Spatial-temporal trends in leprosy burden and its associations with socioeconomic and physical geographic factors: results from the Global Burden of Disease Study 2019.

OBJECTIVES: The purpose of our study was to assess the multiscalar changes in leprosy burden and its associated risk factors over the last three decades. STUDY DESIGN: We conducted an in-depth examination of leprosy's spatial-temporal trends at multiple geographical scale (global, regional, and national), utilizing information from Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2019). METHODS: Incidence and the estimated annual percentage change (EAPC) in age-standardized incidence rate (ASIR) of leprosy were determined, with countries categorized based on leprosy incidence changes. We examined socioeconomic and physical geography influences on leprosy incidence via Spearman correlation analysis, using ternary phase diagrams to reveal the synergetic effects on leprosy occurrence. RESULTS: Globally, incident cases of leprosy decreased by 27.86% from 1990 to 2019, with a reduction in ASIR (EAPC = -2.53), yet trends were not homogeneous across regions. ASIR and EAPC correlated positively with sociodemographic index (SDI), and an ASIR growth appeared in high SDI region (EAPC = 3.07). Leprosy burden was chiefly distributed in Tropical Latin America, Oceania, Central Sub-Saharan Africa, and South Asia. Negative correlations were detected between the incidence of leprosy and factors of SDI, GDP per capita, urban population to total population, and precipitation, whereas the number of refugee population, temperature, and elevation showed opposite positive results. CONCLUSIONS: Despite a global decline in leprosy over the past three decades, the disparities of disease occurrence at regional and national scales still persisted. Socioeconomic and physical geographic factors posed an obvious influence on the transmission risk of leprosy. The persistence and regional fluctuations of leprosy incidence necessitate the ongoing dynamic and multilayered control strategies worldwide in combating this ancient disease.

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

The burden of skin diseases in India: Global Burden of Disease Study 2017.

Background The prevalence of skin diseases has increased over the last few decades, and they contribute to a significant burden on health-care systems across the world. Aims/Objective This report looks at the burden of skin and subcutaneous diseases in terms of years lived with disability and agestandardised years lived with disability in India using the Global Burden of Disease Study results from 2017. Methods Data were obtained from the Global Burden of Disease online interactive tool. Updated estimates of the world's health for 359 diseases and injuries and 84 risk factors from 1990 to 2017 are available in this interactive tool. Results Years lived with disability due to skin and subcutaneous diseases accounted for 4.02% of the total years lived with disability in India in 2017. There was an increase of 53.7% in all age standardised years lived with disability for all the skin and subcutaneous diseases from 1990 to 2017. Among skin and subcutaneous diseases, dermatitis contributed maximum years lived with disability (1.40 million; 95% uncertainty interval, 0.82-2.21) in 2017, followed by urticaria (1.02 million; 95% uncertainty interval, 0.06-1.44) with percentage increases of 48.9% and 45.7% respectively. Conclusion The burden due to infectious skin diseases (e.g., scabies, fungal skin disease and bacterial skin disease) and non-infectious diseases (e.g., dermatitis, urticaria and psoriasis) has increased over the past three decades, however the age-standardised years lived with disability for leprosy, scabies, fungal infections, sexually transmitted infections and non-melanoma skin cancer (basal cell carcinoma) has decreased. The high burden of skin and subcutaneous diseases demand that they be given due importance in the national programmes and health policy of India.

Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey.

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level. METHODS: We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods. RESULTS: The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels 'high' and 'low' were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators. CONCLUSION: There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies.

Harnessing Clinical Trial Capacity to Mitigate Zoonotic Diseases: The Role of Expert Scientists in Ethiopia.

