COVID-19 vaccination and leprosy-A UK hospital-based retrospective cohort study.

BACKGROUND: Individuals with leprosy are at risk of leprosy reactions, T-cell mediated immunological complications, which lead to nerve function impairment. Leprosy reactions require systemic immunosuppression which is a risk factor for severe COVID-19. Vaccination for SARS-CoV-2 infection is recommended in the UK and became widely available in 2021 with individuals at increased risk of severe disease, including the immunosuppressed, prioritised. Vaccines for SARS-CoV-2 may provoke a T cell response. The latter poses a theoretical risk of provoking an immunological response to latent Mycobacterium leprae infection leading to clinical disease or in those with clinical disease triggering a leprosy reaction. BCG vaccination is associated with the development of leprosy in a small proportion of healthy contacts of people with leprosy within twelve weeks of administration. BCG causes a Th1 immune response. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective cohort study to determine the SARS-CoV-2 vaccination status of individuals diagnosed with leprosy attending the Leprosy Clinic in 2021 and whether any had developed leprosy or experienced a new leprosy reaction within twelve weeks of receiving a dose of a SARS-CoV-2 vaccine. The electronic patient records were used to retrieve data. Fifty-two individuals with leprosy attended the clinic in 2021 of which five people were newly diagnosed with leprosy. Thirty-seven (71%) were male and the median age was 48.5 years old (Range 27-85 years). Eight (15.4%) individuals were taking multi-drug therapy (MDT) and eight (15.4%) had completed MDT within three years of the study. Twenty-two (41.5%) individuals were prescribed a systemic immunosuppressant drug during 2021. Ten (18.9%) individuals have one or more risk factors for severe COVID-19. The SARS-CoV-2 vaccination status of fifty (96%) were recorded of which forty-nine were vaccinated (98%). One individual had declined vaccination. One individual was diagnosed with borderline tuberculoid (BT) leprosy having developed red skin lesions with reduced sensation (which increased in size and number) and thickened peripheral nerves one week after a second dose of BNT162b2 vaccine. Another individual who had completed MDT more than three years earlier developed red plaques and tender thickened nerves consistent with a leprosy Type 1 reaction eight weeks after a single dose of BNT162b2 vaccine (having received two doses of CoronaVac vaccine three months earlier). CONCLUSIONS/SIGNIFICANCE: The development of BT leprosy and a Type 1 reaction in another individual shortly after a dose of BNT162b2 vaccine may be associated with vaccine mediated T cell responses. The benefits of vaccination to reduce the risk of severe COVID-19 outweigh these unwanted events but data from leprosy endemic countries may provide further information about potential adverse effects of augmented T cell responses in individuals with leprosy or latent M. leprae infection.

Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned.

BACKGROUND: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. METHODS: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. RESULTS: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). CONCLUSION: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.

Prevalence and Predictors of COVID-19 Long-Term Symptoms: A Cohort Study from the Amazon Basin.

It remains unclear whether a previous history of tropical infectious diseases and a second SARS-COV-2 infection may influence the likelihood of later symptoms. In this prospective cohort study, individuals infected with SARS-CoV-2 were followed up by telephone shortly after diagnosis of COVID-19 and again 12 months later. Poisson regression was used to identify the predictors of the highest number of symptoms in the post-COVID-19 syndrome. A total of 1,371 patients with COVID-19, with a mean age of 39.7 ± 11.7 years and 50% female, were followed for 12 months. Reinfection was found in 32 (2.3%) participants, and 806 (58.8%) individuals reported a previous history of dengue, malaria, Zika, chikungunya, leprosy, and visceral leishmaniasis. Eight hundred seventy-seven (63.9%) participants reported late symptoms related to COVID-19. After adjusting for multiple factors, female sex, non-White race, number of acute-phase symptoms, body mass index, and reinfection were independent predictors of higher number of symptoms in post-COVID-19 syndrome. Female sex, non-White race, number of acute-phase symptoms, body mass index, and reinfection, but not previous endemic tropical diseases, were associated with long-term symptoms.

