Prevalência e distribuição espacial da infecção pelo Mycobacterium leprae em município de média endemicidade / Prevalence and spatial distribution of Mycobacterium leprae infection in a medium endemicity municipality

Objetivo: analisar o perfil sorológico e a distribuição espacial da infecção e do adoecimento pelo Mycobacterium leprae. Métodos: estudo transversal, conduzido com casos de hanseníase (n=42), contatos intradomiciliares (n=81) e escolares (n=358). Realizados entrevista, exame dermatoneurológico, sorológico e georreferenciamento dos endereços. Resultados: dos casos soropositivos, todos residiam em zona rural, com mais de duas pessoas no domicílio, 50,0% apresentavam alguma alteração de força nos pés. Dos contatos soropositivos, 75,0% eram idosos e casados. Dentre os escolares, 75,0% eram do sexo feminino, 69,4% residiam com mais de quatro pessoas e 80,6% dormiam no quarto com alguém. Foi possível observar áreas hiperendêmicas de casos no munícipio estudado e relação espaço-temporal entre eles (p=0,010). Além disso, concentração de casos e escolares em setores de menor renda familiar per capita. Conclusão: a análise sorológica revelou que a condição de convivência se relacionou com a infecção pelo Mycobacterium leprae, e a espacial demonstrou cenário de endemia oculta. (AU)

Evidence of hidden leprosy in a supposedly low endemic area of Brazil

OBJECTIVES Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations. METHODS The study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA). RESULTS From July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases. CONCLUSIONS During the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.

Estratégia saúde da família e hanseníase: análise territorial / Family health strategy and leprosy: a territorial analysis

OBJETIVOS: Correlacionar a cobertura territorial da Estratégia Saúde da Família (ESF) com a distribuição espacial dos casos de hanseníase em um município hiperendêmico do Norte do País. MÉTODOS: Foram mapeados os territórios da ESF e os casos de Hanseníase do período de 2004 a 2010. Utilizou-se um Sistema de Informações Geográficas(SIG) para visualizar a distribuição espacial dos casos de hanseníase em relação à cobertura da ESF do município de Castanhal-PA. RESULTADOS: Foram desenvolvidos os shapes de cobertura da ESF (aproximadamente 76,38% da população é atendida pelo programa) e de distribuição dos casos de hanseníase (aproximadamente 81,62% destes casos estão dentro da área de atuação da ESF no município de estudo). CONCLUSÃO: Através desta técnica, foram identificadas as áreas descobertas pela ESF, bem como a distribuição de casos de Hanseníase.

OBJECTIVES: Correlate the territorial coverage of Family Health Strategy (FHS) with the spatial distribution of the leprosy cases in a hiperendemic municipality of North Region of the Country. METHODS: We mapped the FHS territories and the leprosy cases in the period from 2004 to 2010. We used a Geographic Information System (GIS) to visualize the spatial distribution of leprosy cases in relationship to the FHS coverage in Castanhal-PA. RESULTS: Were developed the shapes of FHS coverage (approximately 76.38% of the population is attended by the program) and distribution of leprosy cases (approximately 81.62% of these cases are within the FHS operating area in the municipality of study). CONCLUSION: Using this technique, the areas uncovered by the FHS as well as the distribution of Leprosy cases have been identified.

High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region

Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.