Background: The emergence and resurgence of zoonotic diseases have continued to be a major threat to global health and the economy. Developing countries are particularly vulnerable due to agricultural expansions and domestication of animals with humans. Scientifically sound clinical trials are important to find better ways to prevent, diagnose, and treat zoonotic diseases, while there is a lack of evidence to inform the clinical trials' capacity and practice in countries highly affected with the diseases. This study aimed to investigate expert scientists' perceptions and experiences in conducting clinical trials toward zoonotic diseases in Ethiopia. Methods: This study employed a descriptive, qualitative study design. It included major academic and research institutions in Ethiopia that had active engagements in veterinary and public health researches. It included the National Veterinary Institute, the National Animal Health Diagnostic and Investigation Center, the College of Veterinary Medicine at Addis Ababa University, the Ethiopian Public Health Institute, the Armauer Hansen Research Institute, and the College of Health Sciences at Addis Ababa University. In-depth interviews were conducted with expert scientists. Data were collected from October 2019 to April 2020. Data analysis was undertaken using open code 4.03 for qualitative data analysis. Results: Five major themes, with 18 sub-themes, emerged from the in-depth interviews. These were: challenges in the prevention, control, and treatment of zoonotic diseases; One Health approach to mitigate zoonotic diseases; personal and institutional experiences in conducting clinical trials on zoonotic diseases; barriers in conducting clinical trials toward zoonotic diseases; and strategies that promote conducting clinical trials on zoonotic diseases. Conducting clinical trials on zoonotic diseases in Ethiopia is hampered by a lack of clearly articulated ethics and regulatory frameworks, trial experts, financial resources, and good governance. Conclusion: In Ethiopia, conducting clinical trials on zoonotic diseases deserves due attention. Strengthening institutional and human resources capacity is a pre-condition to harness effective implementation of clinical trials on zoonotic diseases in the country. In Ethiopia where skilled human resource is scarce, One Health approach has the potential to form multidisciplinary teams to systematically improve clinical trials capacity and outcomes in the country.

COVID-19 and the Unfinished Agenda of VISION 2020.

PURPOSE: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020. DESIGN: Perspective supplemented with epidemiologic insights from available online databases. METHODS: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020. RESULTS: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population. CONCLUSIONS: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Neglected tropical diseases in Brazil: lack of correlation between disease burden, research funding and output.

OBJECTIVES: To assess the correlation between the burden of seven priority neglected tropical diseases (NTDs) included in the Brazilian National Agenda of Priorities in Health Research - tuberculosis, Chagas disease, leprosy, malaria, leishmaniasis, dengue and schistosomiasis - and their respective research funding and output. METHODS: This retrospective review obtained data on disease burden from the Global Burden of Disease Study and funding data from open access sources. Publications were retrieved from Scopus and SciELO, and characterised according to the type of research conducted. Correlation between funding, research output and burden was assessed by comparing the 'expected' and 'observed' values for funding and publications relative to the proportional burden for each disease. RESULTS: There was an emphasis in basic biomedical research (average 30% of publications) and a shortage of health policy and systems (average 7%) and social sciences research (average 3%). Research output and funding were poorly correlated with disease burden. Tuberculosis, Chagas disease and schistosomiasis accounted for more than 75% of total NTD-related DALYs, but accounted for only 34% of publications. Leprosy, leishmaniasis and malaria, together, received 49% of NTD-related funding despite being responsible for only 9% of DALYs. CONCLUSIONS: The analysis evidenced a lack of correlation between disease burden, research output and government funding for priority NTDs in Brazil. Our findings highlight the importance of monitoring health needs, research investments and outputs to inform policy and optimise the uptake of evidence for action, particularly in developing countries, where resources are scarce and the research capacity is limited. The results contribute to health policy by highlighting the need for improving coordination of scientific activities and public health needs for effective impact.

OBJECTIFS: Evaluer la corrélation entre la charge de sept maladies tropicales négligées (MTN) prioritaires incluses dans le programme national brésilien des priorités en matière de recherche en santé - tuberculose, maladie de Chagas, lèpre, paludisme, leishmaniose, dengue et schistosomiase - et leurs financements de recherche respectifs et les résultats. MÉTHODES: Cette revue rétrospective a obtenu des données sur la charge de morbidité de l'étude sur la Charge Globale des Maladies et des données de financement provenant de sources en accès publique. Les publications ont été extraites de Scopus et SciELO et caractérisées selon le type de recherche menée. La corrélation entre le financement, les résultats de la recherche et la charge a été évaluée en comparant les valeurs "attendues" et "observées" pour le financement et les publications par rapport à la charge proportionnel de chaque maladie. RÉSULTATS: L'accent a été mis sur la recherche biomédicale fondamentale (en moyenne 30% des publications) et une pénurie de politiques et de systèmes de santé (en moyenne 7%) et de recherche en sciences sociales (en moyenne 3%). Les résultats et le financement de la recherche étaient mal associés à la charge de morbidité. La tuberculose, la maladie de Chagas et la schistosomiase représentaient plus de 75% du total des EVCI, mais ne représentaient que 34% des publications. La lèpre, la leishmaniose et le paludisme, ensemble, ont reçu 49% des financements liés aux MTN alors qu'ils n'étaient responsables que de 9% des EVCI. CONCLUSIONS: L'analyse a mis en évidence une absence de corrélation entre la charge de morbidité, le résultat de la recherche et le financement de la plupart des MTN. Nos résultats soulignent l'importance du suivi des besoins en matière de santé, des investissements dans la recherche et des résultats pour éclairer les politiques et optimiser l'utilisation des données pour l'action, en particulier dans les pays en développement, où les ressources sont rares et la capacité de recherche est limitée. Les résultats contribuent à la politique de santé en soulignant la nécessité d'améliorer la coordination et la planification stratégique des activités scientifiques pour un impact efficace.

