Epidemiology and grade 2 disability of leprosy among migrant and resident patients in Guangdong: an unignorable continued transmission of leprosy.

Introduction: Leprosy remains a major public health concern worldwide and one of the leading causes of disability. New cases of leprosy with grade 2 disability (G2D) often reflect delayed detection due to the limited capacity of the health system to recognize leprosy early. This study aimed to describe the epidemiology and G2D of leprosy among migrant and resident patients with leprosy in Guangdong province, China. Methods: Data on newly diagnosed cases of leprosy were collected from the leprosy management information system in China. Descriptive statistical analysis was used to describe the status of G2D. Joinpoint regression model and logistic regression were performed to analyze the temporal trends and influencing factors for G2D. Results: The G2D rate among migrant, resident, and total patients with leprosy was 17.5%, 18.7%, and 18.4%, respectively. The total G2D rate increased significantly from 18.0% in 2001 to 25.7% in 2021 (average annual per cent change: 2.5%). Multivariate analysis revealed that factors that negatively influence G2D between migrant and resident patients included delayed discovery time (migrants: OR = 2.57; residents: OR = 4.99) and nerve damage when diagnosed (migrants: OR = 9.40; residents: OR = 21.28). Discussion: Our findings indicate that the targeted intervention measures implemented by our health system are urgently needed to improve the current situation, such as programs to promote early detection, strengthen awareness and skills of healthcare workers, and rehabilitation for disabled patients to improve their quality of life.

Current status of infectious diseases among migrants and non-citizens in Malaysia.

The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants' populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.

Internal Migration and Leprosy in Shanghai from 2000 to 2019: an Epidemiological Study of New Cases.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Massive internal migration from rural to urban areas poses new challenges for leprosy control in Shanghai, China. This retrospective epidemiological study examined new cases of leprosy diagnosed in Shanghai from 2000 to 2019, with emphasis on internal migration cases. There were 145 cases of leprosy in the study period; the majority of cases (89.0%) were internal migrants. Migrant cases had a mean of 25.4 months lag time from onset of symptoms to diagnosis, which was significantly longer than that of resident cases (mean 10.8 months, p < 0.001). Greater lag time from the first visit to diagnosis was observed in migrant cases (mean 23.2 months) compared with resident cases (mean 9.4 months, p < 0.001). A large majority of cases (91.0%) had been misdiagnosed. Internal migrant cases were responsible for most incidences of leprosy in Shanghai. They often did not receive timely diagnosis and treatment, which may have an adverse impact on the prevention of epidemic leprosy.

Diagnosis of leprosy in a Nigerian migrant: implementation of surveillance measures in the current migration context.

BACKGROUND: In Italy, leprosy diagnosis is reported in immigrants from endemic countries or Italians who have stayed in endemic areas. We report the first leprosy case to be observed in a migrant from Nigeria in the Rimini district (Emilia-Romagna, Northern Italy). METHODS: After describing the tasks of the various health Institutions in the Italian integrated system for diagnosis, treatment, and surveillance of leprosy, we describe the management and outcomes of the leprosy case and of the patient's contacts. RESULTS: In April 2017, Multibacillary Lepromatose Leprosy was diagnosed in a 29-year-old Nigerian man who arrived in Rimini in July 2014 after a 2-year stay in Libya. The local Public Health Service implemented the epidemiological investigation and identified the patient's close contacts. The management of the case and the surveillance of the 13 identified contacts, 7 Italians and 6 migrants, highlighted some critical issues. The late diagnosis of the case, due to the lack of knowledge of exotic diseases by general practitioners and other health and social professionals, and the loss at follow up of the close contacts (5 out of 6 migrants), represented important obstacles to the full success of surveillance measures. CONCLUSIONS: Although in Italy there is a well codified system of notification and surveillance of leprosy, the recognising of cases and the tracing and follow up of contacts are made difficult by the particular conditions of the involved people. This represents a new challenge for the Italian Public Health Authorities which, in the current context of immigration, often uncontrolled, must know how to respond to the new needs, in close collaboration with the State Institutions responsible for registering migrants and those health and social professionals who could facilitate the access of foreign people to health services.

Evaluation of the economic burden of leprosy among migrant and resident patients in Guangdong Province, China.

