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1.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47228

RESUMEN

O “Boletim Epidemiológico de Hanseníase”, do Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, da Secretaria de Vigilância em Saúde, do Ministério da Saúde (DCCI/SVS/MS), apresenta informações acerca dos casos de hanseníase no Brasil, regiões, Unidades da Federação e capitais


Asunto(s)
Lepra , Epidemiología , Lepra/epidemiología
2.
PLoS Negl Trop Dis ; 14(4): e0008276, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32339201

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar pathologic conditions. They primarily target the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease, being endemic in specific locations within countries of the Americas, Asia, and Africa, while in Europe it is only rarely reported. The reason for a spatial inequality in the prevalence of leprosy in so-called endemic pockets within a country is still largely unexplained. A systematic review was conducted targeting leprosy transmission research data, using PubMed and Scopus as sources. Publications between January 1, 1945 and July 1, 2019 were included. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. The transmission of this disease is probably much more complicated than was thought before. In the Americas, the nine-banded armadillo (Dasypus novemcinctus) has been established as another natural host and reservoir of M. leprae. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. More recently, in red squirrels (Sciurus vulgaris) with leprosy-like lesions in the British Isles M. leprae and M. lepromatosis DNA was detected. This finding was unexpected, because leprosy is considered a disease of humans (with the exception of the armadillo), and because it was thought that leprosy (and M. leprae) had disappeared from the United Kingdom. Furthermore, animals can be affected by other leprosy-like diseases, caused by pathogens phylogenetically closely related to M. leprae. These mycobacteria have been proposed to be grouped as a M. leprae-complex. We argue that insights from the transmission and reservoirs of members of the M. leprae-complex might be relevant for leprosy research. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. A reduction in transmission cannot be expected to be accomplished by actions or interventions from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, to increase our understanding of the intricate picture of leprosy transmission, we propose a One Health transdisciplinary research approach.


Asunto(s)
Reservorios de Enfermedades , Transmisión de Enfermedad Infecciosa , Lepra/transmisión , Lepra/veterinaria , Animales , Armadillos/microbiología , Salud Global , Humanos , Incidencia , Lepra/epidemiología , Mycobacterium/aislamiento & purificación , Mycobacterium leprae/aislamiento & purificación , Prevalencia , Sciuridae/microbiología
3.
Rev Bras Epidemiol ; 23: e200019, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159629

RESUMEN

OBJECTIVE: To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. METHODS: This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. RESULTS: From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. CONCLUSION: The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde - SUS).


Asunto(s)
Personas con Discapacidad , Enfermedades Endémicas/estadística & datos numéricos , Lepra/prevención & control , Brasil/epidemiología , Ciudades , Estudios de Cohortes , Evaluación de la Discapacidad , Humanos , Incidencia , Lepra/epidemiología , Vigilancia de la Población , Características de la Residencia , Factores de Riesgo , Análisis Espacio-Temporal
4.
Rev Soc Bras Med Trop ; 53: e20190507, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32187344

RESUMEN

INTRODUCTION: Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS: A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS: Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS: The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found.


Asunto(s)
Vacuna BCG/administración & dosificación , Trazado de Contacto/estadística & datos numéricos , Lepra/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Lepra/prevención & control , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Factores Socioeconómicos , Adulto Joven
5.
PLoS Negl Trop Dis ; 14(3): e0008127, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32203502

RESUMEN

Understanding the prevalence of M. leprae infection in armadillos is important because of evidence from Brazil and other countries of an association between contact with armadillos and the development of Hansen's Disease (leprosy). Our aim was to characterize studies which have investigated natural M. leprae infection in wild armadillos in Brazil, and to quantify and explore variability in the reported prevalence of infection. We conducted a systematic review (PROSPERO CRD42019155277) of publications in MEDLINE, EMBASE, Global Health, Scopus, LILACS, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses e Dissertações de CAPES, and Biblioteca Virtual em Saúde up to 10/2019 using Mesh and text search terms (in English, Portuguese, Spanish, and French). The 10 included studies represented a total sample of 302 armadillos comprising 207 (69%) Dasypus novemcinctus, 67 (22%) Euphractus sexcinctus, 16 (5%) Priodontes maximus, 10 (3%) Cabassous unicinctus, and 2 (1%) Cabassous tatouay from 7 different states. Methods used included histopathology (4 studies), PGL-1 and LID-1 antigen detection (4 studies) and examination for clinical signs of disease (4 studies). Eight studies used PCR of which 7 targeted the RLEP repetitive element and 3 tested for inhibitory substances. M. leprae prevalence by PCR ranged from 0% (in 3 studies) to 100% in one study, with a summary estimate of 9.4% (95% CI 0.4% to 73.1%) and a predictive interval of 0-100%. The average prevalence is equivalent to 1 in 10 armadillos in Brazil being infected with M. leprae, but wide variation in sample estimates means that the prevalence in any similar study would be entirely unpredictable. We propose instead that future studies aim to investigate transmission and persistence of M. leprae within and between armadillo populations, meanwhile adopting the precautionary principle to protect human health and an endangered species in Brazil.