Reservoirs and transmission routes of leprosy; A systematic review.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar pathologic conditions. They primarily target the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease, being endemic in specific locations within countries of the Americas, Asia, and Africa, while in Europe it is only rarely reported. The reason for a spatial inequality in the prevalence of leprosy in so-called endemic pockets within a country is still largely unexplained. A systematic review was conducted targeting leprosy transmission research data, using PubMed and Scopus as sources. Publications between January 1, 1945 and July 1, 2019 were included. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. The transmission of this disease is probably much more complicated than was thought before. In the Americas, the nine-banded armadillo (Dasypus novemcinctus) has been established as another natural host and reservoir of M. leprae. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. More recently, in red squirrels (Sciurus vulgaris) with leprosy-like lesions in the British Isles M. leprae and M. lepromatosis DNA was detected. This finding was unexpected, because leprosy is considered a disease of humans (with the exception of the armadillo), and because it was thought that leprosy (and M. leprae) had disappeared from the United Kingdom. Furthermore, animals can be affected by other leprosy-like diseases, caused by pathogens phylogenetically closely related to M. leprae. These mycobacteria have been proposed to be grouped as a M. leprae-complex. We argue that insights from the transmission and reservoirs of members of the M. leprae-complex might be relevant for leprosy research. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. A reduction in transmission cannot be expected to be accomplished by actions or interventions from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, to increase our understanding of the intricate picture of leprosy transmission, we propose a One Health transdisciplinary research approach.

Leprosy: Clinical aspects and diagnostic techniques.

Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.

Why we should stop using the word leprosy.

Leprosy is endemic in more than 100 countries worldwide, with over 200 000 new diagnoses each year and more than 4 million people living with some form of impairment related to leprosy. The term leprosy, as used in the Bible, designated a multitude of diseases with skin manifestations. Biblical leprosy carried huge stigma and was considered synonymous with impurity and divine punishment. Global actions to eliminate leprosy have been implemented but have yet to succeed, with stigmatisation and discrimination against people affected by the disease being recognised as two of the biggest obstacles. In Brazil, leprosy was officially renamed hanseníase (Hansen's disease) in 1975, and the Brazilian experience of renaming leprosy during the past four decades has given clear signs of the benefit of this measure in fighting stigma and discrimination. More recent actions by WHO and many years of advocacy by patient organisations have followed, but concrete and effective measures to dignify language and terminology need to be implemented as soon as possible.

Leprosy in the post-elimination phase: so near and yet so far.

Leprosy is a chronic infectious disease affecting primarily the skin and peripheral nerves. WHO multi-drug therapy launched in 1982 revolutionized the treatment of this old age scourge, paving the way for leprosy elimination at global and national level. The global prevalence came down from over 5 million cases in the 1980s to less than 200,000 at the end of 2016. At present, India, Brazil and Indonesia are the top three countries with maximum leprosy load. The Indian national leprosy programme achieved the prevalence rate of less than 1/10,000 in the year 2005 but even after decade of attaining the WHO elimination target, India still contributes over 50% of the cases to the global leprosy burden leading the pack. Despite achieving the elimination target, the incidence of the disease has not come down as new cases continue to be reported or have plateaued worldwide. Adding to the boil is the persistence of social disparity and shadow of discriminatory laws in the statute books of many countries. Although significant success has been achieved in leprosy control over the years, but as the old adage goes, 'the last lap is the hardest and requires special efforts'. WHO global leprosy strategy 2016-2020 has a vision to achieve "the three zeros": zero disease, zero disability and zero discrimination. The present review focuses on the global and national leprosy scenario, changes made in the leprosy programme in the post-elimination phase and its consequences particularly in India, new scientific advances/insights and global and national strategies to deal with the hurdles in the road towards a "leprosy free world".

