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1.
BMC Infect Dis ; 19(1): 1033, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805862

RESUMO

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.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição/métodos , Rifampina/uso terapêutico , Pré-Escolar , Comores/epidemiologia , Características da Família , Feminino , Humanos , Incidência , Hansenostáticos/administração & dosagem , Hanseníase/epidemiologia , Madagáscar/epidemiologia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Rifampina/administração & dosagem
2.
BMC Infect Dis ; 19(1): 1016, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783799

RESUMO

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.


Assuntos
Hanseníase/diagnóstico , Bases de Dados Factuais , Humanos , Hanseníase/epidemiologia , Modelos Logísticos , Vigilância em Saúde Pública , Estudos Retrospectivos , Análise Espaço-Temporal , Uganda/epidemiologia
3.
An Bras Dermatol ; 94(5): 603-607, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777363

RESUMO

The objective of this study was to describe the trend of detection of the disease in Brazil from 1990 to 2016. The joinpoint regression model was used. There was a significant trend of decreased detection in the country (average annual percent change -1.8%) and in the South (average annual percent change=-3.5%) and Southeast regions (average annual percent change=-4.5%). The Northeast (average annual percent change=0.2%), the Central-West (average annual percent change=-1.5%), and the North (average annual percent change=-2.6%) showed a stationary trend (p>0.05). Eleven states showed a decreasing trend. Alagoas (average annual percent change=2.1%) and Rio Grande do Norte (average annual percent change=1.4%) presented significant increase (p<0.001). The heterogeneous pattern of trend between regions and states shows that efforts are needed to eliminate the disease.


Assuntos
Hanseníase/epidemiologia , Brasil/epidemiologia , Geografia , Humanos , Fatores de Tempo
4.
An Bras Dermatol ; 94(4): 405-410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644611

RESUMO

BACKGROUND: A high prevalence of leprosy among children under 15 years of age indicates the need to implement actions to prevent new cases of the disease. Serological tests have been developed with the aim of helping to control the disease by indicating, through seropositivity, the presence of infection. OBJECTIVE: To analyze the prevalence and factors associated with seropositivity rate for anti-NDO-LID antibodies in children under 15 years of age, contacts of leprosy patients. METHOD: We performed a cross-sectional study with 210 children under 15 years old of age. Of them, 50 were household contacts and 160 were neighborhood contacts living in the municipality of Cuiabá, state of Mato Grosso, in 2016. The data were obtained from interviews and the NDO-LID rapid test during home visits from February to July 2016. For the analysis, we used Poisson regression and prevalence ratio. RESULTS: Seropositivity in contacts was 6.2%. Variables associated with seropositive tests included sex (PR = 1.05; 95% CI: 1.01 - 1.08), race/skin color (PR = 0.95; 95% CI: 0.90 - 0.99), residence area (PR = 1.05; 95% CI: 1.01 - 1.09), and number of people per household (PR = 1.06; 95% CI: 1.02 - 1.08). STUDY LIMITATIONS: The small sample size, besides leading to wide confidence intervals, may have been a limitation for the identification of associated factors. CONCLUSIONS: The prevalence of seropositivity was high. Variables associated with NDO-LID seropositivity included female sex, not to be brown skinned, live in urban areas, and live with five or more people.


Assuntos
Anticorpos Anti-Idiotípicos/imunologia , Anticorpos Antibacterianos/imunologia , Hanseníase/epidemiologia , Hanseníase/imunologia , Adolescente , Distribuição por Idade , Fatores Etários , Anticorpos Anti-Idiotípicos/sangue , Anticorpos Antibacterianos/sangue , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Lactente , Masculino , Características de Residência , Testes Sorológicos/métodos , Distribuição por Sexo , Fatores Socioeconômicos
5.
Emerg Microbes Infect ; 8(1): 1479-1489, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621517