Asunto(s)
Armadillos/microbiología , Lepra/epidemiología , Lepra/veterinaria , Mycobacterium leprae/aislamiento & purificación , Animales , Animales Salvajes/microbiología , Brasil/epidemiología , ADN Bacteriano/análisis , Bases de Datos Factuales , Mapeo Geográfico , Mycobacterium leprae/genética , Reacción en Cadena de la Polimerasa , Prevalencia , Secuencias Repetitivas de Ácidos Nucleicos , Zoonosis/epidemiología , Zoonosis/microbiología
6.
Rev Bras Epidemiol ; 23: e200007, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32130396

RESUMEN

INTRODUCTION: Leprosy is a disease that reserves close relation with social and economic conditions. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. OBJECTIVE: This study aimed to analyze social deprivation in the municipalities of Bahia and its relation with the detection of new cases of leprosy in the population. METHODS: It is an ecological study conducted in the state of Bahia, from 2001 to 2015. Variables analyzed: detection rate of new cases, social deprivation index (SDI) and Hansen's disease in children under 15 years of age. The SDI was built on four variables: socioeconomic performance index, per capita income, proportion of extremely poor, and household density. For spatial analysis, local empirical bayesian modeling and global and local Moran statistics were used. Statistical analysis used multivariate, spatial and logistic regression, odds ratio calculation and analysis of variance. RESULTS: Leprosy showed heterogeneous distribution in the state, with concentration in the north-west and south axis. 60.4% (n = 252) of the municipalities presented very low life conditions. An association was observed between living conditions and the detection of leprosy, with higher coefficients in the municipality group with better living conditions (p < 0.001). CONCLUSION: It was concluded that the worst conditions acted as an impediment to the diagnosis, while increasing the risk of illness. Good conditions have the opposite effect.


Asunto(s)
Lepra/epidemiología , Pobreza/estadística & datos numéricos , Adolescente , Análisis de Varianza , Brasil/epidemiología , Niño , Preescolar , Ciudades/epidemiología , Enfermedades Endémicas , Femenino , Humanos , Modelos Logísticos , Masculino , Factores de Riesgo , Factores Socioeconómicos , Análisis Espacial
9.
Am J Trop Med Hyg ; 102(4): 724-727, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32043454

RESUMEN

The ongoing transmission of leprosy in India is worrisome, and emerging drug resistance may be one of the factors responsible for the continued transmission of leprosy in India. Emerging cases of multidrug-resistant Mycobacterium leprae pose a great threat to eradication of leprosy and must be addressed with utmost priority. We report a case of multidrug-resistant M. leprae in a case of relapse where slit skin smear (SSS) was negative and histopathology was inconclusive. Drug resistance studies in leprosy are undertaken only in smear-positive relapse cases, and detection of this type of multidrug resistance in a case with negative SSS and innocuous histopathology is rather unusual and highlights the importance of undertaking drug resistance tests even in smear-negative cases of leprosy relapse. Resistance to ofloxacin (OFL) is also a cause for concern as OFL is one of the reserve drugs recommended for treatment of rifampicin-resistant strains.


