Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil.

Importance: Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries. Objective: To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors. Design, Setting, and Participants: This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018. Exposures: Clinical characteristics of the primary case and sociodemographic factors of the household contact. Main Outcomes and Measures: Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects. Results: Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42). Conclusions and Relevance: The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.

An evaluation of the future role of non-governmental organizations currently engaged in leprosy control in India.

The mass implementation of short term multi-drug therapy in India, has led to dramatic falls in the prevalence of leprosy. This paper addresses the future role of non-governmental organizations currently involved in leprosy control. This evaluation is based on current trends in leprosy control, projected health needs in the future and the necessity to maximize health care outputs in the face of limited resources.

Leprosy control in Zambia.

Leprosy was a serious public health problem in Zambia until recently, with over 16,000 cases in 1982. Since then leprosy patients in the country have been put under multidrug therapy (MDT), as recommended by WHO, with support from the Sasakawa Memorial Health Foundation. Leprosy control in Zambia is combined with tuberculosis control and integrated within general health services. By 1990 52 districts (93%) had MDT, with an overall coverage of about 70% of all patients. As a result the number of registered cases has come down steadily from 16,642 in 1982 to 3,663 in 1989. Similarly, the number of new cases detected has been reduced from 1,010 cases in 1982 to 577 in 1989. On the whole the programme has gained significant momentum, although it is too early to expect a complete eradication of the disease in the near future, given the continued low level of observed new cases. Further, the implementation of MDT still lags behind the projected targets so that the potential of MDT is not being fully utilized. In addition, the problem of rehabilitation of disabled patients needs special attention. A subprogramme aimed at reducing disability through community participation is being developed within the framework of primary health care.

The national leprosy eradication programme in India.

India has the largest leprosy problem in the world, with an estimated 4 million patients. The number of registered cases in the country was 2.4 million by June 1990, and the number of new cases detected during 1989-1990, 0.47 million. The disease prevalence varies widely from state to state and even among districts within states--8 of the 26 states contribute to 90% of all the registered cases. The country has a high priority for leprosy and the National Leprosy Eradication Programme (NLEP) aims to arrest the disease among all known cases in the country by the turn of the century through a strategy which includes multidrug therapy (MDT), early case detection, health education and rehabilitation. The specialized leprosy infrastructure in the country has a total of about 8,500 establishments including 719 leprosy control units, 244 district leprosy units and 49 training centres. By June 1990, 130 districts with 2.15 million patients had come under MDT. It is planned to cover 196 districts by 1992, ensuring coverage for 90% of the patients in the country. The country spends approximately 600 million rupees (US$ 33.3 million) per year on NLEP. In addition, a number of bilateral and international agencies including nongovernmental organizations participate in the programme. WHO supports the NLEP through technical inputs, monitoring and evaluation, and training. Plans to integrate leprosy control within primary health care, particularly after completion of the intensive phase of MDT, are being developed. Operational and technical constraints are constantly reviewed in order to find optimal solutions.

Leprosy control activities of the International Federation of Anti-leprosy Associations.

The International Federation of Anti-leprosy Associations (ILEP) founded in 1966, consists of 22 autonomous nongovernmental organizations raising funds from the general public in the North for anti-leprosy work in the South. ILEP Member associations support over 800 field projects in 92 countries, in addition to over 130 research and other projects with a total annual expenditure of about US+ 60 million. 72% of the resources are spent on leprosy-control activities, 12% on training, 10% on research and 6% on socioeconomic activities. About 55% of resources are devoted to activities of national/regional leprosy programmes. ILEP-supported projects had detected over 100,000 patients in 1988. ILEP Member associations introduced WHO-recommended multidrug therapy (MDT) quite early, and the coverage for MDT in ILEP-supported projects has increased from 8% in 1984 to 35% in 1988 (271,000 patients in 1989 out of 769,000 on treatment). ILEP Member associations are currently supporting approaches towards integration of leprosy control with other services, urban leprosy programmes and social and physical rehabilitation. Thanks to their flexibility, their sense of innovation and their commitment to the worldwide anti-leprosy campaign, ILEP Members are well placed to meet the challenge of making MDT available to all leprosy patients by the year 2000.

A review of refugee medical screening in New South Wales.

Public health concern in relation to refugees arriving in New South Wales is due to the high prevalence of tuberculosis, syphilis and hepatitis B infection in some refugee groups. Other infectious diseases (with the exception of malaria in the Northern Territory and Queensland) do not pose a significant threat to public health owing to their low prevalence (which may result from overseas screening and treatment) and/or low infectivity in Australian conditions. Because of overseas screening by the Commonwealth Government before the departure of the refugees, it was uncommon in 1984 for previously undetected tuberculosis to be detected when refugees were screened on arrival in Sydney (found in only one in 800 refugees who underwent screening). However, of the refugees in Sydney who had positive results of serological tests for syphilis, a substantial proportion (at times in excess of 50%) had had a negative result at the overseas screening; subsequent follow-up of those with positive serological results indicated inactive disease in almost all cases. There is a need to monitor the infectious disease prevalence and the effectiveness of overseas screening of refugees by on-arrival screening; decisions about screening procedures and the selection of particular incoming refugee groups for screening should be based on sound epidemiological and clinical analysis.