RESUMO

Reports on antimicrobial resistance (AMR) of Mycobacterium leprae, relationship with bacteriological index (BI), and transmission in China are limited. We investigated the emergence of AMR mutations, the relationship between BI and AMR in complete, moderate and lack of BI decline cases, and molecular epidemiological features of AMR cases by enrolling 290 leprosy cases from four endemic provinces. Seven (2.41%), one (0.34%), five (1.72%), one (0.34%), and one (0.34%) strains had single mutations in folP1, rpoC, gyrA, gyrB, and 23S rRNA, respectively. Double mutations in folP1 and gyrA, rpoB and gyrA, and gyrA and 23S rRNA were observed in one (0.34%) strain each. Mutated strains occurred in three out of 81 (95% CI-0.005-0.079, p = 0.083) cases with complete BI decline, in seven out of 103 (95% CI 0.018-0.117, p = 0.008) cases with moderate BI decline, and in four out of 34 (95% CI 0.003-0.231, p = 0.044) cases with lack of BI decline. Most of these mutated strains were geographically separated and diverged genotypically. AMR mutations may not be the main cause of the lack of BI decline. The low transmission of AMR strains at the county level indicates an ongoing transmission at close contact levels.


Assuntos
Farmacorresistência Bacteriana , Hansenostáticos/farmacologia , Hanseníase/microbiologia , Mycobacterium leprae/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , China/epidemiologia , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Mycobacterium leprae/classificação , Mycobacterium leprae/genética , Mycobacterium leprae/isolamento & purificação , Filogenia , Adulto Jovem
6.
PLoS Negl Trop Dis ; 13(10): e0007713, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31603913

RESUMO

Few investigations to date have analyzed the epidemiology of Hansen's disease (leprosy) in the United States, and in particular, if birth location is related to multibacillary versus paucibacillary leprosy. We collected data on 123 patients diagnosed with leprosy in Georgia from the National Hansen's Disease Program from 1923-January 2018. A logistic regression model was built to examine the relationship between country of origin (U.S.-born or immigrant) and the type of leprosy. While the model showed no significant relationship between country of origin and type of leprosy, being Asian or Pacific Islander was associated with a higher odds of multibacillary disease (aOR = 5.71; 95% CI: 1.25-26.29). Furthermore, since the early 1900s, we found an increasing trend of leprosy reports in Georgia among both domestic born and immigrant residents, despite the overall decrease in cases in the United States during the same time period. More research is therefore necessary to further evaluate risk for multibacillary leprosy in certain populations and to create targeted interventions and prevention strategies.


Assuntos
Hanseníase/epidemiologia , Hanseníase/história , Emigrantes e Imigrantes , Grupos Étnicos , Feminino , Georgia/epidemiologia , História do Século XX , História do Século XXI , Humanos , Hanseníase/prevenção & controle , Hanseníase Multibacilar/epidemiologia , Hanseníase Multibacilar/história , Hanseníase Multibacilar/prevenção & controle , Hanseníase Paucibacilar/epidemiologia , Hanseníase Paucibacilar/história , Hanseníase Paucibacilar/prevenção & controle , Masculino , Estados Unidos
7.
PLoS Negl Trop Dis ; 13(10): e0007798, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31652262

RESUMO

INTRODUCTION: Post-kala-azar dermal leishmaniasis (PKDL) is a skin manifestation that is a late clinical outcome of visceral leishmaniasis (VL). Its presentation is similar to leprosy, and the differential diagnosis is not always easy. In VL endemic rural areas of Bihar, India, both infectious diseases co-exist. This observational study aimed to determine the prevalence and distribution of both conditions in an area that had until recently been highly endemic for VL. METHODS: We conducted a door-to-door survey in an area that belongs to the Health and Demographic Surveillance Site (HDSS) of Muzaffarpur, Bihar, India. Within the HDSS we selected the villages that had reported the highest numbers of VL cases in preceding years. All consenting household members were screened for skin conditions, and minor conditions were treated on the spot. Upon completion of screening activities at the level of a few villages, a dermatology clinic ("skin camp") was conducted to which suspect leprosy and PKDL patients and other patients with skin conditions requiring expert advice were referred. We studied the association between distance from an index case of leprosy and the probability of disease in the neighborhood by fitting a Poisson model. RESULTS: We recorded a population of 33,319, out of which 25,686 (77.1%) were clinically screened. Participation in skin camps was excellent. Most common conditions were fungal infections, eczema, and scabies. There were three PKDL patients and 44 active leprosy patients, equivalent to a prevalence rate of leprosy of 17.1 per 10,000. Two out of three PKDL patients had a history of VL. Leprosy patients were widely spread across villages, but within villages, we found strong spatial clustering, with incidence rate ratios of 6.3 (95% C.I. 1.9-21.0) for household members and 3.6 (95% C.I. 1.3-10.2) for neighbors within 25 meters, with those living at more than 100 meters as the reference category. DISCUSSION: Even in this previously highly VL endemic area, PKDL is a rare condition. Nevertheless, even a single case can trigger a new VL outbreak. Leprosy is also a rare disease, but current prevalence is over 17 times the elimination threshold proclaimed by WHO. Both diseases require continued surveillance. Active case finding for leprosy can be recommended among household members and close neighbors of leprosy patients but would not be feasible for entire populations. Periodic skin camps may be a feasible and affordable alternative.


