Carboxymethyl Cellulose, Trichloroacetic Acid, and Unna Boot for Healing Venous Ulcers: A Comparative Study of Their Efficacy and Socioeconomic Impact.

Chronic ulcers are defined as a breakdown of the long-term cutaneous barrier or frequent recurrence of breakdowns. Dressings are a form of treatment and, in view of the variety and high cost of the products on the market, three agents were selected for this investigation, regarding their efficacy and cost/benefit ratio. The objective of the investigation was to evaluate and compare the efficacy, costs, and benefits of carboxymethylcellulose in paste at 20% (CMC 20%), trichloroacetic acid at 90% (TCA 90%), and Unna boot for treatment of chronic venous ulcers. Three groups of 30 patients each were chosen randomly for ambulatory treatment with TCA 90% (G1), CMC 20% (G2), and Unna boot (G3). The evolution of the cicatricial process of each group separately and between groups was analyzed with measurement of the lesion areas in square centimeters (cm2) and observation of the amount of exudate from observation of the photographic record, until their healing, in the maximum period of 20 weeks. A significant reduction of lesion areas in all groups was observed (P=.0001), with a median reduction of 7.6 cm2 (38.1%) for G1, 3.9 cm2 (38.8%) for G2, and 16.2 cm2 (77.8%) for G3. There was a significant difference in the absolute delta of the lesion areas (P=.0001) of the groups. The three types of treatments promoted effective improvement, with acquisition and utilization of all three products in the public health services being recommended.

Drug and multidrug resistance among Mycobacterium leprae isolates from Brazilian relapsed leprosy patients.

Skin biopsy samples from 145 relapse leprosy cases and from five different regions in Brazil were submitted for sequence analysis of part of the genes associated with Mycobacterium leprae drug resistance. Single nucleotide polymorphisms (SNPs) in these genes were observed in M. leprae from 4 out of 92 cases with positive amplification (4.3%) and included a case with a mutation in rpoB only, another sample with SNPs in both folP1 and rpoB, and two cases showing mutations in folP1, rpoB, and gyrA, suggesting the existence of multidrug resistance (MDR). The nature of the mutations was as reported in earlier studies, being CCC to CGC in codon 55 in folP (Pro to Arg), while in the case of rpoB, all mutations occurred at codon 531, with two being a transition of TCG to ATG (Ser to Met), one TCG to TTC (Ser to Phe), and one TCG to TTG (Ser to Leu). The two cases with mutations in gyrA changed from GCA to GTA (Ala to Val) in codon 91. The median time from cure to relapse diagnosis was 9.45 years but was significantly shorter in patients with mutations (3.26 years; P = 0.0038). More than 70% of the relapses were multibacillary, including three of the mutation-carrying cases; one MDR relapse patient was paucibacillary.

Hansen's disease: a vanishing disease?

The introduction, implementation, successes and failures of multidrug therapy (MDT) in all Hansen's disease endemic countries are discussed in this paper. The high efficacy of leprosy treatment with MDT and the global reduction of prevalence led the World Health Organization, in 1991, to establish the goal of elimination of Hansen's disease (less than 1 patient per 10,000 inhabitants) to be accomplished by the year 2000. Brazil, Nepal and East Timor are among the few countries that didn't reach the elimination goal by the year 2000 or even 2005. The implications of these aspects are highlighted in this paper. Current data from endemic and previously endemic countries that carry a regular leprosy control programme show that the important fall in prevalence was not followed by the reduction of the incidence. This means that transmission of Mycobacterium leprae is still an issue. It is reasonable to conclude that we are still far from the most important goal of Hansen's disease control: the interruption of transmission and reduction of incidence. It is necessary to emphasize to health managers the need of keeping Hansen's disease control activities to better develop control programmes in the future. The recent international proposal to interrupt the transmission of leprosy by the year 2020 seems to unrealistic and it is discussed in this paper. The possibility of epidemiological impact related to the human immunodeficiency virus/Hansen's disease coinfection is also considered.

TNF -308G>A single nucleotide polymorphism is associated with leprosy among Brazilians: a genetic epidemiology assessment, meta-analysis, and functional study.