Cocrystallizing and Codelivering Complementary Drugs to Multidrugresistant Tuberculosis Bacteria in Perfecting Multidrug Therapy.

Bacteria cells exhibit multidrug resistance in one of two ways: by raising the genetic expression of multidrug efflux pumps or by accumulating several drug-resistant components in many genes. Multidrug-resistive tuberculosis bacteria are treated by multidrug therapy, where a few certain antibacterial drugs are administered together to kill a bacterium jointly. A major drawback of conventional multidrug therapy is that the administration never ensures the reaching of different drug molecules to a particular bacterium cell at the same time, which promotes growing drug resistivity step-wise. As a result, it enhances the treatment time. With additional tabletability and plasticity, the formation of a cocrystal of multidrug can ensure administrating the multidrug chemically together to a target bacterium cell. With properly maintaining the basic philosophy of multidrug therapy here, the synergistic effects of drug molecules can ensure killing the bacteria, even before getting the option to raise the drug resistance against them. This can minimize the treatment span, expenditure and drug resistance. A potential threat of epidemic from tuberculosis has appeared after the Covid-19 outbreak. An unwanted loop of finding molecules with the potential to kill tuberculosis, getting their corresponding drug approvals, and abandoning the drug after facing drug resistance can be suppressed here. This perspective aims to develop the universal drug regimen by postulating the principles of drug molecule selection, cocrystallization, and subsequent harmonisation within a short period to address multidrug-resistant bacteria.

The application of digital health as a nursing solution for leprosy patients during the COVID-19 pandemic: A systematic review.

Objectives: To analyse the effect of using digital health technology on leprosy control programmes. Method: The systematic review comprised search on PubMed, Scopus, ScienceDirect, SAGE and ProQuest databases for interventional studies published in English language from 2013 to 2021 which used digital health technology for leprosy contact tracing, active leprosy detection, monitoring of multi-drug therapy and treatment management during the corona virus disease-2019 pandemic A standard risk of bias tool was used to evaluate bias in the studies, and the Joanna Briggs Institute protocol was used to assess the quality of the studies analysed. RESULTS: Of the 205 studies initially identified, 15(7.3%) were analysed in detail. Quasi-experimental studies had a low risk of bias compared to the rest. The e-leprosy framework was being used along with applications based on smartphones and artificial intelligence Digital health technology was found to be practical, accessible and effective in leprosy control programmes. CONCLUSIONS: Studies reported favourable findings regarding the use of digital health technology in services related to leprosy patients.

High prevalence of olfactory impairment among leprosy patients: A cross-sectional study.

BACKGROUND: The effect of leprosy on the sense of smell is not yet fully established. Studies that have relied only on patients' perceptions may have under- or over-estimated the change in smell perception. A validated and psychophysical method is necessary to avoid these errors in assessment. OBJECTIVES: This study aimed to validate the existence of olfactory involvement in leprosy patients. METHODS: A cross-sectional, controlled study was conducted, in which individuals with leprosy (exposed individuals) and individuals without leprosy (control patients) were recruited. For each exposed individual, we selected two control patients. A total of 108 patients (72 control patients and 36 exposed individuals) with no history of infection with the new coronavirus (COVID-19) took the University of Pennsylvania Smell Identification Test (UPSIT). RESULTS: Most exposed individuals had olfactory dysfunction [n = 33, 91.7% (CI 95%: 77.5%-98.3%)] when compared with the control patients [n = 28, 38.9% (CI 95%: 27.6%-51.1%)], but only two (5.6%) had olfactory complaints. The olfactory function was significantly worse among exposed individuals [UPSIT leprosy = 25.2 (CI 95%: 23.1-27.3) when compared with the UPSIT control patients = 34.1 (CI 95%: 33.0-35.3); p<0.001]. The risk of olfactory loss was higher among the exposed individuals [OR: 19.5 (CI 95%: 5.18-105.70; p < 0.001)]. CONCLUSIONS: Olfactory dysfunction was highly prevalent among exposed individuals, although they had little or no self-knowledge of the disorder. The results show that it is important to assess the sense of smell in exposed individuals.

