Fatores sociodemográficos e clínicos de casos de hanseníase associados ao desempenho da avaliação de seus contatos no Ceará, 2008-2019 / Factores sociodemográficos y clínicos de los casos de lepra asociados con el desempeño de la evaluación de sus contactos en Ceará, Brasil, 2008-2019 / Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019

Objetivo:Analisar o efeito de características sociodemográficas e clínicas de casos novos (CNs) de hanseníase como determinantes no desempenho da avaliação dos contatos. Métodos: Estudo transversal, com abordagem temporal do indicador de avaliação de 100% os contatos examinados de CNs registrados no Ceará, Brasil, via Sistema de Informação de Agravos de Notificação (Sinan), em 2008-2019. Empregou-se regressão logística para estimar razão de chances-odds ratio (OR) com intervalos de confiança de 95% (IC95%). A tendência temporal baseou-se em regressão joinpoint. Resultados: Foram analisados 23.675 CNs, 65,4% com contatos examinados. Verificou-se maior chance para não avaliação de 100% dos contatos registrados com CN multibacilar (OR=1,19 - IC95% 1,11;1,28) e com exame de contatos como modo de entrada (OR=1,71 - IC95% 1,35;2,18). A tendência temporal do indicador foi de aumento (variação percentual anual: 2,1 - IC95% 1,2;3,0). Conclusão: Dimensões distintas de vulnerabilidade individual e social de CNs de hanseníase influenciam o persistente desempenho insatisfatório da avaliação de contatos.

Objetivo: Analizar la asociación entre características sociodemográficas y clínicas de casos nuevos (CNs) de lepra como determinantes para el desempeño de la evaluación de contactos. Métodos: Estudio transversal con abordaje temporal del indicador de evaluación de 100% de los contactos examinados de cada CN registrado en el Sistema de Información de Enfermedades Notificables del Estado de Ceará, Brasil, 2008-2019. Análisis de regresión logística para estimar la razón de probabilidades (OR) e intervalos de confianza de 95% (IC95%), y tendencia temporal basada por regresión joinpoint. Resultados: Fueron analizados 23.675 CN, 65,4% con contactos examinados. Se verificó mayor probabilidad para la no-evaluación del 100% de los contactos registrados cuando el CN: era multibacilar (OR=1,19 - IC95% 1,11;1,28) y forma de entrada por examen de contactos (OR=1,71 - IC95% 1,35;2,18). Tendencia temporal de aumento de este indicador (cambio porcentual anual: 2,1 (IC95% 1,2;3,0). Conclusión: Diferentes dimensiones de la vulnerabilidad individual y social de los nuevos casos de lepra en Ceará influyen en el desempeño insatisfactorio persistente de la evaluación de sus contactos.

Objective: To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts Methods: This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression. Results: 23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0). Conclusion: Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.

Importance of epidemiological surveillance of leprosy: analysis of the occurrence of leprosy in intra-domiciliary contacts in a capital in the Brazilian northeast region.

INTRODUCTION: Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS: A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS: Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS: The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found.

Importance of epidemiological surveillance of leprosy: analysis of the occurrence of leprosy in intra-domiciliary contacts in a capital in the Brazilian northeast region

Abstract INTRODUCTION Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found.

[Performance of leprosy case-contact surveillance: a space-time analysis in Bahia State, Northeast Brazil]. / Desempenho da vigilância de contatos de casos de hanseníase: uma análise espaço-temporal no Estado da Bahia, Região Nordeste do Brasil.

The aim was to analyze the space-time trend in the proportion of contacts examined among those recorded, according to demographic profile of new leprosy cases in the State of Bahia, Brazil, in the 2003-2014 cohort. This was a state population-based ecological study with temporal and spatial analyses of the proportion of contacts examined among those recorded, according to characteristics of the reference leprosy case, based on the Information System for Notifiable Diseases of the Brazilian Ministry of Health. The time trend analysis was based on Poisson regression (Joinpoints). Spatial analysis used spatial autocorrelation by local indicators of spatial association. Over the course of the historical series, 52.9% (55,116/104,142) of the recorded contacts were examined, with lower proportions in persons < 60 years of age, indigenous individuals, and residents of large cities (especially the state capital Salvador). There was an upward trend in the proportion of contacts examined, less evident when the reference leprosy case was a male, black, living in the rural area, and in small towns or the state capital. Spatial distribution showed that the majority of the municipalities showed precarious performance, with clusters identified in the North and Far South of the state. Bahia shows precarious performance on contact surveillance, particular in conditions of greater social vulnerability. Additional strategies should be implemented in order to overcome the operational obstacles to contact surveillance, considered essential for interrupting leprosy transmission in the state.