Asunto(s)
Leprostáticos/farmacología , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra/microbiología , Mycobacterium leprae/efectos de los fármacos , Adulto , Farmacorresistencia Bacteriana Múltiple , Humanos , India/epidemiología , Lepra/epidemiología , Masculino , Recurrencia
10.
PLoS Negl Trop Dis ; 14(2): e0008030, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32023242

RESUMEN

BACKGROUND: Skin neglected tropical diseases (NTDs) such as Buruli ulcer (BU) and leprosy produce significant stigma and disability. Shared clinical presentations and needs for care present opportunities for integrated case management in co-endemic areas. As global policies are translated into local integrated services, there remains a need to monitor what new configurations of care emerge and how individuals experience them. METHODS: To explore patient experiences of integrated case management for skin NTDs, in 2018, we conducted a field-based qualitative case series in a leprosy rehabilitation centre in Ganta, Liberia where BU services were recently introduced. Twenty patients with BU (n = 10) and leprosy (n = 10) participated in in-depth interviews that incorporated photography methods. We contextualised our findings with field observations and unstructured interviews with health workers. FINDINGS: The integration of care for BU and leprosy prompted new conceptualisations of these diseases and experiences of NTD stigma. Some patients felt anxiety about using services because they feared being infected with the other disease. Other patients viewed the two diseases as 'intertwined': related manifestations of the same condition. Configurations of inter-disease stigma due to fear of transmission were buffered by joint health education sessions which also appeared to facilitate social support between patients in the facility. For both diseases, medication and wound care were viewed as the cornerstones of care and appreciated as interventions that led to rehabilitation of the whole patient group through shared experiences of healing, avoidance of physical deformities and stigma reduction. Patient accounts of intense pain during wound care for BU and inability of staff to manage severe complications, however, exposed some shortcomings of medical care for the newly integrated service, as did patient fears of long-lasting disability due to lack of physiotherapy services. SIGNIFICANCE: Under integrated care policies, the possibility of new discourses about skin NTD identities emerging along with new configurations of stigma may have unanticipated consequences for patients' experiences of case management. The social experience of integrated medication and wound dressing has the potential to link patients within a single, supportive patient community. Control programmes with resource constraints should anticipate potential challenges of integrating care, including the need to ameliorate lasting disability and provide adequate clinical management of severe BU cases.


Asunto(s)
Úlcera de Buruli/complicaciones , Úlcera de Buruli/epidemiología , Manejo de Caso , Lepra/complicaciones , Lepra/epidemiología , Enfermedades Desatendidas , Humanos , Liberia/epidemiología , Estigma Social , Apoyo Social , Clima Tropical , Medicina Tropical
11.
PLoS Negl Trop Dis ; 14(2): e0007891, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32078623

RESUMEN

BACKGROUND: A few new leprosy cases still can be seen in Shandong province after elimination. In post-elimination era, government commitments dwindled and active case-finding activities were seldom done. Most of the cases were detected by passive modes and advanced cases with longer delay and visible disability were common. MATERIALS AND METHODS: Comprehensive measures including health promotion, personnel training, reward-offering, symptom surveillance and a powerful referral center were implemented in the past decade. The diagnosis of leprosy was mainly based on three cardinal clinical signs. Two-group classification system developed by the WHO was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. Cases detected during period 2007-2017 were analyzed and associated factors of grade 2 disability (G2D) were explored. RESULTS: 231 new leprosy cases detected during 2007-2017 were analyzed. The mean age at diagnosis is 51.7±16.0 years and the number of males, peasants, illiterates, MB cases, G2D cases and immigrants were 130(56.3%), 221(95.7%), 73(31.6%), 184(79.7%), 92(39.8%) and 40(17.3%) respectively. 181(78.4%) cases were reported by skin clinics and 152 (65.8%) cases came from formerly high endemic counties/districts. The annual number of new cases showed a decreasing trend, from 42 cases in 2008 to 13 cases in 2017. 92 (39.8%) cases presented with G2D at diagnosis. The annual proportion of new cases with G2D declined from 50% in 2008 to 23% in 2017. PB type (OR = 2.76, 95% CI, 1.43-5.32), >12 months of patient delay (OR = 2.40, 95% CI, 1.38-4.19), >24 months of total delay (OR = 4.35, 95% CI, 2.33-8.11), detected by non skin-clinic (OR = 3.21, 95% CI, 1.68-6.14), known infectious source (OR = 1.77, 95% CI, 1.01-3.12) were associated with G2D. CONCLUSION: A few scattered cases still can be seen in post-elimination era and some kind of leprosy control program is still necessary. Government commitments including adequate financial security and strong policy support are vital. Comprehensive case-finding measures including health promotion, personnel training, reward-offering, with an emphasis on former high or middle endemic areas, are necessary to improve early presentation of suspected cases and to increase suspicion and encourage participation of all relevant medical staff. Symptom surveillance based on a powerful transfer center may play an important role in the early detection of new cases in post-elimination era.