Thalidomide interaction with inflammation in idiopathic pulmonary fibrosis.

The "Thalidomide tragedy" is a landmark in the history of the pharmaceutical industry. Despite limited clinical trials, there is a continuous effort to investigate thalidomide as a drug for cancer and inflammatory diseases such as rheumatoid arthritis, lepromatous leprosy, and COVID-19. This review focuses on the possibilities of targeting inflammation by repurposing thalidomide for the treatment of idiopathic pulmonary fibrosis (IPF). Articles were searched from the Scopus database, sorted, and selected articles were reviewed. The content includes the proven mechanisms of action of thalidomide relevant to IPF. Inflammation, oxidative stress, and epigenetic mechanisms are major pathogenic factors in IPF. Transforming growth factor-ß (TGF-ß) is the major biomarker of IPF. Thalidomide is an effective anti-inflammatory drug in inhibiting TGF-ß, interleukins (IL-6 and IL-1ß), and tumour necrosis factor-α (TNF-α). Thalidomide binds cereblon, a process that is involved in the proposed mechanism in specific cancers such as breast cancer, colon cancer, multiple myeloma, and lung cancer. Cereblon is involved in activating AMP-activated protein kinase (AMPK)-TGF-ß/Smad signalling, thereby attenuating fibrosis. The past few years have witnessed an improvement in the identification of biomarkers and diagnostic technologies in respiratory diseases, partly because of the COVID-19 pandemic. Hence, investment in clinical trials with a systematic plan can help repurpose thalidomide for pulmonary fibrosis.

Viral co-infections in leprosy: a scoping review.

CONTEXT: The most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research. METHODS: The authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews. RESULTS: For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, co-infections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part. CONCLUSIONS: This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.

Enfrentamento da hanseníase em tempos de COVID-19: uma experiência exitosa de implantação de um sistema de rastreamento em área endêmica do Nordeste / Coping with leprosy in times of COVID-19: a successful experience of implementing a tracking system in an endemic area in the Northeast / Enfrentando la lepra en tiempos de COVID-19: una experiencia exitosa de implementación de un sistema de rastreo en un área endémica del Nordeste

Introdução: A COVID-19 (coronavirus disease 2019) trouxe inúmeros desafios e sobrecarga ao Sistema Único de Saúde (SUS), gerando dificuldades no enfrentamento das outras enfermidades endêmicas e negligenciadas no território brasileiro, entre elas a hanseníase. Objetivo: Relatar a experiência de enfrentamento da prevalência oculta de hanseníase por uma equipe de atenção primária à saúde do interior do estado de Sergipe durante a pandemia de COVID-19. Métodos: O projeto foi desenvolvido entre os meses de setembro de 2020 e janeiro de 2021 e caracterizou-se pela oferta de exame dermatológico aos indivíduos que buscaram atendimento na unidade de saúde do bairro Cidade Nova, em Estância, Sergipe. Confirmado o diagnóstico de hanseníase, foi introduzido o tratamento com esquema de poliquimioterapia da Organização Mundial da Saúde (PQT-OMS) e os contatos foram examinados, respeitando-se as medidas sanitárias de prevenção à contaminação pela COVID-19. Resultados: No período analisado, foram avaliados 235 indivíduos, sendo feitos seis diagnósticos clínicos de hanseníase (2,5%), entre os quais um em menor de 15 anos de idade. No município, durante todo o ano de 2020, registrou-se o total de nove casos novos de hanseníase. Sem o projeto, o coeficiente de detecção de casos novos de hanseníase no município seria de 4,3/100 mil habitantes e, com o projeto, esse coeficiente foi três vezes superior (12,9/100 mil habitantes). Conclusão: A oferta de exame dermatoneurológico durante consultas médicas de rotina em áreas vulneráveis permitiu evidenciar a prevalência oculta de hanseníase no bairro Cidade Nova, Estância. Além disso, ações dessa natureza permitem o diagnóstico precoce, evitando-se a evolução para incapacidades físicas.

