High-risk areas of leprosy in Brazil between 2001-2015.

OBJECTIVES: to identify high-risk areas of leprosy in Brazil from 2001 to 2015. METHODS: this is an ecological study of spatial analysis based on Brazilian municipalities. Spatial scan statistics were used to identify spatial clustering and measure the relative risk from the annual detection rate of new cases of leprosy. By criterion based on the Gini index, only secondary clusters were considered. RESULTS: spatial scan statistics detected 26 clusters, in which the detection rate was 59.19 cases per 100 thousand inhabitants, while in the remainder of the country it was 11.76. Large part of the cluster area is located in the Legal Amazon. These groups included only 21.34% of the total population, but 60.40% of the new cases of the disease. CONCLUSIONS: Leprosy remains concentrated in some areas, showing the need for control programs to intensify actions in these municipalities.

High-risk areas of leprosy in Brazil between 2001-2015 / Áreas de alto riesgo de lepra en Brasil, en el período de 2001 a 2015 / Áreas de alto risco de hanseníase no Brasil, período 2001-2015

ABSTRACT Objectives: to identify high-risk areas of leprosy in Brazil from 2001 to 2015. Methods: this is an ecological study of spatial analysis based on Brazilian municipalities. Spatial scan statistics were used to identify spatial clustering and measure the relative risk from the annual detection rate of new cases of leprosy. By criterion based on the Gini index, only secondary clusters were considered. Results: spatial scan statistics detected 26 clusters, in which the detection rate was 59.19 cases per 100 thousand inhabitants, while in the remainder of the country it was 11.76. Large part of the cluster area is located in the Legal Amazon. These groups included only 21.34% of the total population, but 60.40% of the new cases of the disease. Conclusions: Leprosy remains concentrated in some areas, showing the need for control programs to intensify actions in these municipalities.

RESUMEN Objetivos: identificar las áreas de alto riesgo de lepra en el período de 2001 a 2015, en Brasil. Métodos: estudio ecológico de análisis espacial, con base en los datos de los municipios brasileños. Se utilizó la estadística scan espacial para identificar las agrupaciones espaciales y medir el riesgo relativo a partir del indicador índice de detección anual de nuevos casos de lepra. Con base en el índice de Gini, se consideraron solo los clusters secundarios. Resultados: la estadística scan espacial detectó 26 clusters, en que la tasa de detección fue de 59,19 casos por 100 mil habitantes, mientras que en el resto del país fue de 11,76. La gran parte del área de clusters se encuentra en la Amazonía Legal. Estos grupos incluyeron solo el 21,34% de la población total, pero representa el 60,40% de nuevos casos de la enfermedad en el período. Conclusiones: la lepra sigue concentrada en algunas áreas, lo que apunta la necesidad que tienen los programas de control de intensificar las acciones en estos municipios.

RESUMO Objetivos: identificar as áreas de alto risco da hanseníase no período de 2001 a 2015 no Brasil. Métodos: trata-se de um estudo ecológico de análise espacial, segundo dados dos municípios brasileiros. A estatística scan espacial foi utilizada para identificar agrupamentos espaciais e medir o risco relativo a partir do indicador taxa de detecção anual de casos novos de hanseníase. Pelo critério baseado no índice de Gini, foram considerados apenas os clusters secundários. Resultados: a estatística scan espacial detectou 26 clusters, em que a taxa de detecção foi de 59,19 casos por 100 mil habitantes, enquanto no restante do país foi de 11,76. Grande parte da área de clusters está situada na Amazônia Legal. Esses grupos incluíram apenas 21,34% da população total, mas 60,40% dos novos casos da doença do período. Conclusões: a hanseníase permanece concentrada em algumas áreas, apontando a necessidade de os programas de controle intensificarem ações nesses municípios.

Setting targets for HIV/AIDS-What lessons can be learned from other disease control programmes?

In a Collection Review, Richard Hayes and colleagues discuss metrics for assessing progress in control of the HIV/AIDS epidemic in the context of prior disease control programmes.

Día Mundial de la Lepra / No disponible

No disponible

Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination.

