Leprosy among schoolchildren in the Amazon region: A cross-sectional study of active search and possible source of infection by contact tracing.

BACKGROUND: The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing. METHODOLOGY/PRINCIPAL FINDINGS: This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children's cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate. CONCLUSIONS/SIGNIFICANCE: This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization's goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease's transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.

A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil.

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

Leprosy decline in Amazonas State, Brazil.

OBJECTIVE: To analyse the leprosy case detection rates in Amazonas State, Brazil, by age group from 1980 to 2009. METHOD: The historical data series of leprosy cases by age group from 1980 to 2009 were fitted as a function of time using Poisson regression models. Relative annual reduction in the detection rate (RAR) by age group was estimated as one minus the exponential of the estimated regression coefficient for time. To compare the regression coefficients, we used their 95% confidence interval. RESULTS: The relative annual reduction varied from 9% in the age group of 0-4 years to 1% in the age group of 60-69 years. There was a declining trend of the RAR in the younger age groups that disappeared after 29 years of age. The detection rate in people >29 years old declined very little over time, with no statistically significant difference between age groups. CONCLUSION: Our findings show a reduction in the infection risk in the last 30 years and a birth cohort effect: cohorts born in more recent years faced smaller risks of leprosy infection than older cohorts.

Nosological profile in a dermatology referral center in the state of Amazonas -Brazil.

BACKGROUNDS: Fundaments: Skin diseases are associated wih high morbidity, low mortality and low rate of hospitalization. However, they can cause considerable interference in physical and emotional well-being of the individual. Several of them reach large population, requiring specific interventions for their control. OBJECTIVE: To describe the frequency of skin disease diagnosed in the dermatology service in Manaus, capital of Amazonas State. METHODS: We collected data on registered sex, age, origin and diagnostics for the first consultation of patients attended between January 2000 and December 2007. RESULTS: Of the 56.024 recorded visits, we obtained 56.720 cases of dermatological diagnoses, being the most common sexually transmitted diseases (25,12%), allergic skin disesases (14,03%), unspecified dermatoses (13,01%), leprosy (6,34%) and acne, seborrhea and related diseases (5,05%). The frequency was similar for both sexes, aged 20-29 years predominated and Manaus the origin most reported. CONCLUSIONS: The pattern of skin diseases identified in this study may serve as a baseline to managers of health system in the region develop strategies for prevention and control of dermatoses, with emphasis on sexually transmitted diseases, allergic skin diseases, leprosy and acne.

Perfil nosológico de centro de referência em dermatologia no estado do Amazonas - Brasil / Nosological profile in a dermatology referral center in the state of Amazonas -Brazil

FUNDAMENTOS: As doenças de pele estão associadas a alta morbidade, baixa mortalidade e baixa proporção de hospitalização. Entretanto, podem causar considerável interferência no bem-estar físico e emocional do indivíduo. Várias delas atingem grandes contingentes populacionais, havendo necessidade de intervenções específicas para seu controle. OBJETIVO: Descrever a frequência das dermatoses diagnosticadas em serviço de dermatologia na cidade de Manaus, capital do estado do Amazonas. MÉTODOS: Coletaram-se dados registrados sobre sexo, idade, procedência e diagnósticos referentes à primeira consulta dos pacientes atendidos entre janeiro de 2000 e dezembro de 2007. RESULTADOS: Das 56.024 consultas registradas, obtiveram-se 56.720 diagnósticos dermatológicos, sendo mais comuns as doenças sexualmente transmissíveis (25,12 por cento), as dermatoses alérgicas (14,03 por cento), as dermatoses não especificadas (13,01 por cento), a hanseníase (6,34 por cento) e acne, seborreia e afins (5,05 por cento). A frequência foi semelhante para ambos os sexos, a faixa etária de 20-29 anos foi predominante e Manaus foi a procedência mais referida. CONCLUSÕES: O padrão das doenças cutâneas identificadas neste estudo pode servir como linha de base para que gestores do sistema de saúde da região desenvolvam estratégias de prevenção e controle das dermatoses mais comuns, com ênfase nas doenças sexualmente transmissíveis, doenças cutâneas alérgicas, hanseníase e acne.

BACKGROUNDS: Fundaments: Skin diseases are associated wih high morbidity, low mortality and low rate of hospitalization. However, they can cause considerable interference in physical and emotional well-being of the individual. Several of them reach large population, requiring specific interventions for their control. OBJECTIVE: To describe the frequency of skin disease diagnosed in the dermatology service in Manaus, capital of Amazonas State. METHODS: We collected data on registered sex, age, origin and diagnostics for the first consultation of patients attended between January 2000 and December 2007. RESULTS: Of the 56.024 recorded visits, we obtained 56.720 cases of dermatological diagnoses, being the most common sexually transmitted diseases (25,12 percent), allergic skin disesases (14,03 percent), unspecified dermatoses (13,01 percent), leprosy (6,34 percent) and acne, seborrhea and related diseases (5,05 percent). The frequency was similar for both sexes, aged 20-29 years predominated and Manaus the origin most reported. CONCLUSIONS: The pattern of skin diseases identified in this study may serve as a baseline to managers of health system in the region develop strategies for prevention and control of dermatoses, with emphasis on sexually transmitted diseases, allergic skin diseases, leprosy and acne.

Hanseníase em Coari: aspectos epidemiológicos da doença na região do médio Solimões no estado do Amazonas / Hansen's disease in Coari: epidemiological aspects of the disease in middle Solimões river, state of Amazonas

O objetivo deste estudo é descrever os aspectos demográficos, as características clínicas e epidemiológicas da hanseníase, de forma a tratar o perfil epidemiológico da hanseníase no Município de Coari, Estado do Amazonas. Trata-se de um estudo descritivo baseado na análise de uma amostra de 226 pacientes diagnosticados no período entre 1997 entre 2006. Na análise dos dados foram utilizados os testes do qui quadrado de Pearson, t de Student e ANOVA. No período do estudo observou-se um declínio de 63,1 por cento no coeficiente de prevalência da hanseníase, 47,6 por cento no de detecção geral, além de uma redução de 91,9 por cento na detecção em menores de 15 anos. Foi constatada associação estatística ao nível de 5 por cento do sexo em relação à classificação operacional (p menor que 0,001) e da idade em relação ao grau de incapacidade (p igual a 0,002). O alto número de pacientes com graus I e II de incapacidade demonstra que no município de Coari há um grande número de casos com diagnóstico tardio e ainda uma possível prevalência oculta da doença.

Hanseníase em Coari: aspectos epidemiológicos da doença na região do médio Solimões no estado do Amazonas / Hansen´s disease in Coari: epidemiological aspects of the disease in middle Solimões river, state of Amazonas

O objetivo deste estudo é descrever os aspectos demográficos, as caracteristícas clínicas e epidemiológicas da hanseníase, de forma a traçar o perfil epidemiológico da hanseníase no Município de Coari, Estado do Amazonas. Trata-se de um estudo descritivo baseado na análise de uma amostra de 226 pacientes diagnosticados no período entre 1997 a 2006. Na análise dos dados foram utilizados os testes do qui-quadrado de Pearson, t de Student e ANOVA. No período do estudo observou-se um declínio de 63,1% no coeficienete de prevalência da hanseníaes, 47,6% no de detecção geral, além de uma redução de 91,9% na detecção em menores de 15 anos. Foi constatada associação estatística ao nivel de 5% do sexo em relação à classificação operacional (p <0,001) e da idade em relação ao grau de inacapacidade demonstra que no município de Coari há um grande número de casos com diagnóstico tardio e ainda uma possível prevalência oculta da doença.