Assuntos
Leishmaniose Cutânea/epidemiologia , Leishmaniose Visceral/epidemiologia , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Surtos de Doenças , Monitoramento Epidemiológico , Feminino , Humanos , Índia/epidemiologia , Lactente , Leishmaniose Cutânea/diagnóstico , Leishmaniose Visceral/diagnóstico , Hanseníase/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , Pele/parasitologia , Adulto Jovem
8.
PLoS Negl Trop Dis ; 13(9): e0007646, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31539374

RESUMO

BACKGROUND: The country of Kiribati is a small Pacific island nation which had a new case detection rate of 191 per 100,000 in 2016, and is one of the few countries yet to reach the WHO leprosy elimination goal. Chemoprophylaxis of household contacts of new cases, or to the whole population in a highly endemic areas have been found to be effective in reducing new case rates. This study investigated the potential impact of different chemoprophylaxis strategies on future cases in South Tarawa, the main population centre of Kiribati. METHODOLOGY: The microsimulation model SIMCOLEP was calibrated to simulate the South Tarawa population and past leprosy control activities, and replicate annual new cases from 1989 to 2016. The impact of six different strategies for delivering one round of single dose rifampicin (SDR) chemoprophylaxis to household contacts of new cases and/or one or three rounds of SDR to the whole population was modelled from 2017 to 2030. PRINCIPAL FINDINGS: Our model predicted that continuing the existing control program of high levels of public awareness, passive case detection, and treatment with multidrug treatment would lead to a substantial reduction in cases but this was less effective than all modelled intervention scenarios. Mass chemoprophylaxis led to a faster initial decline in cases than household contact chemoprophylaxis alone, however the decline under the latter was sustained for longer. The greatest cumulative impact was for household contact chemoprophylaxis with three rounds of mass chemoprophylaxis at one-year intervals. CONCLUSIONS: The results suggest that control of leprosy would be achieved most rapidly with a combination of intensive population-based and household chemoprophylaxis. These findings may be generalisable to other countries where crowding places social contacts as well as household contacts of cases at risk of developing leprosy.


Assuntos
Hanseníase/prevenção & controle , Adolescente , Adulto , Quimioprevenção , Criança , Busca de Comunicante , Características da Família , Feminino , Humanos , Hansenostáticos/administração & dosagem , Hanseníase/epidemiologia , Masculino , Micronésia/epidemiologia , Modelos Teóricos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Adulto Jovem
9.
PLoS Negl Trop Dis ; 13(9): e0007714, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31490925

RESUMO

BACKGROUND: Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25-1.97) and Northeast (OR = 1.44; 95%CI 1.17-1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01-1.69), no income (OR = 1.41; 95%CI 1.07-1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13-1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28-1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10-1.66). CONCLUSIONS: The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Fatores Socioeconômicos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Brasil/epidemiologia , Estudos de Coortes , Quimioterapia Combinada/estatística & dados numéricos , Grupos Étnicos , Feminino , Geografia , Humanos , Hanseníase/epidemiologia , Masculino
10.
PLoS Negl Trop Dis ; 13(9): e0007709, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31479442