BACKGROUND: A lot of time and money was needed during the diagnosis and treatment process of leprosy, the delayed leprosy would also impair the labor capability of patients as well, and these put a heavy burden for the leprosy patients. The migrant leprosy patient is a special group and need more concern. Our goal was to assess the economic burden of leprosy on migrant and resident patient populations in Guangdong province, China. METHODS: We conducted a population-based cross-sectional survey from February to July of 2016. A self-designed questionnaire was administered to leprosy patients who: (1) had registered in Leprosy Management Information System in China (LEPMIS) by the end of February 2016, (2) had received multiple drug treatment (MDT) drugs at a local leprosy control institution for three consecutive months or had had at least one physical check in the past half year, and (3) were willing to take part in the investigation and give informed written consent. Demographic characteristics, Financial and disease information, and costs before and after leprosy diagnosis were collected and compared using t-test and χ2 test. RESULTS: A total of 254 participants completed the questionnaires, including 168 males and 86 females. Migrants and residents accounted for 33.9% and 66.1% of patients, respectively. Among migrant patients, the median cost before diagnosis was $131.6 (39.2-450.9), the median yearly cost of leprosy treatment after diagnosis was $300.6 (158.4-868.5), and the median yearly cost of leprosy complications was $69.5 (11-178.4). In comparison, among residents the median yearly costs were $152.4 (30.7-770.9) pre-diagnosis, $309.7 (103.2-1016.7) after diagnosis, and $91.9 (32.6-303.1) for leprosy complications. Base on this, we determined that the median yearly total expense after diagnosis amounted to 15% of migrant and 38% of resident patients' annual income. CONCLUSION: Leprosy places a heavy economic burden on both migrant and resident leprosy patients and governmental policies and programs could substantially alleviate this. Measures to implement more active surveillance and early diagnosis would benefit both populations, while labor protection and medical insurance are urgently needed for migrant patients and easier access to medical services and social aids could substantially decrease the burden of leprosy for resident patients.

Progress towards a leprosy-free country: The experience of Oman.

INTRODUCTION: The World Health Organization (WHO) released the Global Leprosy Strategy 2016-2020 towards a leprosy-free world. The author described the progress made towards the elimination of leprosy and suggested recommendations for the acceleration towards a Leprosy-free country according to WHO laid out criterion. METHODOLOGY: Case record review of Leprosy patients managed between the years 1992 to 2015 were registered and analyzed. Data were collected from annual reports of the Ministry of Health including demographics, classification of leprosy new cases, relapse, childhood, grades of disability (GD) and multidrug therapy (MDT) completion rates. RESULTS: Leprosy prevalence rate declined from 1.64 to 0.09 per 10,000 population during the period 1992 and 2015 (p<0.0001). Between 2005 and 2015, 77 patients were diagnosed with Leprosy as per definition and 75/77 (98%) had smear or biopsy positive. Of these, 53 (69%) cases were among foreign-born (non-national) (p<0.003) and 19 (25%) were among women. Most of the leprosy cases were notified in Muscat governorate 29 (38%) and among patients between 25-44 years of age 41 (53%), followed by ≥45 years 29 (38%) and 6 (8%) were children age ≤ 14 years. Multi-bacillary (MB) cases reported 60 versus 17 for Pauci-bacillary (PB) (p< 0.01), while MB was highest among both nationals (83%) and foreign-born (75%). MDT completion rate was 100% and no relapse cases were notified among nationals. The rate of new patients diagnosed with leprosy related disability was 2.3 per million population, and grade 2 disability (G2D) rate among nationals was 0.9 per million population. No disability was recorded among women or children less than 14 years within the nationals group from 2013. Almost all the foreign-born patients didn't complete their treatment in Oman as they left the country shortly after diagnosis of leprosy due to a very short term contract, discretionary employment practices by the employers and prefer to go home to complete their treatment. CONCLUSION: Oman has met the elimination goals and made great strides towards becoming a leprosy-free country. However, challenges such as improving surveillance system efficiency and sensitivity for detecting timely leprosy cases, as well as foreign-born workers are still a major concerns.

Marshallese COFA Migrants in Arkansas.

