Evidence of high endemicity of leprosy and yaws in the municipality of Balé-Loko in the Central African Republic.

The incidence of neglected tropical diseases (NTD) can serve as an indicator for assessing the quality of healthcare systems because these diseases affect the poorest populations, living in areas where healthcare access is most difficult. The Central African Republic Ministry of Health, in collaboration with FAIRMED, decided to conduct the survey reported here in a village named/owned by the Central African Society of Agriculture and Wood Peeling (SCAD). The study took place from June 11-20, 2017. There were 137 clinical diagnoses of yaws, 102 of them positive on laboratory tests. Moreover, 79% were highly contagious forms. The prevalence of yaws in our study is higher than the 11% found in 2012 in the Lobaye region [4]. We also identified 57 cases of leprosy by screening; 68.42% (n= 39) were multibacillary. Among children younger than 15 years, 8 (16.66%) had grade 2 impairments. The screening rate for new cases is 13.333 per 10 000, quite substantially higher than the mean rate of 2.9 per 10 000 for the 121 countries and territories of this WHO region in 2016 [6]. Among the cases screened during the study, 51% (n=29/57) were already known to healthcare facilities. This study demonstrates the extent of the NTDs in Lobaye in the Central African Republic.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas.

BACKGROUND: Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings. There is a need to know what rapid diagnostic technologies are available, have been properly assessed, and are being implemented to improve control of these diseases in the urban context. This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty. MAIN BODY: A scoping review was conducted. Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases, diagnostics evaluations, rapid tests, and urban setting. The review was limited to studies published between 2000 and 2016 in English, Spanish, French, and Portuguese. Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography. A total of 179 documents of the 7806 initially screened were included in the analysis. Malaria (n = 100) and tuberculosis (n = 47) accounted for the majority of studies that reported diagnostics performance, impact, and implementation outcomes. Fewer studies, assessing mainly performance, were identified for visceral leishmaniasis (n = 9), filariasis and leptospirosis (each n = 5), enteric fever and schistosomiasis (each n = 3), dengue and leprosy (each n = 2), and Chagas disease, human African trypanosomiasis, and cholera (each n = 1). Reported sensitivity of rapid tests was variable depending on several factors. Overall, specificities were high (> 80%), except for schistosomiasis and cholera. Impact and implementation outcomes, mainly acceptability and cost, followed by adoption, feasibility, and sustainability of rapid tests are being evaluated in the field. Challenges to implementing rapid tests range from cultural to technical and administrative issues. CONCLUSIONS: Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection. However, most evidence comes from malaria rapid diagnostics, with variable results. While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies, more evidence on performance of current tests or development of new alternatives is needed for dengue, Chagas disease, filariasis, leptospirosis, enteric fever, human African trypanosomiasis, schistosomiasis and cholera.

Analysis of the epidemiological situation of leprosy in an endemic area in Brazil: spatial distribution in the periods 2001 - 2003 and 2010 - 2012. / Análise da situação epidemiológica da hanseníase em uma área endêmica no Brasil: distribuição espacial dos períodos 2001 - 2003 e 2010 - 2012.

INTRODUCTION: In Brazil, the spatial distribution of leprosy is heterogeneous. Areas with high transmission of the disease remain in the North, Center-west and Northeast. Areas with high transmission of the disease remain in the Northern, Central-Western and Northeastern regions of the country. OBJECTIVE: to describe the spatial distribution of leprosy in municipalities with high risk of transmission, in the periods from 2001 - 2003 and 2010 - 2012. METHODS: This was an ecological study using data from the Notifiable Diseases Information System (SINAN). They included all municipalities in the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão. The following leprosy indicators were calculated per 100,000 inhabitants: incidence rate of leprosy, incidence rate in children aged less than 15 years and rate of new cases with grade 2 disabilities. The spatial scan statistic was used to detect significant clusters (p ≤ 0.05) in the study area. RESULTS: In the period 2001 - 2003, the scan spatial statistics identified 44 significant clusters for the leprosy incidence rate, and 42 significant clusters in the period 2010 - 2012. In the period 2001 - 2003, it was possible to identify 20 significant clusters to the incidence rate in children aged less than 15, and 14 significant clusters in the period 2010 - 2012. For the rate of new cases with grade 2 disability, the scan statistics identified 19 significant clusters in the period 2001 - 2003, and 14 significant clusters in the period 2010 - 2012. CONCLUSIONS: Despite the reduction in the detection of leprosy cases, there is a need intensify disease control actions, especially in the clusters identified.