RESUMO

BACKGROUND: Leprosy has a global presence; more than 180 thousand new cases were registered in 2013, 15% of which were found in the Americas. The elderly are a very susceptible demographic in terms of developing illnesses, mainly because of characteristics natural to the senescence of the human organism. This study's goals were to analyze leprosy in an elderly population from a hyperendemic region of the Brazilian Amazon in a historical series from 2004 to 2013 and to determine the clinical and epidemiological profile of a series of leprosy cases of elderly people in the period spanning from 2009 to 2013. METHODS: To achieve these goals, an observational, longitudinal, retrospective and descriptive study was put together to analyze leprosy in elderly people from data acquired from the Notification Aggravations Information System. Furthermore, a profile of the disease from a retrospective cohort based on data collected from medical records was developed. RESULTS: The number of new cases and the leprosy detection rate decreased across the observed period but remained stable among the elderly. The trend for the next ten years indicates decreases in the number of cases and in the detection rate in the general population and an increase in only the elderly. The overall profile was characterized by a predominance of males (64.32%), the multibacillary clinical form (87.57%), Type 1 reaction episodes (37.50%) and some physical incapacity at diagnosis (49.19%). The risk of reaction was greater in the first six months of multidrug therapy, and the positive result from the skin smear was associated with the greater chance of reactional condition development. CONCLUSIONS: The resulting data demonstrate that leprosy amongst the elderly deserves attention because of the increased susceptibility to disability in this age group, with their higher risk of reaction and their greater level of co-morbidity.


Assuntos
Quimioterapia Combinada/estatística & dados numéricos , Hansenostáticos/uso terapêutico , Hanseníase/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Hansenostáticos/efeitos adversos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
Rev Saude Publica ; 53: 61, 2019 Aug 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31390430

RESUMO

OBJECTIVE: To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015. METHODS: This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region. RESULTS: 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators. CONCLUSIONS: A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.


Assuntos
Doenças Endêmicas/estatística & dados numéricos , Indicadores Básicos de Saúde , Hanseníase/epidemiologia , Doenças Negligenciadas/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Geografia , Humanos , Hanseníase/diagnóstico , Hanseníase/prevenção & controle , Hanseníase/transmissão , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Tempo , Adulto Jovem
12.
Med Sante Trop ; 29(2): 155-158, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379340

RESUMO

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


Assuntos
Hanseníase/epidemiologia , Bouba/epidemiologia , Adolescente , República Centro-Africana/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Doenças Endêmicas , Feminino , Humanos , Masculino , Saúde da População Urbana
13.
Rev Bras Epidemiol ; 22: e190047, 2019 Aug 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31460663

RESUMO

INTRODUCTION: Tocantins is the most hyperendemic state for leprosy in Brazil. OBJECTIVE: To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012. METHODOLOGY: Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression. RESULTS: There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7). CONCLUSION: Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands.


Assuntos
Hanseníase/epidemiologia , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Análise de Regressão , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Fatores de Tempo
14.
An. bras. dermatol ; 94(4): 405-410, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1038299

RESUMO

Abstract: Background: A high prevalence of leprosy among children under 15 years of age indicates the need to implement actions to prevent new cases of the disease. Serological tests have been developed with the aim of helping to control the disease by indicating, through seropositivity, the presence of infection. Objective: To analyze the prevalence and factors associated with seropositivity rate for anti-NDO-LID antibodies in children under 15 years of age, contacts of leprosy patients. Method: We performed a cross-sectional study with 210 children under 15 years old of age. Of them, 50 were household contacts and 160 were neighborhood contacts living in the municipality of Cuiabá, state of Mato Grosso, in 2016. The data were obtained from interviews and the NDO-LID rapid test during home visits from February to July 2016. For the analysis, we used Poisson regression and prevalence ratio. Results: Seropositivity in contacts was 6.2%. Variables associated with seropositive tests included sex (PR = 1.05; 95% CI: 1.01 - 1.08), race/skin color (PR = 0.95; 95% CI: 0.90 - 0.99), residence area (PR = 1.05; 95% CI: 1.01 - 1.09), and number of people per household (PR = 1.06; 95% CI: 1.02 - 1.08). Study Limitations: The small sample size, besides leading to wide confidence intervals, may have been a limitation for the identification of associated factors. Conclusions: The prevalence of seropositivity was high. Variables associated with NDO-LID seropositivity included female sex, not to be brown skinned, live in urban areas, and live with five or more people.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Anticorpos Anti-Idiotípicos/imunologia , Hanseníase/imunologia , Hanseníase/epidemiologia , Anticorpos Antibacterianos/imunologia , Fatores Socioeconômicos , Brasil/epidemiologia , Testes Sorológicos/métodos , Características de Residência , Características da Família , Anticorpos Anti-Idiotípicos/sangue , Estudos Transversais , Fatores Etários , Distribuição por Sexo , Distribuição por Idade , Lactente , Anticorpos Antibacterianos/sangue
15.
Cien Saude Colet ; 24(7): 2431-2441, 2019 Jul 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31340262