Socioeconomic factors related to leprosy: an integrative literature review / Factores socioeconómicos relacionados con la lepra: revisión integrativa de la literatura / Fatores socioeconômicos relacionados à hanseníase: revisão integrativa da literatura

ABSTRACT Objective: To investigate in the literature the relation of socioeconomic factors in the incidence of the disease and other outcomes related to leprosy. Method: Integrative review conducted in Lilacs, Medline, Scopus databases and SciELO online library with studies from 2000 to 2016. Results: 32 studies were included. Only studies that analyzed statistical associations of socioeconomic factors and outcomes related to leprosy were selected. Conclusion: Leprosy is greatly affected by the social context in which the patient is inserted, the chances of exposure to illness are the result of a set of not only individual aspects, but also of contexts or collective conditions. It is imperative for Nursing, as an essential part of the multiprofessional team entrusted with the care and surveillance of the disease, to recognize these factors to predict unfavorable outcomes and to develop new practices capable of reducing inequities.

RESUMEN Objetivo: Investigar en la literatura la relación de los factores socioeconómicos en la ocurrencia de la enfermedad y otros resultados relacionados con la lepra. Método: Revisión integrativa realizada en las bases de datos Lilacs, Medline, Scopus y en la biblioteca en línea SciELO con estudios de 2000 a 2016. Resultados: Se incluyeron 32 estudios. Sólo las encuestas que analizaron las asociaciones estadísticas de los factores socioeconómicos y los resultados relacionados con la lepra fueron seleccionados. Conclusión: La lepra sufre una gran influencia del contexto social en que el paciente está inserto, las posibilidades de exposición al enfermo se derivan de un conjunto de aspectos no sólo individuales, sino también de contextos o condiciones colectivas. Es imperativo a la Enfermería, como parte esencial del equipo multiprofesional encargado, para el cuidado y vigilancia de la enfermedad, reconocer esos factores para predecir desenlaces desfavorables y construir nuevas prácticas capaces de reducir iniquidades.

RESUMO Objetivo: Investigar na literatura a relação dos fatores socioeconômicos na ocorrência da doença e outros desfechos relacionados à hanseníase. Método: Revisão integrativa realizada nas bases de dados Lilacs, Medline, Scopus e na biblioteca on-line SciELO com estudos de 2000 a 2016. Resultados: Foram incluídos 32 estudos. Apenas pesquisas que analisaram associações estatísticas dos fatores socioeconômicos e os desfechos relacionados à hanseníase foram selecionadas. Conclusão: A hanseníase sofre grande influência do contexto social em que o doente está inserido, as chances de exposição ao adoecimento são resultantes de um conjunto de aspectos não apenas individuais, mas também de contextos ou condições coletivas. É imperativo à Enfermagem, como parte essencial da equipe multiprofissional incumbida, para o cuidado e vigilância da doença, reconhecer esses fatores para predizer desfechos desfavoráveis e construir novas práticas capazes de reduzir iniquidades.

Socioeconomic factors related to leprosy: an integrative literature review.

OBJECTIVE: To investigate in the literature the relation of socioeconomic factors in the incidence of the disease and other outcomes related to leprosy. METHOD: Integrative review conducted in Lilacs, Medline, Scopus databases and SciELO online library with studies from 2000 to 2016. RESULTS: 32 studies were included. Only studies that analyzed statistical associations of socioeconomic factors and outcomes related to leprosy were selected. CONCLUSION: Leprosy is greatly affected by the social context in which the patient is inserted, the chances of exposure to illness are the result of a set of not only individual aspects, but also of contexts or collective conditions. It is imperative for Nursing, as an essential part of the multiprofessional team entrusted with the care and surveillance of the disease, to recognize these factors to predict unfavorable outcomes and to develop new practices capable of reducing inequities.

Life history tradeoffs in humans: increased life expectancy with sperm count reduction.

Although not without controversy, as a general trend, the human sperm count is declining world-wide. One major reason for such a decline is an increase in the human life-span.  According to the life history tradeoff theory, fecundity is inversely related to the lifespan; the longer the lifespan, the lower the fecundity. This is essential to the maintainance of diversity and balance of different species. Such a corrleation validated by experimental data that show that the extension of life in Caenorhabditis elegans, Drosophila and Rodents is  associated with reduction in fecundity. The demographic data from a public data source, shows that the total fertility rate is positively correlated with the infant death rate, it is inversely correlated with the life expectancy. We postulate that the fall in spermatogenesis might be regulated by the neuroendocrine system that underlie human longevity.