Objetivou-se analisar a tendência espaço-temporal da proporção de contatos examinados entre os registrados, segundo perfil demográfico de casos novos de hanseníase diagnosticados no Estado da Bahia, Brasil, na coorte 2003-2014. Trata-se de estudo ecológico de base populacional estadual, com análises temporal e espacial da proporção de contatos examinados entre os registrados segundo características do caso referência de hanseníase, com base no Sistema de Informação de Agravos de Notificação do Ministério da Saúde. A análise de tendência temporal foi baseada na regressão de Poisson por pontos de inflexão (Joinpoints). A análise espacial utilizou a autocorrelação espacial pelo Índice Local de Associação Espacial. Ao longo da série histórica, 52,9% (55.116/104.142) dos contatos registrados foram examinados, com menor proporção entre pessoas < 60 anos, raça/etnia indígena e residentes em municípios de grande porte (em particular na capital). Verificou-se tendência de aumento da proporção de contatos examinados, com menor expressão quando o caso referência de hanseníase era do sexo masculino, de raça/cor preta, residente em zona rural e em cidades de pequeno porte, além da capital do estado. A distribuição espacial demonstrou que a maioria dos municípios apresentou desempenho com parâmetro precário, com aglomerados identificados nas regiões norte e extremo-sul. O Estado da Bahia apresenta desempenho precário das ações de vigilância de contatos, em particular diante de condições de maior vulnerabilidade social. Estratégias adicionais devem ser implementadas com vistas à superação de obstáculos operacionais para essa ação, considerada essencial para a interrupção da transmissão da hanseníase.

El objetivo de este trabajo fue analizar la tendencia espacio-temporal de la proporción de contactos examinados entre quienes están registrados, según su perfil demográfico, como casos nuevos de lepra, diagnosticados en el estado de Bahía, Brasil, en la cohorte 2003-2014. Se trata de un estudio ecológico de base poblacional estatal, con análisis temporal y espacial de la proporción de contactos examinados entre los registrados, según las características del caso referencia de lepra, a partir del Sistema de Información sobre Enfermedades de Notificación Obligatoria del Ministerio de Salud. El análisis de tendencia temporal se basó en la regresión de Poisson por puntos de inflexión (Joinpoints). El análisis espacial utilizó la autocorrelación espacial mediante el Índice Local de Asociación Espacial. A lo largo de la serie histórica, un 52,9% (55.116/104.142) de los contactos registrados fueron examinados, con una menor proporción entre personas < 60 años, raza/etnia indígena y residentes en municipios de gran tamaño (en particular en la capital). Se verificó la tendencia de aumento de la proporción de contactos examinados, con menor expresión, cuando el caso referencia de lepra era de sexo masculino, de raza/color negro, residente en zona rural y en ciudades de pequeño tamaño, en particular en la capital del estado. La distribución espacial demostró que la mayoría de los municipios tuvo un desempeño con parámetro precario, con aglomerados identificados en las regiones Norte y Extremo-Sur. El Estado de Bahía presenta un desempeño precario de las acciones de vigilancia de contactos, en particular ante condiciones de mayor vulnerabilidad social. Deben ser implementadas estrategias adicionales, con el fin de superar obstáculos operacionales para esta acción, considerada esencial para la interrupción de la transmisión de la lepra.