Leprosy is an infectious disease caused by Mycobacterium leprae. Tumor necrosis factor (TNF) plays a key role in the host response. Some association studies have implicated the single nucleotide polymorphism TNF -308G>A in leprosy susceptibility, but these results are still controversial. We first conducted 4 association studies (2639 individuals) that showed a protective effect of the -308A allele (odds ratio [OR] = 0.77; P = .005). Next, results of a meta-analysis reinforced this association after inclusion of our new data (OR = 0.74; P = .04). Furthermore, a subgroup analysis including only Brazilian studies suggested that the association is specific to this population (OR = 0.63; P = .005). Finally, functional analyses using whole blood cultures showed that patients carrying the -308A allele produced higher TNF levels after lipopolysaccharide (LPS) (6 hours) and M. leprae (3 hours) stimulation. These results reinforce the association between TNF and leprosy and suggest the -308A allele as a marker of disease resistance, especially among Brazilians.

Potential plasma markers of Type 1 and Type 2 leprosy reactions: a preliminary report.

BACKGROUND: The clinical management of leprosy Type 1 (T1R) and Type 2 (T2R) reactions pose challenges mainly because they can cause severe nerve injury and disability. No laboratory test or marker is available for the diagnosis or prognosis of leprosy reactions. This study simultaneously screened plasma factors to identify circulating biomarkers associated with leprosy T1R and T2R among patients recruited in Goiania, Central Brazil. METHODS: A nested case-control study evaluated T1R (n = 10) and TR2 (n = 10) compared to leprosy patients without reactions (n = 29), matched by sex and age-group (+/- 5 years) and histopathological classification. Multiplex bead based technique provided profiles of 27 plasma factors including 16 pro inflammatory cytokines: tumor necrosis factor-alpha (TNF-alpha), Interferon-gamma (IFN-gamma), interleukin (IL)- IL12p70, IL2, IL17, IL1 beta, IL6, IL15, IL5, IL8, macrophage inflammatory protein (MIP)-1 alpha (MIP1alpha), 1 beta (MIP1beta), regulated upon activation normal T-cell expressed and secreted (RANTES), monocyte chemoattractrant protein 1 (MCP1), CC-chemokine 11 (CCL11/Eotaxin), CXC-chemokine 10 (CXCL10/IP10); 4 anti inflammatory interleukins: IL4, IL10, IL13, IL1Ralpha and 7 growth factors: IL7, IL9, granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), platelet-derived growth factor BB (PDGF BB), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF). RESULTS: Elevations of plasma CXCL10 (P = 0.004) and IL6 (p = 0.013) were observed in T1R patients compared to controls without reaction. IL6 (p = 0.05), IL7 (p = 0.039), and PDGF-BB (p = 0.041) were elevated in T2R. RANTES and GMCSF were excluded due to values above and below detection limit respectively in all samples. CONCLUSION: Potential biomarkers of T1R identified were CXCL10 and IL6 whereas IL7, PDGF-BB and IL6, may be laboratory markers of TR2. Additional studies on these biomarkers may help understand the immunopathologic mechanisms of leprosy reactions and indicate their usefulness for the diagnosis and for the clinical management of these events.

[Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil]. / Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Leprosy: uncommon presentations.

The uniqueness of the clinical-dermatologic elements of leprosy recommends that control programs worldwide should diagnose the disease based on the so-called main clinical signs: cutaneous-neurological lesions with sensitivity-motor alterations without obligatory bacteriologic or histopathologic examination. The recognition of initial signs and symptoms of Hansen disease sometimes presents difficulties for its diagnosis, especially considering the relevance of an early diagnosis and the present guidelines for performance of decentralized treatment of the patient in the basic health-care network. The clinical cases illustrating this article were selected because of the degree of difficulty found in the confirmation of their diagnoses that required a histopathologic and/or bacteriologic examination.

Could Mycobacterium leprae Infection Be an Occupational Disease? A Survey in Healthcare Workers From an Endemic Area in the Amazonian Region.

A serologic survey was conducted to evaluate the prevalence of Mycobacterium leprae infection among healthcare workers and associated factors. Of 280 workers, 26 (9.3%) were positive using immunoglobulin M serology for PGL-I M. leprae antigen. Exposure to leprosy patients in the workplace was significantly associated with seropositivity (P=.044).

Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil / Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil / Vulnerabilidad programática en el control de la lepra: padrones desde la perspectiva de género en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

[Epidemiological aspects of leprosy: a spatial approach]. / Aspectos epidemiológicos da hanseníase: uma abordagem espacial.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Genotyping of Mycobacterium leprae from Brazilian leprosy patients suggests the occurrence of reinfection or of bacterial population shift during disease relapse.

We performed genotyping of Mycobacterium leprae present in skin biopsy samples that were collected during the first and the second disease occurrences from eight leprosy patients, seven of whom were diagnosed as suffering from disease relapse. Sequence analysis of part of the M. leprae rpoB, folP1, gyrB and gyrA genes did not show genetic change that supported the presence of drug-resistant bacilli. However, we observed a synonymous nucleotide change at position 297 of gyrA among five of these patients, one presenting C to T (CgyrAT) and four presenting T to C (TgyrAC) at this position. Additional genotyping by analysis of the four short tandem repeats GAA, GTA9, AT17 and TA18 showed that the gyrA single nucleotide polymorphism change was accompanied by a change in short tandem repeat genotype. Our data suggest that leprosy relapse in these patients, living in an area endemic for leprosy, could be caused by M. leprae with a genotype different from the one that caused initial disease.

The influence of increased access to basic healthcare on the trends in Hansen's disease detection rate in Brazil from 1980 to 2006.

Brazilian Hansen's disease detection rate rose during the 80s and 90s of the 20th century. The Brazilian health system reform happened during the same period. Detection rate is a function of the real incidence of cases and the diagnostic agility of the health system. Coverage of BCG immunization in infants was used as a proxy variable for primary healthcare coverage. A log-normal regression model of detection rate as a function of BCG coverage, time and time square was adjusted to data. The detection rate presents an upward trend throughout the period and with a downturn beginning in 2003. The model showed a statistically significant positive regression coefficient for BCG coverage, suggesting that detection rate behavior reflects the improvement of access to health care. The detection rate began a trend towards decline in 2003, indicating a new phase of Hansen's disease control.

Leprosy serology using PGL-I: a systematic review.

Serology using a species-specific antigen for Mycobacterium leprae, PGL-I, could be a marker for the bacterial load of patients with leprosy. Various studies have identified the potential use of serology in the classification of patients for treatment purposes, case monitoring, identification of the risk of relapse and selection of household contacts with a higher risk of contracting the disease. A systematic review of the literature was conducted and 26 articles were included in this comparative analysis. The results of the use of PGL-I serology in different situations, its limitations and possible applications were evaluated. Studies show the efficacy of PGL-I serology in the classification of patients, treatment monitoring and as a predictive test for leprosy reactions. To improve early diagnosis and follow-up of the population at greatest risk of developing leprosy, the methodologies used in the past have yet to show a favorable cost-benefit ratio, although studies indicate that the use of the test might positively influence leprosy control programs. With simple and robust techniques, the use of PGL-I serology is viable.

The use of serology as an additional tool to support diagnosis of difficult multibacillary leprosy cases: lessons from clinical care.

Seven multibacillary leprosy and two suspected cases assisted in different situations during clinical care activities at the university in Rio de Janeiro city are described. All cases presented some difficulties for diagnosis, since they evolved with few or no cardinal signs or symptoms of leprosy. A serological test used as an auxiliary tool was helpful in the diagnosis or exclusion procedure of each case, facilitating academic discussions at the time of case examination. Considering serology and bacilloscopy (skin smear) as the only rapid and relatively cheap available tests for confirmation of atypical MB leprosy, the advantages and disadvantages of their use were discussed. Both tests support the diagnostic procedure and the classification of cases for treatment purposes. The advantage of bacilloscopy is its capacity for diagnosis confirmation. The advantages of serology are: (a) its applicability for direct use by health workers, providing immediate results; (b) the potential for patient participation in the process; and (c) it provides a learning opportunity, allowing for improved teaching of leprosy pathogenesis.