INTRODUÇÃO: No Brasil, a distribuição espacial da hanseníase é heterogênea. Áreas com alta transmissão da doença permanecem nas regiões Norte, Centro-Oeste e Nordeste do país. OBJETIVO: Descrever a distribuição espacial da hanseníase em municípios brasileiros com alto risco de transmissão, nos períodos 2001 - 2003 e 2010 - 2012. MÉTODOS: Trata-se de um estudo ecológico com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram incluídos todos os municípios localizados nos Estados de Mato Grosso, do Tocantins, de Rondônia, do Pará e do Maranhão. Os seguintes indicadores de hanseníase foram calculados por 100.000 habitantes: taxa de incidência de hanseníase, taxa de incidência em menores de 15 anos e a taxa de casos novos com grau 2 de incapacidade (por 100.000 habitantes). A estatística espacial scan foi usada para detectar clusters significativos (p ≤ 0,05) na área de estudo. RESULTADOS: No período 2001 - 2003, a estatística espacial scan identificou 44 clusters significativos para a taxa de incidência da hanseníase, e 42 clusters significativos no período 2010 - 2012. No período 2001 - 2003, foram identificados 20 clusters significativos para a taxa de incidência em menores de 15 anos, e 14 clusters significativos no período 2010 - 2012. Para a taxa de casos novos com grau 2 de incapacidade, a estatística scan identificou 19 clusters significativos no período 2001 - 2003, e 14 agrupamentos significativos no triênio 2010 - 2012. CONCLUSÃO: Apesar da redução na detecção de casos de hanseníase, há uma necessidade de intensificar as ações de controle da doença, especialmente nos clusters identificados.

Análise da situação epidemiológica da hanseníase em uma área endêmica no Brasil: distribuição espacial dos períodos 2001 - 2003 e 2010 - 2012 / Analysis of the epidemiological situation of leprosy in an endemic area in Brazil: spatial distribution in the periods 2001 - 2003 and 2010 - 2012

RESUMO: Introdução: No Brasil, a distribuição espacial da hanseníase é heterogênea. Áreas com alta transmissão da doença permanecem nas regiões Norte, Centro-Oeste e Nordeste do país. Objetivo: Descrever a distribuição espacial da hanseníase em municípios brasileiros com alto risco de transmissão, nos períodos 2001 - 2003 e 2010 - 2012. Métodos: Trata-se de um estudo ecológico com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram incluídos todos os municípios localizados nos Estados de Mato Grosso, do Tocantins, de Rondônia, do Pará e do Maranhão. Os seguintes indicadores de hanseníase foram calculados por 100.000 habitantes: taxa de incidência de hanseníase, taxa de incidência em menores de 15 anos e a taxa de casos novos com grau 2 de incapacidade (por 100.000 habitantes). A estatística espacial scan foi usada para detectar clusters significativos (p ≤ 0,05) na área de estudo. Resultados: No período 2001 - 2003, a estatística espacial scan identificou 44 clusters significativos para a taxa de incidência da hanseníase, e 42 clusters significativos no período 2010 - 2012. No período 2001 - 2003, foram identificados 20 clusters significativos para a taxa de incidência em menores de 15 anos, e 14 clusters significativos no período 2010 - 2012. Para a taxa de casos novos com grau 2 de incapacidade, a estatística scan identificou 19 clusters significativos no período 2001 - 2003, e 14 agrupamentos significativos no triênio 2010 - 2012. Conclusão: Apesar da redução na detecção de casos de hanseníase, há uma necessidade de intensificar as ações de controle da doença, especialmente nos clusters identificados.