Factors associated with leprosy in children contacts of notified adults in an endemic region of Midwest Brazil

OBJECTIVES: To analyze the factors associated with leprosy in children who were intradomiciliary contacts of notified adults with the disease in an endemic municipality in Mato Grosso, Brazil. METHOD: Case-control study with 204 children under 15 years of age, living in an endemic municipality. Cases (n=40) were considered as the children with leprosy registered at the National Information System of Notifiable Diseases in 2014 and 2015, who were intradomiciliary contacts of at least one adult diagnosed with the disease in the family, and as a control group (n=164) of children living within a radius of up to 100m of the notified cases. Data were obtained through medical file analysis, interviews, and blood samples for anti-PGL-I serological test by the ELISA method. The binary logistic regression technique was used, with p≤0.05. RESULTS: After adjustments, the following were associated with leprosy age (95% CI 1.24-9.39, p=0.018), area of residence (95% CI 1.11-6.09, p=0.027), waste disposal (95% CI 1.91-27.98, p=0.004), family history of the disease (95% CI 3.41-22.50, p=0.000), and time of residence (95% CI 1.45-7.78, p=0.005). CONCLUSION: Factors associated with the disease indicate greater vulnerability of children aged 8-14 years, associated with living conditions and time of residence, as well as the family history of the disease.

Desempenho da vigilância de contatos de casos de hanseníase: uma análise espaço-temporal no Estado da Bahia, Região Nordeste do Brasil / Performance of leprosy case-contact surveillance: a space-time analysis in Bahia State, Northeast Brazil / Desempeño de la vigilancia de contactos en casos de lepra: un análisis espacio-temporal en el estado de Bahía, región nordeste de Brasil

Resumo: Objetivou-se analisar a tendência espaço-temporal da proporção de contatos examinados entre os registrados, segundo perfil demográfico de casos novos de hanseníase diagnosticados no Estado da Bahia, Brasil, na coorte 2003-2014. Trata-se de estudo ecológico de base populacional estadual, com análises temporal e espacial da proporção de contatos examinados entre os registrados segundo características do caso referência de hanseníase, com base no Sistema de Informação de Agravos de Notificação do Ministério da Saúde. A análise de tendência temporal foi baseada na regressão de Poisson por pontos de inflexão (Joinpoints). A análise espacial utilizou a autocorrelação espacial pelo Índice Local de Associação Espacial. Ao longo da série histórica, 52,9% (55.116/104.142) dos contatos registrados foram examinados, com menor proporção entre pessoas < 60 anos, raça/etnia indígena e residentes em municípios de grande porte (em particular na capital). Verificou-se tendência de aumento da proporção de contatos examinados, com menor expressão quando o caso referência de hanseníase era do sexo masculino, de raça/cor preta, residente em zona rural e em cidades de pequeno porte, além da capital do estado. A distribuição espacial demonstrou que a maioria dos municípios apresentou desempenho com parâmetro precário, com aglomerados identificados nas regiões norte e extremo-sul. O Estado da Bahia apresenta desempenho precário das ações de vigilância de contatos, em particular diante de condições de maior vulnerabilidade social. Estratégias adicionais devem ser implementadas com vistas à superação de obstáculos operacionais para essa ação, considerada essencial para a interrupção da transmissão da hanseníase.

Abstract: The aim was to analyze the space-time trend in the proportion of contacts examined among those recorded, according to demographic profile of new leprosy cases in the State of Bahia, Brazil, in the 2003-2014 cohort. This was a state population-based ecological study with temporal and spatial analyses of the proportion of contacts examined among those recorded, according to characteristics of the reference leprosy case, based on the Information System for Notifiable Diseases of the Brazilian Ministry of Health. The time trend analysis was based on Poisson regression (Joinpoints). Spatial analysis used spatial autocorrelation by local indicators of spatial association. Over the course of the historical series, 52.9% (55,116/104,142) of the recorded contacts were examined, with lower proportions in persons < 60 years of age, indigenous individuals, and residents of large cities (especially the state capital Salvador). There was an upward trend in the proportion of contacts examined, less evident when the reference leprosy case was a male, black, living in the rural area, and in small towns or the state capital. Spatial distribution showed that the majority of the municipalities showed precarious performance, with clusters identified in the North and Far South of the state. Bahia shows precarious performance on contact surveillance, particular in conditions of greater social vulnerability. Additional strategies should be implemented in order to overcome the operational obstacles to contact surveillance, considered essential for interrupting leprosy transmission in the state.