Introduction: COVID-19 (coronavirus disease 2019) has brought numerous challenges and burdens on the Unified Health System (SUS, acronym in Portuguese), creating difficulties for the facing of other endemic diseases in the Brazilian territory, such as leprosy. Objective: To report an experience of coping with the hidden prevalence of leprosy by a primary health care team in the countryside of the state of Sergipe during the COVID-19 pandemic. Methods: The project was developed from September 2020 to January 2021 and was characterized for offering a dermatological examination to individuals seeking care at the health unit in the Cidade Nova neighborhood, Estância, Sergipe. For confirmed cases, treatment was instituted and household contacts were examined, respecting the measures to prevent contamination by COVID-19. Results: In the analyzed period, 235 individuals were evaluated, with six diagnoses of leprosy (2.5%), one under the age of 15. In 2020, the municipality registered nine total cases. Without the project, the detection rate of new leprosy cases in the municipality would have been 4.3/100,000 inhabitants and, with the project, this coefficient was three times higher (12.9/100,000 inhabitants). Conclusion: The offer of dermato-neurological exams during routine medical appointments made it possible to show the hidden prevalence of leprosy in the neighborhood of Cidade Nova, Estância. In addition, actions of this nature allow early diagnosis, preventing the occurrence of physical disabilities.

Introducción: La COVID-19 (enfermedad por coronavirus 2019) trajo numerosos desafíos y cargas al Sistema Único de Salud (SUS), creando dificultades para enfrentar otras enfermedades endémicas en el territorio brasileño, como la lepra. Objetivo: Informar una experiencia de afrontamiento de la prevalencia oculta de lepra por parte de un equipo de atención primaria en el interior del estado de Sergipe durante la pandemia de COVID-19. Métodos: El proyecto se desarrolló desde septiembre de 2020 hasta enero de 2021 y se caracterizó por ofrecer un examen dermatológico a las personas que buscaban atención en la unidad de salud del barrio Cidade Nova, en Estância, Sergipe. En caso de confirmarse los casos, se instituyó el tratamiento y se examinaron los contactos domiciliarios, respetando las medidas para prevenir la contaminación por COVID-19. Resultados: En el período analizado se evaluaron 235 individuos, con 06 diagnósticos de lepra (2,5%), uno menor de 15 años. En 2020, el municipio registró nueve casos en total. Sin el proyecto, la tasa de detección de nuevos casos de lepra en el municipio sería de 4,3/100 mil habitantes y, con el proyecto, este coeficiente era tres veces mayor (12,9/100 mil habitantes). Conclusión: La oferta de exámenes dermatoneurológicos durante las consultas médicas de rutina permitió mostrar la prevalencia oculta de la lepra en el barrio Cidade Nova, Estância. Además, acciones de esta naturaleza permiten un diagnóstico precoz, evitando la aparición de discapacidades físicas.

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic.

The unprecedented onset of the COVID-19 crisis poses a significant challenge to all fields of medicine, including dermatology. Since the start of the coronavirus outbreak, a stark decline in new skin cancer diagnoses has been reported by countries worldwide. One of the greatest challenges during the pandemic has been the reduced access to face-to-face dermatologic evaluation and non-urgent procedures, such as biopsies or surgical excisions. Teledermatology is a well-integrated alternative when face-to-face dermatological assistance is not available. Teledermoscopy, an extension of teledermatology, comprises consulting dermoscopic images to improve the remote assessment of pigmented and non-pigmented lesions when direct visualisation of lesions is difficult. One of teledermoscopy's greatest strengths may be its utility as a triage and monitoring tool, which is critical in the early detection of skin cancer, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. Mobile teledermoscopy may act as a communication tool between medical practitioners and patients. By using their smartphone (mobile phone) patients can monitor a suspicious skin lesion identified by their medical practitioner, or alternatively self-detect concerning lesions and forward valuable dermoscopic images for remote medical evaluation. Several mobile applications that allow users to photograph suspicious lesions with their smartphones and have them evaluated using artificial intelligence technology have recently emerged. With the growing popularity of mobile apps and consumer-involved healthcare, this will likely be a key component of skin cancer screening in the years to come. However, most of these applications apply artificial intelligence technology to assess clinical images rather than dermoscopic images, which may lead to lower diagnostic accuracy. Incorporating the direct-to-consumer mobile dermoscopy model in combination with mole-scanning artificial intelligence as a mobile app may be the future of skin cancer detection.