ABSTRACT: Introduction: In Brazil, the spatial distribution of leprosy is heterogeneous. Areas with high transmission of the disease remain in the North, Center-west and Northeast. Areas with high transmission of the disease remain in the Northern, Central-Western and Northeastern regions of the country. Objective: to describe the spatial distribution of leprosy in municipalities with high risk of transmission, in the periods from 2001 - 2003 and 2010 - 2012. Methods: This was an ecological study using data from the Notifiable Diseases Information System (SINAN). They included all municipalities in the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão. The following leprosy indicators were calculated per 100,000 inhabitants: incidence rate of leprosy, incidence rate in children aged less than 15 years and rate of new cases with grade 2 disabilities. The spatial scan statistic was used to detect significant clusters (p ≤ 0.05) in the study area. Results: In the period 2001 - 2003, the scan spatial statistics identified 44 significant clusters for the leprosy incidence rate, and 42 significant clusters in the period 2010 - 2012. In the period 2001 - 2003, it was possible to identify 20 significant clusters to the incidence rate in children aged less than 15, and 14 significant clusters in the period 2010 - 2012. For the rate of new cases with grade 2 disability, the scan statistics identified 19 significant clusters in the period 2001 - 2003, and 14 significant clusters in the period 2010 - 2012. Conclusions: Despite the reduction in the detection of leprosy cases, there is a need intensify disease control actions, especially in the clusters identified.

Temporal trends of leprosy in a Brazilian state capital in Northeast Brazil: epidemiology and analysis by joinpoints, 2001 to 2012. / Tendência temporal da hanseníase em uma capital do Nordeste do Brasil: epidemiologia e análise por pontos de inflexão, 2001 a 2012.

The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.

Tendência temporal da hanseníase em uma capital do Nordeste do Brasil: epidemiologia e análise por pontos de inflexão, 2001 a 2012 / Temporal trends of leprosy in a Brazilian state capital in Northeast Brazil: epidemiology and analysis by joinpoints, 2001 to 2012

RESUMO: O objetivo deste estudo foi caracterizar aspectos epidemiológicos e tendência temporal da hanseníase, no município de Fortaleza, Ceará, de 2001 a 2012. Foram registrados 9.658 casos novos cuja tendência foi analisada pelo modelo de regressão do joinpoint . O coeficiente de detecção geral apresentou tendência decrescente, com annual percent change (APC) de -4,0 e intervalo de confiança de 95% (IC95%) -5,6 - -2,3. O coeficiente de detecção em menores de 15 anos de idade (APC = -1,4; IC95% -5,4 - 2,8) e o coeficiente de detecção de grau 2 de incapacidade (APC = -0,8; IC95% -4,5 - 3,1) foram estáveis. A proporção do sexo feminino foi decrescente (APC = -1,5; IC95% -2,3 - -0,8). As proporções de casos multibacilares a partir de 2005 até 2012 (APC = 1,4; IC95% 0,6 - 2,3) e, dentre eles, de casos virchowianos a partir de 2004 até 2012 (APC = 6,0; IC95% 3,4 - 8,6) foram crescentes. Houve estabilidade na proporção de casos com grau 1 (APC = 1,4; IC95% -0,9 - 3,7) e grau 2 de incapacidade (APC = 3,7; IC95% -0,1 - 7,8). Apesar da tendência à redução na detecção geral, mantém-se a dinâmica de transmissão no município, além de sinalizar para diagnóstico tardio.

ABSTRACT: The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.