Resumen: El objetivo de este trabajo fue analizar la tendencia espacio-temporal de la proporción de contactos examinados entre quienes están registrados, según su perfil demográfico, como casos nuevos de lepra, diagnosticados en el estado de Bahía, Brasil, en la cohorte 2003-2014. Se trata de un estudio ecológico de base poblacional estatal, con análisis temporal y espacial de la proporción de contactos examinados entre los registrados, según las características del caso referencia de lepra, a partir del Sistema de Información sobre Enfermedades de Notificación Obligatoria del Ministerio de Salud. El análisis de tendencia temporal se basó en la regresión de Poisson por puntos de inflexión (Joinpoints). El análisis espacial utilizó la autocorrelación espacial mediante el Índice Local de Asociación Espacial. A lo largo de la serie histórica, un 52,9% (55.116/104.142) de los contactos registrados fueron examinados, con una menor proporción entre personas < 60 años, raza/etnia indígena y residentes en municipios de gran tamaño (en particular en la capital). Se verificó la tendencia de aumento de la proporción de contactos examinados, con menor expresión, cuando el caso referencia de lepra era de sexo masculino, de raza/color negro, residente en zona rural y en ciudades de pequeño tamaño, en particular en la capital del estado. La distribución espacial demostró que la mayoría de los municipios tuvo un desempeño con parámetro precario, con aglomerados identificados en las regiones Norte y Extremo-Sur. El Estado de Bahía presenta un desempeño precario de las acciones de vigilancia de contactos, en particular ante condiciones de mayor vulnerabilidad social. Deben ser implementadas estrategias adicionales, con el fin de superar obstáculos operacionales para esta acción, considerada esencial para la interrupción de la transmisión de la lepra.

Trends and patterns in leprosy in nine states of the Republic of the Sudan 7 years after the introduction of routine contact screening.

Background: This paper analyzes the trends of key indicators reflecting the epidemiological situation of leprosy in nine different states of the Republic of the Sudan after the introduction of a systematic contact screening in 2010. Methods: The routinely assessed data from the leprosy control program from 2010 to 2016 were analyzed. Results: Despite, intense contact screening, the overall number of new cases detected showed a decreasing trend. The female:male ratio among new cases was constantly low. The overall average number of contacts needed to screen in order to detect a new case among contacts was 64. However, this number varied significantly in the nine states under investigation, with the best yield being observed in the state with the lowest case detection rate. Conclusions: The total number of new cases of leprosy in nine states of the Republic of the Sudan has shown declining tendencies since 2010. Our data are not suggestive of a significant impact of contact screening on the trends of leprosy key indicators. Overall, contact screening proved to be efficient in most states, including those that exhibited very low annual new case detection rates (ANCDRs). Sensitization of personnel undergoing training and measures improving access of females to leprosy services are urgently needed.

A importância da busca ativa como estratégia de controle da hanseníase em territórios endêmicos / The importance of active surveillance as a strategy to control leprosy in endemic areas

De acordo com a literatura, contatos de casos de hanseníase apresentam maior risco de adoecimento e, nesse sentido, é primordial fortalecer e ampliar as ações de busca ativa de casos no âmbito da atenção primária de saúde, potencializando a ampliação do diagnóstico precoce, tratamento oportuno e demais medidas de vigilância, controle e reabilitação necessárias. Neste cenário, objetivou-se realizar a busca ativa de novos casos de hanseníase em um distrito rural do município de Mantena, MG, e caracterizar a situação socioeconômica e epidemiológica da doença na região. Foram realizadas visitas aos residentes do distrito e palestras informativas sobre a doença, sendo os moradores convidados a participar da pesquisa. Um total de 292 indivíduos foi examinado no período de julho de 2016 a fevereiro de 2017. Foram diagnosticados 27 casos novos, 22 dos quais eram multibacilares. Os graus de incapacidade 1 e 2 foram identificados em 74% da amostra. Sobre as variáveis socioeconômicas, a maioria dos casos possui baixa escolaridade e baixa renda familiar, além de todos os casos terem tido contato com a doença em algum momento. A busca ativa foi eficiente para a detecção de casos novos de hanseníase na população estudada e contribuiu para o controle da doença que é endêmica na região. Ademais, a busca ativa foi relevante, especialmente considerando a baixa instrução dos indivíduos e, portanto, menor acesso à informação.