Mucocutaneous manifestations of COVID-19-associated mucormycosis: A retrospective cross-sectional study.

Background Cutaneous mucormycosis has shown a significant upsurge during the COVID-19 pandemic. Due to the rapid progression and high mortality of cutaneous mucormycosis in this context, it is important to identify it early. However, very few studies report detailed clinical descriptions of cutaneous mucormycosis in COVID-19 patients. Objectives To describe mucocutaneous lesions of COVID-19-associated mucormycosis based on clinical morphology and attempt to correlate them with radiological changes. Methods A retrospective cross-sectional study was conducted at a tertiary care centre from 1st April to 31st July 2021. Eligibility criteria included hospitalised adult patients of COVID-19-associated mucormycosis with mucocutaneous lesions. Results All subjects were recently recovering COVID-19 patients diagnosed with cutaneous mucormycosis. One of fifty-three (2%) patients had primary cutaneous mucormycosis, and all of the rest had secondary cutaneous mucormycosis. Secondary cutaneous mucormycosis lesions presented as cutaneous-abscess in 25/52 (48%), nodulo-pustular lesions in 1/52 (2%), necrotic eschar in 1/52 (2%) and ulcero-necrotic in 1/52 (2%). Mucosal lesions were of three broad sub-types: ulcero-necrotic in 1/52 (2%), pustular in 2/52 (4%) and plaques in 1/52 (2%). Twenty out of fifty-two patients (38%) presented with simultaneous mucosal and cutaneous lesions belonging to the above categories. Magnetic resonance imaging of the face showed variable features of cutaneous and subcutaneous tissue involvement, viz. peripherally enhancing collection in the abscess group, "dot in circle sign" and heterogeneous contrast enhancement in the nodulo-pustular group; and fat stranding with infiltration of subcutaneous tissue in cases with necrotic eschar and ulcero-necrotic lesions. Limitations The morphological variety of cutaneous mucormycosis patients in a single-centre study like ours might not be very precise. Thus, there is a need to conduct multi-centric prospective studies with larger sample sizes in the future to substantiate our morphological and radiological findings. Conclusions COVID-19-associated mucormycosis patients in our study presented with a few specific types of mucocutaneous manifestations, with distinct magnetic resonance imaging findings. If corroborated by larger studies, these observations would be helpful in the early diagnosis of this serious illness.

Temporal trend, distribution and spatial autocorrelation of leprosy in Brazil: ecological study, 2011 to 2021.

OBJECTIVE: To characterize the temporal trend and spatial behavior of leprosy in Brazil, from 2011 to 2021. METHODS: This is an ecological study, with data from the Notifiable Diseases Information System, obtained in June 2022. The annual detection rate of new leprosy cases per 100 thousand inhabitants was calculated. To estimate the trend of the 2011-2019 and 2011-2021 series, the polynomial regression model was used, testing first-, second-, and third-order polynomials. For spatiality, natural breaks were used and, later, the univariate global and local Moran's indexes. A significance level of 5% was adopted and the analyses were performed using SPSS®, GeoDa®, and QGIS® software. RESULTS: The findings indicated an upward trend in the incidence of leprosy in Brazilian regions and in 20 federative units between 2011 and 2019. However, there was a decrease in most of the country when considering the COVID-19 pandemic years. Spatiality showed that the highest detection rates throughout the period were observed in the North, Midwest, and Northeast regions, with high-risk clusters, and the lowest detection rates in the South and Southeast regions, with low-risk clusters. CONCLUSION: The leprosy detection rate showed an upward trend in Brazil between 2011 and 2019, with greater spatial concentration in the North, Northeast, and Midwest regions. Nevertheless, the study raises an alert for the programmatic sustainability of leprosy control in Brazil, considering the drop in the COVID-19 pandemic, presumably due to the influence of the reorganization of the development of initiatives and provision of services in face of COVID-19.