Saúde nas metrópoles – doenças infecciosas / Health in metropolises - Infectious Diseases

A urbanização é um processo irreversível em escala mundial e estima-se que o número de pessoas que vivem em cidades deverá atingir 67% da população do planeta até 2050. Os países de baixa ou média renda, por sua vez, possuem 30% a 40% da população urbana vivendo atualmente em favelas, em situação de risco para diversos agravos de saúde. No Brasil, embora 84,3% da população residissem em áreas urbanas já em 2010, não se verificam no momento ações consistentes voltadas ao enfrentamento das questões de saúde urbana. Neste artigo discute-se a situação epidemiológica de agravos infecciosos de interesse para a saúde pública (dengue, infecção por HIV/aids, leptospirose, hanseníase e tuberculose) a partir do ano 2000 nas 17 metrópoles do país, de modo a esclarecer o papel atual das doenças infecciosas no contexto da saúde urbana brasileira...

Urbanization is an irreversible global process and the number of people living in cities is estimated to reach 67% of the world population by 2050. In low- and middle-income countries, 30% to 40% of the population currently lives in slum areas, under risk of several diseases. Even though 84.3% of the Brazilian population already lived in urban areas in 2010, no consistent initiatives have been implemented to address urban health issues. We discuss here the epidemiological features of communicable diseases that are relevant to public health (dengue, HIV/aids, leptospirosis, leprosy and tuberculosis) in Brazil’s 17 metropolitan areas since 2000 to help clarify the current role of infections in the context of Brazilian urban health...

[Patients from a reference center for leprosy: Rio de Janeiro and Duque de Caxias, 1986-2008]. / Pacientes em centro de referência para Hanseníase: Rio de Janeiro e Duque de Caxias, 1986-2008.

UNLABELLED: The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). RESULTS: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.

Pacientes em centro de referência para Hanseníase: Rio de Janeiro e Duque de Caxias, 1986-2008 / Patients from a Reference Center for Leprosy: Rio de Janeiro and Duque de Caxias, 1986-2008

O objetivo deste trabalho foi comparar dados epidemiológicos de pacientes de hanseníase residentes em dois municípios com perfil socioeconômico e nível de endemicidade diferentes e que foram acompanhados em um mesmo centro de referência. Foi realizado um estudo descritivo dos dados de pacientes tratados no ambulatório Souza Araújo, 1986 a 2008, residentes nos municípios do Rio de Janeiro (n = 1353) e Duque de Caxias (n = 336). Entre os pacientes desta cidade, em comparação com os da outra, observou-se maior proporção de casos: com idade inferior a 15 anos, multibalicares, com maior índice baciloscópico (IB) inicial, e detectados através da vigilância de contatos. Os pacientes de Duque de Caxias apresentaram menor renda média e nível de escolaridade. Não foram observadas diferenças estatisticamente significativas quanto ao sexo, grau de incapacidade inicial, reação no diagnóstico, IB final, abandono e regularidade do tratamento. As diferenças encontradas entre os pacientes acompanhados em um mesmo centro de referência poderiam estar, em parte, relacionadas a diferenças contextuais existentes entre os municípios. Por outro lado, observou-se que a oferta de tratamento e acompanhamento podem minimizar o efeito que os fatores contextuais apresentam sobre os desfechos de saúde.

The scope of this study was to compare epidemiological data on leprosy patients living in two cities with different socioeconomic and endemic profiles that were monitored in a single center of reference. A descriptive study was made of data from patients in the Souza Araújo Outpatient facility treated in the period 1986-2008, who were resident in the cities of Rio de Janeiro = 1353) and Duque de Caxias (n = 336). Results: Among patients from Duque de Caxias, in comparison with patients from Rio de Janeiro, there was a higher proportion of cases: below the age of 15 years, multibacillary, higher initial bacilloscopic index (BI) and cases detected through surveillance of contacts. Patients in Duque de Caxias had lower average incomes and education levels. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, final BI, bandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities. On the other hand, it was observed that the provision of treatment and monitoring can minimize the effect of different contextual factors on health outcomes.