Contacts of leprosy cases present a higher risk of illness and, therefore it is essential to strengthen and expand actions to actively search for cases in primary health care, thus intensifying early diagnosis, timely treatment and other surveillance measures, and improve control and rehabilitation. In this setting, we aimed to perform the active search of new cases of leprosy in the rural area of Mantena, MG, and to characterize the socioeconomic and epidemiological situation related to the disease in the region. For this purpose, visits were made to the residents of the region with informative talks about the disease, and subsequently inhabitants were invited to participate in the research. A total of 292 individuals were examined from July 2016 to February 2017. Twenty-seven new cases were diagnosed, 22 of which were multibacillary. Grade 1 and 2 physical disabilities were identified in 74% of the new cases. Regarding socioeconomic variables, the majority of the cases had little schooling and low family income. In addition, all cases had had contact with the illness, at some point. We conclude that the active search was efficient to detect new leprosy cases in the population, and it contributed to the control of the disease, which is endemic in the region. In addition, active search is an important methodology, especially when the population involved has little schooling and thus less access to information.

Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients.

INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS: Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.

Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients

Abstract: INTRODUCTION: Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value. METHODS: This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period. RESULTS : Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511). CONCLUSIONS: The adoption of these combined assays may impose measures for leprosy control strategies.

New strategies for active finding of leprosy cases in the Amazonian region.

INTRODUCTION: The use of the Self-Image Form (SIF) expands the identification of active leprosy cases to neighbors of index cases. METHODS: The SIF was used to screen two groups: case (neighbors of index cases of leprosy) and control (individuals residing next to houses without leprosy) group. A specialist investigated suspected leprosy cases for disease confirmation. RESULTS: New cases of leprosy were diagnosed in the case group (n = 7, 8.6%), but not the control group. CONCLUSIONS: The new surveillance strategy is inexpensive, efficient, and feasible within a primary health strategy. Future studies can help improve the use of the SIF.

Characteristics of leprosy diagnosed through the surveillance of contacts: a comparison with index cases in Rio de Janeiro, 1987-2010

Contact surveillance is an important strategy to ensure effective early diagnosis and control of leprosy; passive detection may not be as efficient because it is directly tied to the ready availability of heath care services and health education campaigns. The aim of this study was to reinforce that contact surveillance is the most effective strategy for the control of leprosy. The analysed data were obtained from a cohort of contacts and cases diagnosed through a national referral service for leprosy. We analysed data from patients diagnosed between 1987-2010 at the Souza Araújo Ambulatory in Rio de Janeiro. Epidemiological characteristics of leprosy cases diagnosed through contact surveillance and characteristics of passively detected index cases were compared using a conditional logistic regression model. Cases diagnosed by contact surveillance were found earlier in the progression of the disease, resulting in less severe clinical presentations, lower levels of initial and final disability grades, lower initial and final bacterial indices and a lower prevalence of disease reaction. In this respect, contact surveillance proved to be an effective tertiary prevention strategy, indicating that active surveillance is especially important in areas of high endemicity, such as Brazil.

Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.

Characteristics of leprosy diagnosed through the surveillance of contacts: a comparison with index cases in Rio de Janeiro, 1987-2010.

Contact surveillance is an important strategy to ensure effective early diagnosis and control of leprosy; passive detection may not be as efficient because it is directly tied to the ready availability of heath care services and health education campaigns. The aim of this study was to reinforce that contact surveillance is the most effective strategy for the control of leprosy. The analysed data were obtained from a cohort of contacts and cases diagnosed through a national referral service for leprosy. We analysed data from patients diagnosed between 1987-2010 at the Souza Araújo Ambulatory in Rio de Janeiro. Epidemiological characteristics of leprosy cases diagnosed through contact surveillance and characteristics of passively detected index cases were compared using a conditional logistic regression model. Cases diagnosed by contact surveillance were found earlier in the progression of the disease, resulting in less severe clinical presentations, lower levels of initial and final disability grades, lower initial and final bacterial indices and a lower prevalence of disease reaction. In this respect, contact surveillance proved to be an effective tertiary prevention strategy, indicating that active surveillance is especially important in areas of high endemicity, such as Brazil.

Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts.