Asunto(s)
Lepra/diagnóstico , Lepra/epidemiología , Adulto , Anciano , China/epidemiología , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
PLoS Negl Trop Dis ; 14(1): e0008016, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31929530

RESUMEN

BACKGROUND: Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world's newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India's official declaration of 'elimination', which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. METHODS AND FINDINGS: This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital's sustainability. Open coding, axial coding and selective coding were conducted, and Glaser's Six C's model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients' strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a 'consumer-provider cooperative', where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients' occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. CONCLUSIONS: This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.


Asunto(s)
Lepra/tratamiento farmacológico , Lepra/epidemiología , Personas con Discapacidad , Salud Holística , Hospitales , Humanos , India/epidemiología , Pobreza , Investigación Cualitativa , Estigma Social
13.
An Bras Dermatol ; 95(1): 91-94, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31889593

RESUMEN

This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC]=-3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.


Asunto(s)
Lepra/epidemiología , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Personas con Discapacidad/estadística & datos numéricos , Enfermedades Endémicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución por Sexo , Factores Socioeconómicos , Factores de Tiempo
14.
BMC Public Health ; 20(1): 119, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996183

RESUMEN

BACKGROUND: Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. METHOD: This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. RESULTS: A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. CONCLUSION: The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Progresión de la Enfermedad , Lepra/epidemiología , Lepra/patología , Adulto , Argentina/epidemiología , Brasil/epidemiología , Ciudades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paraguay/epidemiología , Medición de Riesgo , Análisis Espacial
15.
Am J Trop Med Hyg ; 102(3): 547-552, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31933458

RESUMEN

Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for M leprae DNA and sequenced for drug resistance-determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ± 13.4 (range 14-71) years and 34.9 ± 12.6 years (range 10-63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens. Mutations seen were those associated with resistance to rifampicin, ofloxacin, and dapsone. All the six patients were drug-naive. The clinical and pathological manifestations in this group did not differ from the drug-sensitive group. This study highlights the occurrence of resistance to the standard multidrug therapy and ofloxacin in leprosy. Among the entire cohort, 1/77 (1.3%) showed resistance to rifampicin, 2/77 (2.6%) to dapsone, and 5/77 (6.4%) to ofloxacin. Six new patients showing infection by mutant strains indicated the emergence of primary resistance. Resistance to ofloxacin could be due to frequent use of quinolones for many bacterial infections. The results of the study indicate the need for development of a robust and strict surveillance system for detecting drug resistance in leprosy in India.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra/microbiología , Mycobacterium leprae/efectos de los fármacos , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Femenino , Humanos , India/epidemiología , Lactante , Leprostáticos/farmacología , Lepra/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mutación , Mycobacterium leprae/genética , Adulto Joven
16.
Am J Trop Med Hyg ; 102(1): 42-47, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31769407

RESUMEN

In addition to the complications of leprosy, people affected by leprosy (PALs) can suffer from chronic diseases. We evaluated the recent pattern of deaths among Korean PALs and compared it with that in the general population. We analyzed the death certificate data of 1,359 PALs from 2010 through 2013. The all-cause and cause-specific standardized mortality ratio (SMR) and standardized mortality with 95% CI were calculated. Malignancy had the highest standardized mortality, with 130.9 deaths per 100,000 persons, followed by cardiovascular diseases (CVDs; 85.5 deaths) and respiratory diseases (38.2 deaths). Of malignancies, liver cancer caused the greatest number of cancer deaths (40.0 deaths). The all-cause mortality of PALs was significantly lower than that in the general population, corresponding to an SMR of 0.84 (95% CI 0.79-0.88). Deaths from malignancy and CVDs were significantly lower, corresponding to SMRs (95% CIs) of 0.88 (0.79-0.98) and 0.75 (0.67-0.84), respectively. The death rates for lung and stomach cancers were lower, whereas mortality due to liver cancer was higher, with an SMR of 1.79 (95% CI 1.43-2.22). Except for liver cancer and infection, the causes of mortality of PALs tend to be lower than that in the general population. The most common underlying cause of death in PALs was stroke, followed by ischemic heart disease, liver cancer, and pneumonia.