Prevalência de HIV em gestantes e transmissão vertical segundo perfil socioeconômico, Vitória, ES / HIV prevalence in pregnant women and vertical transmission in according to socioeconomic status, Southeastern Brazil / Factores asociados a recidiva en hanseníasis en Mato Grosso, Centro-oeste de Brasil

OBJETIVO: Descrever a prevalência de infecção por HIV em gestantes e a taxa de transmissão vertical, segundo o perfil socioeconômico dos bairros de residência das mães. MÉTODOS: Estudo ecológico exploratório utilizando a base de dados do Sistema de Informação de Agravos de Notificação de gestantes HIV-positivas e aids em crianças notificadas entre 2000 e 2006 em Vitória, ES. Para análise das informações socioeconômicas foi utilizado o Índice de Qualidade Urbana. A prevalência de HIV em gestantes e a taxa de transmissão vertical foram calculadas. A distribuição espacial dos casos foi realizada no programa Terraview 3.2.0. Para verificar a associação entre a qualidade urbana e a prevalência de HIV em gestantes utilizou-se o modelo de regressão de Poisson. RESULTADOS: Um total de 137 gestantes e 14 crianças infectadas por transmissão vertical foi notificado no período. Sete crianças correspondiam a mães HIV-positivas sem notificação de caso no período analisado. A prevalência de infecção em gestantes no período foi de 0,44 por cento e a taxa de transmissão vertical foi de 9,7 por cento. CONCLUSÕES: A prevalência de infecção por HIV em gestantes e a transmissão vertical associam-se à qualidade urbana do bairro de residência, indicando que os bairros com menor qualidade urbana devem ser priorizados quanto às ações para redução da transmissão vertical.

OBJECTIVE: To describe HIV prevalence in pregnant women and the rate of vertical transmission according to socioeconomic status of residential neighborhoods. METHODS: Ecological exploratory study, which used the Information System of Notifiable Diseases database on HIV-positive pregnant women and AIDS in children, reported from 2000 to 2006, in Vitória, Southeastern Brazil. For analysis of socioeconomic data the Urban Quality Index was utilized The HIV prevalence rate in pregnant women and vertical transmission rate were calculated. Spatial distribution was carried out by Terraview 3.2.0. To verify the association between urban quality and HIV prevalence in pregnant women, Poisson regression was used. RESULTS: A total of 137 HIV-positive women and 14 children infected by vertical transmission was reported. Seven children matched to HIV-positive mothers without notification in the period analyzed. HIV prevalence among pregnant women in the period was 0.44 percent, and the vertical transmission rate was 9.7 percent. CONCLUSIONS: The prevalence of HIV infection among pregnant women and vertical transmission were associated with the urban quality of residential neighborhood. Neighborhoods with lower urban quality should be prioritized in actions to reduce vertical transmission.

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseníasis. MÉTODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 años diagnosticados con hanseníasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyó 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificación operacional. Se usaron datos del Sistema de Información de Agravios de Notificación, Prontuarios y entrevistas. Se utilizó regresión logística condicional y abordaje jerárquico. RESULTADOS: Posterior al análisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95 por ciento:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95 por ciento:1,16;8,76), que moraban con más de cinco personas (OR=2,1; IC95 por ciento:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95 por ciento:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95 por ciento: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95 por ciento:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95 por ciento: 2,36;12,63), forma clínica de la enfermedad (OR= 7,1;IC95 por ciento: 2,48;20,52) y esquema terapéutico (OR= 3,7; IC95 por ciento:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, hábitos de vida, organización de los servicios de salud, formas clínicas y esquemas terapéuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, así como garantizar la regularidad del tratamiento.

[Smallpox in São Paulo (SP, Brazil): history of admissions at the Institute of Infectious Diseases Emilio Ribas between 1898 and 1970]. / A varíola em São Paulo (SP, Brasil): histórico das internações no Instituto de Infectologia Emílio Ribas entre 1898 e 1970.