BACKGROUND: Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES: We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS: Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS: We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS: Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Impacto del control de la lepra sobre la transmisión del M. Leprae: ¿Se está alcanzando la eliminación? / No disponible

En 1991 la Asamblea Mundial sobre la Salud decidió “eliminar la lepra como problema de salud pública” para el año 2000. La eliminación se definió como la reducción de la prevalencia global de la enfermedad a menos de 1 caso por 10.000. En el año 2000, la Organización Mundial de la Salud (OMS) anunció que la eliminación ya se había alcanzado globalmente. De manera convencional, el control de una enfermedad se define como la reducción de su carga hasta un nivel localmente aceptable. La eliminación de la enfermedad se define como la reducción a cero de la incidencia en un área geográfica definida y erradicación se define como la reducción permanente a cero de la incidencia mundial de la infección causada por un agente específico. Sin embargo en la lepra, la OMS limitó la eliminación o el control en vez de la transmisión, al emplear prevalencia en vez de incidencia de la enfermedad. Las estadísticas de la lepra normalmente informan sobre la prevalencia y detección de nuevos casos. Las tendencias en la incidencia cuando no hay cambios en la detección de casos en la lepra están muy influenciadas por factores operativos. Para la estrategia de la eliminación de la lepra se supuso que la MDT podría reducir la transmisión de M. Leprae, pero no se dispone de evidencias convincentes que lo confirmen. No se dispone de la información sobre el impacto de la MDT sobre la transmisión, debido a su largo período de incubación. También hay que considerar que la disminución en la detección de casos puede ser por otros motivos, como la vacunación BCG. Modelos matemáticos para la transmisión y control de la lepra revelaron que la estrategia de eliminación reduce lentamente la transmisión, con un declive anual predictivo en incidencias que va desde el 2% al 12%. La detección precoz era el factor clave para conseguir este declive. Pronósticos futuros sobre la carga mundial de la lepra revelan que se detectarán 5 millones de nuevos casos entre 2000 y 2020 y que en el año 2020 habrá 1 millón de personas con discapacidades de tipo grado 2 de la OMS. Se concluye en que ha habido un progreso sustancial en el control de la lepra, pero cuando se define la eliminación como la reducción a cero de la incidencia, resulta obvio que la lepra no esta eliminada. Para conseguir la eliminación de la lepra hay que llevar a cabo intervenciones efectivas para interrumpir la transmisión del M. Leprae y además disponer de técnicas prácticas de diagnóstico para detectar niveles de infección que pueden conllevar a la transmisión. Esto requiere una investigación exhaustiva en las especialidades de la epidemiología y microbiología (AU)

In 1991 the World Health Assembly decided to “eliminate leprosy as a public health problema” by the year 2000. Elimination was defined as reducing the global prevalence of the disease to less than 1 case per 10,000. En 2000 the World. Health Organization (WHO) announced that elimination was reached globally Conventionally control of disease is defined as the reduction of disease burden to a locally acceptable level. Elimination of disease is defined as the reduction to zero of the incidence in a defined geographical area, and eradication is defined as the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent. In leprosy however, WHO limited elimination to control instead to transmission, by using prevalence and new case detection. Prevalence is linked to length of treatment, which has changed over time. Trends in new case detection rates only reflect trends in incidence rates when no changes occur in case detection, but in the past 25 years case detection in leprosy has been determined strongly by operations factors. For the leprosy elimination strategy it was assumed that MDT would reduce transmission are not readily available because leprosy has a long incubation period. Also declines in case detection may have other causes, such as BCG vaccination. Mathematical modeling of the transmission and control of leprosy showed that the elimination strategy reduces transmission slowly, with a predicted annual decline in incidence ranging from 2% to 12%. Early case finding was the key factor to attain this decline. Future projections of the global leprosy burden indicated that 5 million new cases would arise between 2000 and 2020, and that in2020 there would be 1 million people with WHO grade 2 disability. It is con concluded that substantial progress has been made to control leprosy, but when elimination of disease is defined as the reduction to zero of the incidence, leprosy is definitely not eliminated. To attain elimination of leprosy it is necessary to find effective interventions to interrupt transmission of M. leprae and practical diagnostic tools to detect levels of infection that can lead to transmission. This requires extensive research in the areas of epidemiology and microbiology (AU)