RESUMO

The study aimed to characterize food insecurity, nutritional status, and eating habits of people affected by leprosy. This is a descriptive cross-sectional study based on a census population. We evaluated 276 cases, reported in the Notifiable Diseases Information System, between 2001 and 2014, in the municipalities of Vitória da Conquista and Tremedal, in the state of Bahia. Food insecurity was estimated according to the Brazilian Food Insecurity Scale. We collected weight and height measurements, meal frequency, and household, socioeconomic, psychosocial and clinical variables. The prevalence of food insecurity was 41.0% among the study population - 28.3% mild, 8.0% moderate and 4.7% severe. Overweight/obesity was estimated in 60.1% of the study participants, and excessive salt intake was reported by 8.6%. Beans and red meat were the most regularly consumed foods; there was low consumption of milk, raw and cooked vegetables, and fruits. This population presented high food insecurity prevalence, inadequate eating habits and nutritional status, reflecting nutritional vulnerability. The insertion of nutritional assistance in the leprosy control programmes is recommended, to improve health care.


Assuntos
Comportamento Alimentar , Abastecimento de Alimentos/estatística & dados numéricos , Hanseníase/epidemiologia , Estado Nutricional , Brasil/epidemiologia , Cidades , Estudos Transversais , Humanos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores Socioeconômicos
16.
Rev Soc Bras Med Trop ; 52: e20180540, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340360

RESUMO

INTRODUCTION: Monitoring disability trends is required to evaluate leprosy elimination. We assessed the trends in disability indicators and its association with space in Alagoas, Brazil. METHODS: We conducted an ecological study in all leprosy cases from 2006 to 2016. Disability indicators were analyzed using the joinpoint regression model. RESULTS: The proportion of new cases with grade 2 disability at diagnosis ranged from 4.7% to 11.9% (annual percent change, 1.4; P= 0.7), while at discharge, it ranged from 0.0% to 12.3% (annual percent change, -21.8; P= 0.2). CONCLUSIONS: Disability indicators had a stable trend over the study period.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Hanseníase/epidemiologia , Brasil/epidemiologia , Doenças Endêmicas/estatística & dados numéricos , Humanos , Hanseníase/complicações , Análise Espacial
17.
Cien Saude Colet ; 24(6): 2009-2020, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269160

RESUMO

This study examines the health situation in Brazil's Federal District between 2005 and 2017. A related set of indicators were selected and compared to those for Brazil's Midwest ("Centro-Oeste") region and for the country as a whole. First, data are presented on the demographic profile and current organizational structure of the health regions and administrative areas of the Federal District. The results show that infant mortality declined from 18.3% in 2006 to 10.3% (one of the lowest in rates in Brazil) in 2016. AIDS incidence in the Federal District declined 21.3% between 2006 and 2016, a positive result when compared to data for the Midwest region and Brazil. Tuberculosis incidence and mortality rates were among the lowest in Brazil between 2006 and 2016, well below the national average, as were those for Hansen's disease, where both annual incidence and incidence of grade 2 disability decreased significantly between 2007 and 2017. Congenital syphilis in under 1 year-olds has increased in recent years in Brazil and the Midwest, and also in the Federal District, where the rate was 2.56 per 1,000 live births in 2006 and 4.7 per 1,000 live births in in 2016. These data enable managers to identify trends and challenges to be met, and inform decision-making in response to health realities in the Federal District.


Assuntos
Nível de Saúde , Mortalidade Infantil/tendências , Síndrome de Imunodeficiência Adquirida/epidemiologia , Brasil/epidemiologia , Feminino , Humanos , Incidência , Lactente , Hanseníase/epidemiologia , Nascimento Vivo , Masculino , Tuberculose/epidemiologia
18.
Emerg Infect Dis ; 25(8): 1604-1607, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310204

RESUMO

Whether Mycobacterium leprae transmits from placenta to fetus remains unknown. We describe the case of a pregnant woman with untreated histoid leproma. Although her newborn was healthy, laboratory examination revealed intact M. leprae present in the placenta, suggesting that the placental barrier might prevent vertical dissemination of M. leprae.