The objective of this article is to describe the admissions for smallpox at the Institute of Infectious Diseases Emilio Ribas, during the period from 1898 to 1970, showing the origin of the patients' residence in the metropolitan region of São Paulo. It is a descriptive study which used secondary data collected from the record books for admissions at the Institute during the period of 1898 to 1970. The hospital records were counted and grouped into periods of 10 years. The total amount of admissions were 11,393. From the total of 533 deaths, 251 of the patients were female, 280 male and two unknown. These patients resided in 139 different locations. The city of São Paulo contributed with 7915 or 69.5% of the total, followed by Santo André, Mogi das Cruzes, Guarulhos, São Caetano do Sul, Osasco and Suzano. It was seen 237 patients in transit. For 994 admissions the municipality of origin was ignored, despite indications in the records.

A varíola em São Paulo (SP, Brasil): histórico das internações no Instituto de Infectologia Emílio Ribas entre 1898 e 1970 / Smallpox in São Paulo (SP, Brazil): history of admissions at the Institute of Infectious Diseases Emilio Ribas between 1898 and 1970

O objetivo deste artigo é descrever as internações por varíola no Instituto de Infectologia Emílio Ribas, no período de 1898 a 1970, evidenciando-se a origem da residência dos pacientes da região metropolitana de São Paulo. Trata-se de um estudo descritivo retrospectivo, mediante coleta de dados secundários nos livros de registro de internação do IIER no período de 1898 a 1970. As internações foram analisadas segundo variáveis de tempo, lugar e pessoa e agrupadas em períodos de dez anos. Foram registradas 11.393 internações, com 533 óbitos, sendo 251 de pacientes do sexo feminino, 280 do masculino e dois óbitos com sexo ignorado. Esses pacientes residiam em 139 localidades diferentes. O município de São Paulo contribuiu com 7.915 69,5 por cento do total, seguido de Santo André, Mogi das Cruzes, Guarulhos, São Caetano do Sul, Osasco e Suzano. Foram atendidos em trânsito 237 pacientes. Para 994 internações ignora-se o município, apesar de indicações nos prontuários.

The objective of this article is to describe the admissions for smallpox at the Institute of Infectious Diseases Emilio Ribas, during the period from 1898 to 1970, showing the origin of the patients' residence in the metropolitan region of São Paulo. It is a descriptive study which used secondary data collected from the record books for admissions at the Institute during the period of 1898 to 1970. The hospital records were counted and grouped into periods of 10 years. The total amount of admissions were 11,393. From the total of 533 deaths, 251 of the patients were female, 280 male and two unknown. These patients resided in 139 different locations. The city of São Paulo contributed with 7915 or 69.5 percent of the total, followed by Santo André, Mogi das Cruzes, Guarulhos, São Caetano do Sul, Osasco and Suzano. It was seen 237 patients in transit. For 994 admissions the municipality of origin was ignored, despite indications in the records.

Detection of previously undetected leprosy cases in a defined rural and urban area of Maharashtra, Western India.

INTRODUCTION: Leprosy has been a major public health problem in India for centuries. In India, between 2001 and 2005, the prevalence of leprosy was reduced by 80%. This sharp decline in the prevalence of leprosy alongside the cessation of active surveillance for detection of leprosy cases has raised a sense of alarm in the scientific community. MATERIALS AND METHODS: This is a total population survey aiming to estimate the prevalence of undetected active cases of leprosy in the community in defined rural (Panvel Taluka, Raigad District) and urban (M-East Ward, Mumbai) areas by health workers from Kushth Nivaran Samiti (Panvel) and Lok Seva Sangam (Mumbai). Those provisionally diagnosed with leprosy were subjected to an independent verification using clinical, bacteriological and histopathological investigations at the Foundation for Medical Research. FINDINGS: A population of 196,694 and 600,247 was covered in defined rural and urban areas respectively. In the rural area on examining 178,646 individuals, 120 provisionally diagnosed leprosy cases were detected, of which 65 were paucibacillary (PB) and 55 were multibacillary (MB) based on the WHO operational classification used by health workers at field level. In the urban area, of the 512,434 individuals who were examined, 134 provisionally diagnosed leprosy cases were detected with 92 PB and 42 MB cases. Among the clinically confirmed cases, 35.6% (32/90) and 34.9% (36/109) in rural and urban areas respectively were children. CONCLUSIONS: There are large numbers of undetected leprosy cases in the community with a high proportion of MB patients and children among them. This indicates active transmission pointing to the need for a paradigm shift in leprosy care services and control programme.