Governing a pandemic: biopower and the COVID-19 response in Zimbabwe.

INTRODUCTION: The extraordinary explosion of state power towards the COVID-19 response has attracted scholarly and policy attention in relation to pandemic politics. This paper relies on Foucault's theoretical differentiation of the political management of epidemics to understand how governmental framing of COVID-19 reflects biopolitical powers and how power was mobilised to control the pandemic in Zimbabwe. METHODS: We conducted a scoping review of published literature, cabinet resolutions and statutory instruments related to COVID-19 in Zimbabwe. RESULTS: The COVID-19 response in Zimbabwe was shaped by four discursive frames: ignorance, denialism, securitisation and state sovereignty. A slew of COVID-19-related regulations and decrees were promulgated, including use of special presidential powers, typical of the leprosy model (sovereign power), a protracted and heavily policed lockdown was effected, typical of the plague model (disciplinary power) and throughout the pandemic, there was reference to statistical data to justify the response measures whilst vaccination emerged as a flagship strategy to control the pandemic, typical of the smallpox model (biopower). The securitisation frame had a large influence on the overall pandemic response, leading to an overly punitive application of disciplinary power and cases of infidelity to scientific evidence. On the other hand, a securitised, geopolitically oriented sovereignty model positively shaped a strong, generally well execucted, domestically financed vaccination (biopower) programme. CONCLUSIONS: The COVID-19 response in Zimbabwe was not just an exercise in biomedical science, rather it invoked wider governmentality aspects shaped by the country's own history, (geo) politics and various mechanisms of power. The study concludes that whilst epidemic securitisation by norm-setting institutions such as WHO is critical to stimulate international political action, the transnational diffusion of such charged frames needs to be viewed in relation to how policy makers filter the policy and political consequences of securitisation through the lenses of their ideological stances and its potential to hamper rather than bolster political action.

Hansen's disease and COVID-19 co-infection in Brazil.

BACKGROUND: The implications of COVID-19 co-infection in patients under treatment for Hansen's disease (HD, leprosy) remain uncertain. We aimed to describe clinical characteristics, treatments, and outcomes in patients with HD and COVID-19 in Brazil. METHODS: Cross-sectional study recruiting adult HD patients with PCR-confirmed COVID-19 from five HD treatment centers in Brazil between March 1, 2020, and March 31, 2021. At the time of this study, no patient had received COVID-19 vaccine. RESULTS: Of 1377 patients under treatment for HD, 70 (5.1%) were diagnosed with COVID-19. Of these, 41 (58.6%) had PCR-confirmed COVID-19, comprising 19 men and 22 women, aged 24-67 (median 45) years. HD was multibacillary in 39/41 patients. Eight patients ceased WHO Multi-Drug Therapy for HD, three for lack of drugs, two because of COVID-19, and three for other reasons. Of the 33 who continued treatment, 26 were on the standard regimen and seven an alternative regimen. Seventeen patients were receiving oral prednisone, including nine patients with type 1 reaction, four with type 2 reaction, three with neuritis, and one with rheumatologic disease. Twelve patients were hospitalized for COVID-19, and six patients died, of whom three had hypertension and one also had type 2 diabetes and obesity. CONCLUSIONS: COVID-19 and Hansen's disease co-infection did not appear to change the clinical picture of either disease in this cross-sectional study. The wider impact of the pandemic on persons affected by HD requires follow-up and monitoring.