparison to region 4, region 5 is safer in regards to criminal activity and as a result, control strategies can be conducted more frequently.