Contact surveillance is a valuable strategy for controlling leprosy. A dynamic cohort study of leprosy contacts was initiated in 1987 at Oswaldo Cruz Foundation. The objective of this work was to review the data on the major risk factors leading up to the infectious stage of the disease, estimate incidence rates of leprosy in the cohort and characterise the risk factors for the disease among the contacts under surveillance. The incidence rate of leprosy among contacts of leprosy patients was estimated at 0.01694 cases per person-year in the first five years of follow-up. The following factors were associated with acquiring the disease: (i) not receiving the BCG vaccine, (ii) a negative Mitsuda reaction and (iii) contact with a patient with a multibacillary clinical form of leprosy. The contacts of index patients who had high bacilloscopic index scores > 1 were at especially high risk of infection. The following factors were associated with infection, which was defined as a seropositive reaction for anti-phenolic glicolipid-1 IgM: (i) young age (< 20 years), (ii) a low measured Mitsuda reaction (< 5 mm) and (iii) contact with an index patient who had a high bacilloscopic index. BCG vaccination and re-vaccination were shown to be protective among household contacts. The main conclusions of this study indicate an urgent need for additional leprosy control strategies in areas with a high incidence of the disease.

[Evaluation and control of missing contacts of leprosy patients]. / Avaliação e controle de contatos faltosos de doentes com hanseníase.

Descriptive study, with qualitative variables, carried on in the Ambulatory of Specialties Region of Taubaté, in order to evaluate the missing contacts of leprosy patients. Thirty-six records of new cases were analyzed, from January 2003 to July 2004. Ninety-two contacts were identified, being 64.1% missing ones, having 25% from 20 to 29 years and 58.5% female. Of these, 61% were submitted to consultation of home nursing. Reported non-membership to the control for forgetfulness (66.6%), and lack of time (11.1%), 4 contacts had symptoms of leprosy, and 1 was confirmed (transmissible form - Dimorfa). Without achieving 100% coverage active search, we suggest, to ensure the goal of eliminating of the disease, partnerships and decentralization of the control activities.

[Leprosy: control of household contacts in the municipality of Londrina-PR for a ten-year period]. / Hanseníase: o controle dos contatos no município de Londrina-PR em um período de dez anos.

The purpose of this descriptive study is to analyze variables related to leprosy patients' household contacts who received treatment in Londrina-PR-Brazil for a ten-year period. The data analysis was based on the health service's records and from a system of infectious disease. Out of 1055 leprosy's patients, it was recorded 3394 contacts with an average of 3,2. The most exposed individuals were those aged up to 40 (71,5%); son/daughter (40.6%) and husband/wife (17.8%). Of the1731 contacts (51.0%) examined, 183 showed some signs of the disease: there were 16 confirmed cases, 47 were excluded and 120 did not finish the clinical investigation. Most of the contacts (51.6%) were exposed to the multibacillary forms and 12.8% proved they were vaccinated with two doses of BCG. It is possible to conclude that the follow-up of the contacts was not adequate.

Avaliação e controle de contatos faltosos de doentes com hanseníase / Evaluación y control de contactos faltantes de enfermos con lepra / Evaluation and control of missing contacts of leprosy patients

Estudo descritivo, com variáveis qualitativas, realizado no Ambulatório Regional de Especialidades de Taubaté, com objetivo de resgatar e avaliar contatos faltosos de doentes de hanseníase. Analisou-se 36 prontuários de casos novos, no período de janeiro de 2003 a julho de 2004. Identificou-se 92 contatos, sendo 64,1 por cento faltosos, tendo 25 por cento entre 20 a 29 anos e 58,5 por cento do sexo feminino. Destes, 61 por cento foram submetidos à consulta de enfermagem no domicilio. Relataram não adesão ao controle por esquecimento (66,6 por cento), e falta de tempo (11,1 por cento); 4 contatos tinham sintomas de hanseníase, e 1 foi confirmado (forma transmissível - Dimorfa). Sem atingir 100 por cento da cobertura de busca ativa, sugerimos, para assegurar a meta de eliminação da doença, parcerias e descentralização das ações de controle.

Descriptive study, with qualitative variables, carried on in the Ambulatory of Specialties Region of Taubaté, in order to evaluate the missing contacts of leprosy patients. Thirty-six records of new cases were analyzed, from January 2003 to July 2004. Ninety-two contacts were identified, being 64.1 percent missing ones, having 25 percent from 20 to 29 years and 58.5 percent female. Of these, 61 percent were submitted to consultation of home nursing. Reported non-membership to the control for forgetfulness (66.6 percent), and lack of time (11.1 percent), 4 contacts had symptoms of leprosy, and 1 was confirmed (transmissible form - Dimorfa). Without achieving 100 percent coverage active search, we suggest, to ensure the goal of eliminating of the disease, partnerships and decentralization of the control activities.

