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Risk-benefit assessment of Bacillus Calmette-Guérin vaccination, anti-phenolic glycolipid I serology, and Mitsuda test response: 10-year follow-up of household contacts of leprosy patients
Araujo, Sergio; Rezende, Marina Monteiro Figueiredo; Sousa, Diogo Carrijo Rodrigues de; Rosa, Maraísa Resende; Santos, Danielle Cristina dos; Goulart, Luiz Ricardo; Goulart, Isabela Maria Bernardes.
  • Araujo, Sergio; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Rezende, Marina Monteiro Figueiredo; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Sousa, Diogo Carrijo Rodrigues de; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Rosa, Maraísa Resende; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Santos, Danielle Cristina dos; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Goulart, Luiz Ricardo; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
  • Goulart, Isabela Maria Bernardes; Universidade Federal de Uberlândia. Hospital de Clínicas. Centro de Referência Nacional em Dermatologia Sanitária e Hanseníase. Uberlândia. BR
Rev. Soc. Bras. Med. Trop ; 48(6): 739-745, Nov.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-767834
ABSTRACT
Abstract

INTRODUCTION:

Despite multidrug therapy, leprosy remains a public health issue. The intradermal Bacillus Calmette-Guérin (BCG) vaccine, Mitsuda test (lepromin skin test), and anti-phenolic glycolipid I (PGL-I) serology are widely used in leprosy studies and have shown great epidemiological value.

METHODS:

This longitudinal study evaluated the relative risks and benefits of these three tools by comparing results observed in household contacts (HHCs) of leprosy patients who developed leprosy with those of HHCs who did not in a population of 2,992 individuals monitored during a 10-year period.

RESULTS:

Seventy-five (2.5%) new leprosy cases were diagnosed, including 28 (0.9%) co-prevalent cases. Therefore, for the risk-benefit assessment, 47 (1.6%) HHCs were considered as truly diagnosed during follow-up. The comparison between healthy and affected contacts demonstrated that not only did BCG vaccination increase protection, but boosters also increased to 95% relative risk (RR) reduction when results for having two or more scars were compared with having no scars [RR, 0.0459; 95% confidence interval (CI), 0.006-0.338]. Similarly, Mitsuda reactions >7mm in induration presented 7-fold greater protection against disease development compared to reactions of 0-3mm (RR, 0.1446; 95% CI, 0.0566-0.3696). In contrast, anti-PGL-I ELISA seropositivity indicated a 5-fold RR increase for disease outcome (RR, 5.688; 95% CI, 3.2412-9.9824). The combined effect of no BCG scars, Mitsuda reaction of <7mm, and seropositivity to anti-PGL-I increased the risk for leprosy onset 8-fold (RR, 8.109; 95% CI, 5.1167-12.8511).

CONCLUSIONS:

The adoption of these combined assays may impose measures for leprosy control strategies.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: BCG Vaccine / Glycolipids / Contact Tracing / Leprosy / Antigens, Bacterial Type of study: Etiology study / Observational study / Risk factors Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn Language: English Journal: Rev. Soc. Bras. Med. Trop Journal subject: Tropical Medicine Year: 2015 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de Uberlândia/BR

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Full text: Available Index: LILACS (Americas) Main subject: BCG Vaccine / Glycolipids / Contact Tracing / Leprosy / Antigens, Bacterial Type of study: Etiology study / Observational study / Risk factors Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn Language: English Journal: Rev. Soc. Bras. Med. Trop Journal subject: Tropical Medicine Year: 2015 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de Uberlândia/BR