Arkansas is home to one of the largest populations of Marshallese in the world. Marshallese communities suffer from a disproportionate incidence of chronic diseases, including obesity, cardiovascular disease, diabetes, and infectious diseases, such as Hansen's disease (leprosy), tuberculosis, and types of hepatitis. There are a number of structural, legal, economic, and social issues that must be addressed in order to reduce health disparities and increase access to health care for Marshallese living in Arkansas.

Patterns of migration and risks associated with leprosy among migrants in Maranhão, Brazil.

Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07-2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of migration to localize focused control efforts in endemic areas with high population mobility.

Impact of migration on new case detection rates in leprosy in Gudiyatham Taluk, Tamil Nadu, India.

Migration of persons affected by leprosy was hinted at as early as 1929 (Bhaskara Rao 1930). All new cases of leprosy in Isfahan Province (Iran) were found to be migrants (Asilian et al 2005). Chudasama (2007) suspected increase in leprosy cases in Surat district to migration. These suggest migration contributes to new cases. This study was done to find out 1. Extent of migration among new cases, 2. Characteristics of migrants, 3. Occupational pattern 4.Reasons for migration. 5. Place of origin of migrants 6. Assimilation of migrants into the society. Trained staff collected information regarding migration using special questionnaire from all 222 new untreated cases from the field area of Community Health department during 2004 to 2008. Migrants were 10.4%. Distribution of place of residence, age, gender, marital status, education, mode of detection, Ridley-Jopling and MB/PB classifications of migrants were not significantly different from that of nonmigrants. Grade 2 deformities were more among migrants. All migrants found occupation. Mostly men migrated for job and women for joining their husbands. The role of migration in increasing the number of new cases cannot be minimized. Enhanced efforts should be made to provide adequate medical, health and rehabilitation services for them also.

Hansen disease among Micronesian and Marshallese persons living in the United States.

An increasing proportion of Hansen disease cases in the United States occurs among migrants from the Micronesian region, where leprosy prevalence is high. We abstracted surveillance and clinical records of the National Hansen's Disease Program to determine geographic, demographic, and clinical patterns. Since 2004, 13% of US cases have occurred in this migrant population. Although Hawaii reported the most cases, reports have increased in the central and southern states. Multibacillary disease in men predominates on the US mainland. Of 49 patients for whom clinical data were available, 37 (75%) had leprosy reaction, neuropathy, or other complications; 17 (37%) of 46 completed treatment. Comparison of data from the US mainland with Hawaii and country-of-origin suggests under-detection of cases in pediatric and female patients and with paucibacillary disease in the United States. Increased case finding and management, and avoidance of leprosy-labeled stigma, is needed for this population.

Lepra en el tercer milenio. A propósito de cuatro casos en Málaga, dos autóctonos y dos importados / Leprosy in the third millenium. Four cases in Malaga, two autochthonous and two imported

Aunque los focos históricos de infección leprosa en nuestro país están controlados y prácticamente inactivos, se siguen diagnosticando algunos casosautóctonos aislados. Además, la existencia en los últimos años de una elevada inmigración procedente de zonas endémicas, hace cada vez más posiblela llegada de casos importados.Presentamos 4 pacientes, tres varones y una mujer, de 28, 30, 46 y 81 años de edad, afectos de lepra, dos de tipo lepromatoso, una borderline lepromatosay otra indeterminada. Dos casos eran autóctonos de Málaga y dos importados de Bolivia y Brasil, con diferencias en edad y actividad laboralentre ambos tipos de pacientes. Se destaca un caso de lepra lepromatosa florida en un paciente malagueño de edad avanzada que no se diagnosticóhasta que fue remitido a nuestro hospital por otro problema de salud

Although historical leprosy focus in our country are under control and show low activity, new cases from time to time are energing. In addition, the highimmigration in the last few years from endemic areas provide facilitates the arrival of imported cases.We report four cases of leprosy, three males and a female, 28, 30, 46 and 81-year-old, two with the lepromatous type, one borderline lepromatous andan undetermined one. Two patients are from Malaga and the other two come from Colombia and Brazil, with some differences in age and activityamong both types of patients. It is remarkable one case of lepromatous leprosy in an old patient from Malaga undiagnosed since he was seen at emergencyarea of our hospital for other health problem