Estudio descriptivo, con cualitativas variable, realizado en el Ambulatorio de Especialidades Regional de Taubaté, a fin de canjear y evaluar las deficiencias de enfermos de lepra. Se analizaron los registros de 36 nuevos casos, entre enero de 2003 y julio de 2004. Se identificaron 92 contactos, sendo 64,1 por ciento deficiencias, tendo 25 por ciento de 20 a 29 años y 58,5 por ciento mujeres. De estos, 61 por ciento fueron sometidos a consulta en la casa de los enfermos . Informó de la no pertenencia al control en el olvido (66,6 por ciento), y la falta de tiempo (11,1 por ciento), 4 contactos había síntomas de la lepra, y se confirmó 1 (formulario transmisibles - Dimorfa). Sin lograr una cobertura del 100 por ciento del activo de búsqueda, le sugerimos que, para garantizar el objetivo de eliminar la enfermedad, las asociaciones y la descentralización de las actividades de control.

Hanseníase: o controle dos contatos no município de Londrina-PR em um período de dez anos / Lepra: el control de los contactos en el municipio de Londrina-PR en un periodo de diez años / Leprosy: control of household contacts in the municipality of Londrina-PR for a ten-year period

Estudo descritivo, com o objetivo de analisar variáveis relacionadas aos contatos de pacientes com hanseníase atendidos no município de Londrina, num período de dez anos. Os dados foram obtidos das fichas de comunicantes e do SINAN. Dentre os 1055 casos de hanseníase, foram registrados 3394 contatos, com média de 3,2. Os indivíduos mais expostos possuem até 40 anos de idade (71,5 por cento), sendo filhos/a (40,6 por cento) e esposo/a (17,8 por cento). Foram examinados 1731 (51,0 por cento) contatos, dos quais, 183 apresentavam algum sinal de hanseníase: confirmados 16 casos, descartados 47 e não concluíram a investigação 120 (65,6 por cento). A maioria dos contatos (51,6 por cento) foi exposta às formas multibacilares e 10,1 por cento comprovaram a efetivação de duas doses da BCG. Conclui-se que está havendo falhas no acompanhamento dos contatos.

The purpose of this descriptive study is to analyze variables related to leprosy patients' household contacts who received treatment in Londrina-PR-Brazil for a ten-year period. The data analysis was based on the health service's records and from a system of infectious disease. Out of 1055 leprosy's patients, it was recorded 3394 contacts with an average of 3,2. The most exposed individuals were those aged up to 40 (71,5 percent); son/daughter (40.6 percent) and husband/wife (17.8 percent). Of the1731 contacts (51.0 percent) examined, 183 showed some signs of the disease: there were 16 confirmed cases, 47 were excluded and 120 did not finish the clinical investigation. Most of the contacts (51.6 percent) were exposed to the multibacillary forms and 12.8 percent proved they were vaccinated with two doses of BCG. It is possible to conclude that the follow-up of the contacts was not adequate.

Estudio descriptivo, con el objetivo de analizar variables relacionadas a los contactos de pacientes con Lepra que son atendidos en el município de Londrina, en un período de diez años. Los datos fueron obtenidos en las fichas de los acompañantes y del SINAN (órgano del MInisterio de Salud que registra la ocurrencia de toda enfermedad transmisible). Entre los 1055 casos de hanseníase, fueron registrados 3394 contactos, con una media de 3,2. Los individuos más expuestos tienen hasta 40 años de edad (71,5 por ciento), siendo hijos/as (40,6 por ciento) y esposos/as (17,8 por ciento). Fueron examinados 1731 (51,0 por ciento) contactos, de los cuales, 183 presentaban alguna señal de la lepra: confirmados 16 casos, descartados 47 y sin concluir la investigación 120. La mayoría de los contactos (51,6 por ciento) fue expuesta a las formas multibacilares y 12,8 por ciento comprobó la administración de dos dosis de la BCG. Se concluye que está habiendo fallas en el acompañamiento de los contactos.