Knowledge, attitude and practices about leprosy among medical officers of Hyderabad urban district of Andhra Pradesh.

In India, MDT was implemented through vertical programme staff of the National Leprosy Eradication Programme till the year 2001, when it was integrated into general health services (GHS). Human resource development of GHS is a vital, preparatory action for successful integration of leprosy into GHS. District Technical Support Teams (DTST) have been formed with responsibility for building the capacity of medical and paramedical staff of urban health posts (UHPs). In this context, it is necessary to know the current levels of Knowledge, Attitude and Practices (KAP) about leprosy prevailing among health staff at a given point in time, so that required knowledge and skills can be imparted, if need be. The present study is an attempt in this direction for assessing the KAP status of health staff working in Hyderabad city. 402 staff members (352 females and 50 males) working in urban health posts, the Employees State Insurance Corporation and the Central Government Health Services dispensaries in Hyderabad urban district in Andhra Pradesh were included in the study carried out in 2004 in order to assess KAP, and some operational parameters. A questionnaire was used to elicit responses of 110 medical officers in urban Hyderabad and the data were analysed and discussed. Medical officers have shown consistent higher knowledge on leprosy, followed by nursing staff as compared to other paramedical workers Only 40% of the medical officers had the opportunity of seeing at least 1 case of leprosy in their practice. Medical Officers who received training in leprosy and possessed reference material on leprosy have shown higher knowledge and practice. More than half of the study subjects did not have specific training in leprosy. Two major operational problems expressed by the medical officers were managing big crowds in OPD and time lost in meetings. 96 (87.3%) of 110 medical officers felt integration of leprosy services into general health services can be effectively implemented. 78 (71%) expressed that a leprosy patient with severe reaction needed priority attention at the out-patient department indicating good understanding of reactions in leprosy and a positive attitude towards such patients. There is a need to organize training at regular intervals to cover new persons as well as reinforcing and updating the knowledge of those already trained.

Prevalence of leprosy in Agra District (U.P.) India from 2001 to 20031.

Leprosy prevalence has reportedly declined all over the world, but six countries, including India, are still endemic for the disease. India alone contributes about 60% to the world's leprosy case load, with the major share from its northern states. The present study done in Agra district was based on a randomly-selected sample of over 10% of the population, spread across 300 villages and 16 urban units of the district. A house-to-house survey was conducted from July 2001 to July 2003 in all the 26 selected panchayats (300 villages), all the 11 block headquarters which have an urban component, and 5 (out of 20) localities in Agra city. A population of 361,321 persons was examined for leprosy. A total of 592 leprosy cases [new and cases yet to complete a full course of multi-drug therapy (M.D.T.)] were found, giving a prevalence rate of 16.4/10,000 population. Although the overall prevalence was found to be similar in both rural and urban areas, there were pockets with high prevalence. More cases were detected in the eastern side of Agra (31.4/10,000 in Fatehabad and 28.5/10,000 in Bah Tahsils). Overall, the multibacillary (MB) leprosy rate was 22.3% and the child leprosy rate 8.4%. Of the 592 cases, 523 (88.3%) were new untreated cases, giving a new case detection rate of 14.5/10,000. The MB rate was 17% (89/523), and the child leprosy rate was 8.4% (44/523) among the new patients. The grade 2 deformity rate was found to be 4.8% (25/523) among these cases. The duration of disease among new cases was 32.3 months as compared to 48.1 months among prevalent (registered) cases (i.e., patients who had been diagnosed earlier and had yet to complete a full course of M.D.T.). The large number of undetected cases found in this survey suggests the need for continued intensive health education campaigns and case detection activities. This study highlights the fact that a large number of leprosy cases go undetected in the present integrated system which is mainly based on voluntary reporting of cases.

