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[This corrects the article DOI: 10.1371/journal.pntd.0007714.].
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Importance: Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries. Objective: To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors. Design, Setting, and Participants: This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018. Exposures: Clinical characteristics of the primary case and sociodemographic factors of the household contact. Main Outcomes and Measures: Incidence of leprosy, estimated as the new case detection rate of leprosy per 100â¯000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects. Results: Among 42â¯725 household contacts (22â¯449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17â¯876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100â¯000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100â¯000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42). Conclusions and Relevance: The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.
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Características da Família , Hanseníase Multibacilar/epidemiologia , Hanseníase Multibacilar/transmissão , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Necessidades e Demandas de Serviços de Saúde , Humanos , Incidência , Hanseníase Multibacilar/diagnóstico , Hanseníase Multibacilar/prevenção & controle , Masculino , Programas de Rastreamento/organização & administração , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil. METHODS: Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0-15 years), by leprosy subtype and region of residence. FINDINGS: In an analysis of 23â899â942 individuals including 18â518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32-1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62-2·72, for lowest vs highest level of education). INTERPRETATION: Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control. FUNDING: Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.
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Hanseníase/diagnóstico , Hanseníase/epidemiologia , Determinantes Sociais da Saúde , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
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.
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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 , Etnicidade , Feminino , Geografia , Humanos , Hanseníase/epidemiologia , MasculinoRESUMO
The uniform multidrug therapy clinical trial, Brazil (U-MDT/CT-BR), database was used to describe and report the performance of available tools to classify 830 leprosy patients as paucibacillary (PB) and multibacillary (MB) at baseline. In a modified Ridley and Jopling (R&J) classification, considering clinical features, histopathological results of skin biopsies and the slit-skin smear bacterial load results were used as the gold standard method for classification. Anti-phenolic glycolipid-I (PGL-I) serology by ML Flow test, the slit skin smear bacterial load, and the number of skin lesions were evaluated. Considering the R&J classification system as gold standard, ML Flow tests correctly allocated 70% patients in the PB group and 87% in the MB group. The classification based on counting the number of skin lesions correctly allocated 46% PB patients and 99% MB leprosy cases. Slit skin smears properly classified 91% and 97% of PB and MB patients, respectively. Based on U-MDT/CT-BR results, classification of leprosy patients for treatment purposes is unnecessary because it does not impact clinical and laboratories outcomes. In this context, the identification of new biomarkers to detect patients at a higher risk to develop leprosy reactions or relapse remains an important research challenge.
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Hansenostáticos/uso terapêutico , Hanseníase/classificação , Adolescente , Adulto , Idoso , Biópsia , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/patologia , Hanseníase Multibacilar/classificação , Hanseníase Multibacilar/diagnóstico , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Multibacilar/patologia , Hanseníase Paucibacilar/classificação , Hanseníase Paucibacilar/diagnóstico , Hanseníase Paucibacilar/tratamento farmacológico , Hanseníase Paucibacilar/patologia , Masculino , Pessoa de Meia-Idade , Pele/microbiologia , Pele/patologia , Adulto JovemRESUMO
Brasil presenta unos elevados índices de detección de casos nuevos de lepra. Especialmente en las zonas norte y centro occidental del país. La descentralización del tratamiento para la lepra ha ganado terreno desde el año 2000 y ha mejorado el acceso para los pacientes, consiguiendo un máximo en la detección de nuevos casos en el 2003 y un posterior declive. Esto van en paralelo con programas gubernamentales específicos centrados en la reducción de la pobreza. La prevención de discapacidades y la vigilancia de las resistencias siguen siendo tareas importantes entre los programas del control de la lepra, en el que seis centros de referencia clave señalan el camino
Brazil has high rates of leprosy case detection, especially in the northern and west central areas of the country. Effective decentralization of routine treatment for leprosy has gathered pace since the year 2000 and this has improved access for patients, leading to a peak in new case detection in 2003 and a gradual decline thereafter. This is in parallel with specific government programmes aimed at poverty reduction. Disability prevention and surveillance for drug resistance remain important tasks withing the leprosy control programme, in which six key referral centres lead the way