Asunto(s)
Lepra/epidemiología , Lepra/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Femenino , Humanos , Lepra/complicaciones , Masculino , Persona de Mediana Edad , República de Corea/epidemiología
17.
Nursing (Säo Paulo) ; 23(262): 3652-3655, mar.2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1100415

RESUMEN

Objetivo: analisar e comparar taxas de prevalência de hanseníase nas macrorregiões do estado de Mato Grosso a partir informações coletadas do Departamento de Informática do Sistema Único de Saúde (DATASUS) do Ministério da Saúde do Brasil. Método: estudo retrospectivo transversal onde analisou a taxa de prevalência no período de janeiro a dezembro de 2017. Os dados foram obtidos através do (DATASUS). Os valores foram comparados por análise de variância, testes de KolmogorovSmirnov e Levene, seguidos pelo teste post hoc de Tukey, com nível de significância em p<0,05. Resultados: Houve diferença estatisticamente significante entre as Macrorregiões do estado de Mato Grosso, Teles Pires, Vale do Peixoto, Vale do Arinos e Médio Araguaia, consideradas "hiperendêmicas". Conclusão: As taxas de prevalência de hanseníase encontradas neste estudo a partir da utilização da ferramenta DATASUS avaliando as macrorregiões do estado de Mato Grosso abrem perspectivas futuras para estudo epidemiológicos bem elaborados bem como a análise da qualidade dos serviços de saúde utilizados. A ferramenta DATASUS pode ser utilizada no planejamento de políticas públicas para a hanseníase.(AU)


Background: Objective: To analyze and compare leprosy prevalence rates in the macroregions of the state of Mato Grosso from information collected from the Department of Informatics of the Unified Health System (DATASUS) of the Brazilian Ministry of Health. Method: a retrospective cross-sectional study analyzing the prevalence rate from January to December 2017. Data were obtained through (DATASUS). The values were compared by analysis of variance, Kolmogorov-Smirnov and Levene tests, followed by Tukey post hoc test, with significance level of p <0.05. Results: There was a statistically significant difference between the macroregions of the state of Mato Grosso, TelesPires, Peixoto Valley, Arinos Valley and Middle Araguaia, considered "hyperendemic". Conclusion: The prevalence rates of leprosy found in this study from the use of the DATASUS tool evaluating the macro-regions of the state of Mato Grosso open future perspectives for well-prepared epidemiological studies as well as the analysis of the quality of the health services used. DATASUS tool can be used in the planning of public policies for leprosy.(AU)


Objetivo: analizar y comparar las tasas de prevalencia de lepra en los macrorregiones del estado de Mato Grosso a partir de la información recopilada del Departamento de Informática del Sistema Único de Salud (DATASUS) del Ministerio de Salud de Brasil. Método: estudio retrospectivo transversal que analiza la tasa de prevalencia de enero a diciembre de 2017. Los datos se obtuvieron a través de (DATASUS). Los valores se compararon mediante análisis de varianza, pruebas de KolmogorovSmirnov y Levene, seguidas de la prueba post hoc de Tukey, con un nivel de significación de p <0,05. Resultados: Hubo una diferencia estadísticamente significativa entre los macrorregiones del estado de Mato Grosso, Teles Pires, Peixoto Valley, Arinos Valley y medio Araguaia, consideradas "hiperendémicas". Conclusión: Las tasas de prevalencia de lepra encontradas en este estudio a partir del uso de la herramienta DATASUS que evalúa las macro regiones del estado de Mato Grosso abren perspectivas futuras para estudios epidemiológicos bien preparados, así como el análisis de la calidad de los servicios de salud utilizados. La herramienta DATASUS se puede utilizar en la planificación de políticas públicas.(AU)


Asunto(s)
Humanos , Calidad de la Atención de Salud , Sistema Único de Salud , Prevalencia , Lepra , Lepra/epidemiología
18.
BMC Infect Dis ; 19(1): 1033, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31805862