Clinico-pathological study of 12 cases of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000.

BACKGROUND: Leprosy is considered a chronic disabling condition. Many clinical and immunological aspects of the disease remain ill defined. AIM: The study of clinico-pathological and laboratory findings of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000. METHODS AND PATIENTS: This is a descriptive retrospective cross-sectional study. The statistical community comprised all patients diagnosed leprosy. This diagnosis was clinical and confirmed through pathology (skin-biopsy) and laboratory (peripheral smear) measures. RESULTS: In this study, the disease was more common in males than females with a mean age of 48.5 +/- 16.2 years. Most of the patients were more than 40 years old. Among 12 patients in this study, six cases were urban and six cases were rural. Six cases were living in Hamadan province and two cases migrated to Hamadan province (one of them from Afghanistan and the other from Kurdestan). Clinical diagnosis was confirmed by pathology in 11 cases, but in one case the clinical diagnosis did not match the pathology. In four cases the clinical diagnosis did not match the peripheral smear. Eight cases were admitted just once. Four cases had a history of recurrence and readmission (two patients had one time recurrence and the other two patients had two recurrences). There was no difference in the clinical findings between first presentation and recurrence. From the point of complication and disability, extremity disability was more common than eye disability. Increased severity of complications was found in patients with a delayed diagnosis and incomplete treatment. CONCLUSION: This study showed that a rapid and correct diagnosis and complete treatment was necessary for prevention of complication and disability in patients with leprosy. Also the accuracy of pathology (skin biopsy) in the diagnosis exceeded the peripheral smear. Skin biopsy is recommended to confirm the diagnosis in all cases of leprosy. In the absence of pathology, patients must be considered as multibacillary patients and treated as such.

Inequality and leprosy in Northeast Brazil: an ecological study.

BACKGROUND: Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure. METHODS: To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables. RESULTS: The average incidence rate for all the municipalities for the 1991-1999 period, varied from 0.06 to 14.68 per 10000 persons per year. The level of inequality (beta = 1.67, P = 0.011), the mean years of study among the population >or=25 years old (beta = 1.35, P < 0.001), the population growth from 1991 to 1996 (beta = 0.02, P = 0.007), the percentage of children 7-14 years old that did not go to the school (beta = 0.02, P = 0.028), and the presence of a railroad in the municipality (beta = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará. CONCLUSION: Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.

Childhood leprosy in an urban clinic, Hyderabad, India: clinical presentation and the role of household contacts.

A retrospective case note study was done of children below the age of 14 years who attended Dhoolpet Leprosy Research Centre (DLRC) over the decade 1990-1999. The aim of the study was to describe the pattern of clinical presentation, the role of household or near neighbour contacts and the incidence of neuritis and reactions. In all, 3118 leprosy patients were registered during this period, of whom 306 were children [182 (60%) male]; 95 children had a single patch, 159 had five or fewer than five patches and 37 had multiple patches. The youngest case detected was 9 months old. The spectrum of leprosy in these children was: TT 62 (20.3%); BT 203 (66.3%); BB 3 (1%); BL 23 (7.5%); LL 5 (1.6%) and PNL 10 (3.3%). Twenty-nine cases (9.4%) were smear positive. Ninety-one children (29.7%) developed a reaction, 86 type I and five type II. A history of contact was present in 119 (38.8%) cases, family contact in 113 (95%) and other than family in six (5%). Classification of the contact was available in only 60 patients. Among the contacts of the index case, 21 (35%) suffered from PB leprosy and 39 (65%) from MB leprosy. All contacts were from the immediate family. This study shows that childhood leprosy cases continue to present in significant numbers to this outpatient clinic. There is a high level of family contact with leprosy in these cases, strengthening the strategy of screening children in leprosy-affected households. The high incidence of reactions and nerve damage in children emphasizes the importance of early detection and treatment.