Aspectos epidemiológicos da hanseníase: uma abordagem espacial / Epidemiological aspects of leprosy: a spatial approach

O objetivo foi identificar o padrão espacial da ocorrência da hanseníase em Duque de Caxias, município de alta endemicidade da doença no Estado do Rio de Janeiro, Brasil. Foram selecionados todos os casos novos de hanseníase registrados no banco do Sistema de Informação de Agravos de Notificação (SINAN), entre 1998 e 2006. Realizou-se análise por período subdividido a cada três anos, seguido de análise espacial por meio da estimativa bayesiana empírica local e do cálculo da autocorrelação espacial global (Moran) e local (LISA). A análise mostrou melhora acentuada do quadro epidemiológico, com o diagnóstico mais precoce. Houve redução da proporção de casos com grau II de 13,6% para 8,6% (p = 0,04). Verificou-se aumento da detecção de casos com forma indeterminada, de 10,3% para 18% (p = 0,00). A análise espacial identificou cluster na faixa sul-noroeste, não relacionado diretamente às ações de campanhas ou descentralização, mostrando ser uma ferramenta importante para identificação de áreas críticas da endemia e para avaliação do impacto das ações estratégias de combate à doença.

The objective of this study was to identify spatial patterns in the occurrence of leprosy in Duque de Caxias, a municipality (county) with high endemicity for the disease in the State of Rio de Janeiro, Brazil. The authors selected all new leprosy cases reported to the Brazilian National Database on Diseases of Notification (SINAN) from 1998 to 2006. The analysis was performed according to three-year periods, followed by spatial analysis according to the local empirical Bayesian method and calculation of global (Moran) and local (LISA) spatial autocorrelation. The analysis showed marked improvement in the epidemiological situation associated with earlier diagnosis. There was a reduction in the proportion of cases with grade II leprosy, from 13.6% to 8.6% (p = 0.04), and increased detection of cases with the indeterminate form, from 10.3% to 18% (p = 0.00). Spatial analysis identified a cluster in the South-Northwest of the municipality, not directly related to the actions or decentralization campaign, proving to be an important tool for identifying critical areas for the endemic and assessing the impact of strategic measures to combat the disease.

Memória e história da hanseníase no Brasil através de seus depoentes (1960-2000) / Memories and history of Hansen's disease in Brazil told by witnesses (1960-2000)

Este trabalho é resultado preliminar de pesquisa sobre memória e história da hanseníase, desenvolvido pela Fiocruz e Universidade Federal do Rio de Janeiro. O objetivo é o resgate desta história por meio de depoimentos de quem padeceu da doença ou atuou contra ela. Foi realizada durante aproximadamente cinco anos, período no qual gravamos, transcrevemos e conferimos as entrevistas realizadas, objetivando a constituição de um acervo em história oral, para compor o material já existente na Casa de Oswaldo Cruz. A pesquisa se encontra em fase avançada, partindo para a etapa de finalização com a divulgação das entrevistas por meio de publicação e site (www.memoriadahanseniase.fiocruz.br), o que deverá acontecer ao longo de 2008.

Influência do aumento do acesso à atenção básica no comportamento da taxa de detecção de hanseníase de 1980 a 2006 / The influence of increased access to basic healthcare on the trends in Hansen's disease detection rate in Brazil from 1980 to 2006

A taxa de detecção da hanseníase no Brasil aumentou nas duas últimas décadas do século XX, sendo que a reforma sanitária ocorreu no mesmo período. A taxa de detecção é função da incidência real de casos e da agilidade diagnóstica do sistema de saúde. Utilizou-se a cobertura vacinal por BCG como uma variável procuradora do acesso à atenção primária em saúde. Uma regressão log-normal foi ajustada à taxa de detecção de 1980 a 2006, com o tempo, tempo ao quadrado e da cobertura do BCG como variáveis independentes, sendo positivo o coeficiente de regressão desta última variável, sugerindo que o comportamento da taxa de detecção da hanseníase refletiu a melhora de acesso à atenção primária no período estudado. A tendência de aumento da taxa de detecção se reverte em 2003, indicando o início de uma nova fase no controle da hanseníase.

Brazilian Hansen's disease detection rate rose during the 80s and 90s of the 20th century. The Brazilian health system reform happened during the same period. Detection rate is a function of the real incidence of cases and the diagnostic agility of the health system. Coverage of BCG immunization in infants was used as a proxy variable for primary healthcare coverage. A log-normal regression model of detection rate as a function of BCG coverage, time and time square was adjusted to data. The detection rate presents an upward trend throughout the period and with a downturn beginning in 2003. The model showed a statistically significant positive regression coefficient for BCG coverage, suggesting that detection rate behavior reflects the improvement of access to health care. The detection rate began a trend towards decline in 2003, indicating a new phase of Hansen's disease control.