RESUMEN

BACKGROUND: Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar. METHODS: PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome. DISCUSSION: Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP. TRIAL REGISTRATION: Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/prevención & control , Profilaxis Posexposición/métodos , Rifampin/uso terapéutico , Preescolar , Comoras/epidemiología , Composición Familiar , Femenino , Humanos , Incidencia , Leprostáticos/administración & dosificación , Lepra/epidemiología , Madagascar/epidemiología , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Rifampin/administración & dosificación
19.
BMC Infect Dis ; 19(1): 1016, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783799

RESUMEN

BACKGROUND: Leprosy is a neglected disease that poses a significant challenge to public health in Uganda. The disease is endemic in Uganda, with 40% of the districts in the country affected in 2016, when 42 out of 112 districts notified the National Tuberculosis and Leprosy Program (NTLP) of at least one case of leprosy. We determined the spatial and temporal trends of leprosy in Uganda during 2012-2016 to inform control measures. METHODS: We analyzed quarterly leprosy case-finding data, reported from districts to the Uganda National Leprosy Surveillance system (managed by NTLP) during 2012-2016. We calculated new case detection by reporting district and administrative regions of treatment during this period. New case detection was defined as new leprosy cases diagnosed by the Uganda health services divided by regional population; population estimates were based on 2014 census data. We used logistic regression analysis in Epi-Info version 7.2.0 to determine temporal trends. Population estimates were based on 2014 census data. We used QGIS software to draw choropleth maps showing leprosy case detection rates, assumed to approximate the new case detection rates, per 100,000 population. RESULTS: During 2012-2016, there was 7% annual decrease in reported leprosy cases in Uganda each year (p = 0.0001), largely driven by declines in the eastern (14%/year, p = 0.0008) and central (11%/year, p = 0.03) regions. Declines in reported cases in the western (9%/year, p = 0.12) and northern (4%/year, p = 0.16) regions were not significant. The combined new case detection rates from 2012 to 2016 for the ten most-affected districts showed that 70% were from the northern region, 20% from the eastern, 10% from the western and 10% from the central regions. CONCLUSION: There was a decreasing trend in leprosy new case detection in Uganda during 2012-2016; however, the declining trends were not consistent in all regions. The Northern region consistently identified more leprosy cases compared to the other regions. We recommend evaluation of the leprosy surveillance system to ascertain the leprosy situation.


Asunto(s)
Lepra/diagnóstico , Bases de Datos Factuales , Humanos , Lepra/epidemiología , Modelos Logísticos , Vigilancia en Salud Pública , Estudios Retrospectivos , Análisis Espacio-Temporal , Uganda/epidemiología
20.
Artículo en Portugués | Coleciona SUS, CONASS, SES-GO | ID: biblio-1050132

RESUMEN

A compreensão das condições de vida dos pacientes com hanseníase e o apoio para superar a vulnerabilidade são algumas das principais atribuições dos profissionais da saúde da atenção primária. Objetivou-se identificar e analisar as evidências disponíveis na literatura sobre as variáveis da vulnerabilidade com a incapacidade física dos casos de hanseníase atendidos na atenção primária. Trata-se de uma revisão narrativa a partir de estudos nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Base de dados da Enfermagem (Bdenf), e PubMed. Utilizaram-se as palavras chaves nas expressões: "vulnerability and leprosy and disability"; "leprosy and vulnerability" e "leprosy and disability. Desenvolveu-se a partir da estratégia de identificação do Problema, da Variável de Interesse e do Resultado. Foram encontrados 366 artigos, porém apenas 14 elegíveis para o estudo. A maioria dos estudos mostrou a vulnerabilidade dos pacientes com hanseníase de forma ampla, e relacionou as incapacidades físicas com as variáveis: baixas condições sócias econômicas, presença de comorbidades, sexo masculino, presença de profissionais que referem possuir capacitação insuficiente sobre prevenção de incapacidades, o baixo acesso dos pacientes aos benefícios sociais e danos psicológicos. Conclui-se que, a vulnerabilidade está presente na maioria dos pacientes com incapacidades físicas provocadas pela hanseníase. Ressaltando que as ações ainda estão insuficientes, sendo necessário desenvolvimento de estratégias principalmente na Atenção Básica para atender o paciente de forma integral.


Asunto(s)
Humanos , Atención Primaria de Salud , Lepra , Lepra/complicaciones , Lepra/epidemiología
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