Assuntos
Hanseníase/diagnóstico , Hanseníase/microbiologia , Mycobacterium leprae/isolamento & purificação , Placenta/microbiologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Antituberculosos/uso terapêutico , Biópsia , China/epidemiologia , Feminino , Humanos , Hanseníase/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Pele/patologia , Resultado do Tratamento , Ultrassonografia
19.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 873-879, jul.-set. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005618

RESUMO

Objetivo: Avaliar a situação dos contatos intradomiciliares dos casos de hanseníase notificados no ano de 2012 em São Luís/Maranhão. Métodos: Estudo quantitativo-descritivo-transversal, com coleta de dados utilizando-se instrumento estruturado. Resultados: A maioria dos contatos intradomiciliares eram mulheres (51,87%), idade entre 0 e 20 anos (40,29%), parentesco consanguíneo de 1º grau (54,92%), forma dimorfa (59,78%) e multibacilares (75,53%). Do total, 1880 (67,96%) não realizaram o exame dermatoneurológico. Entre os examinados, houve maior frequência no distrito Bequimão (28,48%), no qual 59,82% eram mulheres, idade entre 0 a 20 anos (44,77%). Ao exame, 91,27% apresentou-se normal. Dentre os suspeitos, 36,73% tinham hanseníase, 58,21% possuíam cicatriz da 1ª dose da BCG e 59,98% foram encaminhados a vacinação. A prevalência da doença entre os contatos foi de 1,62%. As ações da vigilância de contatos classificaram-se como precárias em São Luís. Conclusão: A maioria dos contatos registrados não foi examinada, evidenciando necessidade de fortificação das ações da vigilância no município


Objective: To evaluate the situation of in-house contacts of the cases of leprosy reported in 2012 in São Luis, Maranhão. Methods: Quantitative cross-sectional descriptive study, with data collection using a structured instrument. Results: The majority of in-house contacts were women (51.87%), from 0 to 20 years of age (40.29%), first-degree kinship (54.92%), dimorphic shape (59.78) and multibacillary (75.53%). In total, 1880 (67.96%) did not take the dermato-neurological exam. Among those tested, there was a greater frequency in the Bequimão district (2.48%), 59.82% were women, from 0 to 20 years of age (44.77%). On the exam, 91.27% were normal. Among those suspected of carrying the disease, 36.73% had leprosy, 58.21% had scars from the first dose of BCG and 59.98% were sent to receive vaccination. The prevalence of the disease among the contacts was 1.62%. The actions of contact monitoring were classified as precarious in São Luis. Conclusion: The majority of registered contacts were not examined, highlighting the need for strengthening of monitoring efforts in the city


Objetivo: Evaluar la situación de los contactos intradomiciliares de los casos de hanseniasis notificados en el año 2012 en São Luis - MA. Métodos: Estudio cuantitativo-descriptivo-transversal, con recolección de datos utilizando instrumento estructurado. Resultados: La mayoría de los contactos intradomiciliares eran mujeres (51,87%), edad entre 0 y 20 años (40,29%), parentesco consanguíneo de primer grado (54,92%), forma dimorfa (59,78%), multibacilares (75,53%). Del total, 1880 (67,96%) no realizaron el examen dermatoneurológico. Entre los examinados, hubo mayor frecuencia en el distrito de Bequimão (28,48%), el 59,82% eran mujeres, entre 0 a 20 años (44,77%). En el examen, el 91,27% se presentó normal. Entre los sospechosos, el 36,73% tenían hanseniasis, el 58,21% tenía cicatriz de la 1ª dosis de BCG y el 59,98% fueron encaminados a la vacunación. La prevalencia de la enfermedad entre los contactos fue del 1,62%. Las acciones de la vigilancia de contactos se clasificaron como precarias en San Luis. Conclusión: La mayoría de los contactos registrados no fueron examinados, evidenciando necesidad de fortificación de las acciones de la vigilancia en el municipio


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Notificação de Doenças/estatística & dados numéricos , Hanseníase/transmissão , Hanseníase/epidemiologia , Contaminação/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Monitoramento Epidemiológico
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