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2.
PLoS Negl Trop Dis ; 16(6): e0010476, 2022 06.
Article in English | MEDLINE | ID: covidwho-1957097

ABSTRACT

BACKGROUND: Leprosy reactions, Type-1 and erythema nodosum leprosum, are immune-mediated complications of leprosy, which play a significant role in the morbidity associated with the disease. A considerable amount of literature has been published on the impact of leprosy in general but few studies focus specifically on leprosy reactions. This study aimed to investigate the impact of leprosy reactions on physical, psychological, and social aspects of the lives of people affected by analysing their life experiences and perspectives about leprosy reactions. METHODS/PRINCIPAL FINDINGS: This qualitative study involved people affected by leprosy reactions and their family members in two leprosy endemic countries. The data were collected through 66 interviews and 9 focus group discussions (4-6 participants each) in Surabaya, Indonesia, and Purulia, India. Content analysis and conversational analysis were performed. This study found that both types of leprosy reactions were perceived as an unpredictable and painful condition. Leprosy reactions restricted physical activities of the participants, such as going to bathroom, sleeping, eating, and cooking. In the interviews, the respondents expressed a range of emotions and feelings including confusion, sadness, anxiety, and anger. Some recounted that they felt stigmatized and lost opportunities to socialise and earn money. Differences between the two settings were identified. The majority of Indonesian participants preferred to stay at home, and some concealed the diagnosis of leprosy, while most of the Indian respondents continued working up to the time of hospitalization. CONCLUSION: Leprosy reactions are a distressing complication of leprosy and adversely affect the lives of those affected. Individuals reported physical discomfort, distress, anxiety, stigma, and financial hardship and these negative impacts in the physical, psychological, and social spheres reinforced each other. These findings provide important information about a need for early detection and sustained commitment to follow-up care for people with a history of leprosy reactions. More research on new drugs for reactional episodes, tools to measure knowledge, attitude, and practice, and costing study on leprosy reactions treatment are needed. We recommend the development and testing of holistic strategies to improve the management of leprosy reactions.


Subject(s)
Erythema Nodosum , Leprosy , Erythema Nodosum/epidemiology , Family/psychology , Humans , Leprosy/epidemiology , Qualitative Research , Social Stigma
4.
5.
Lancet ; 399(10335): 1588-1599, 2022 04 23.
Article in English | MEDLINE | ID: covidwho-1805372
6.
Int J Environ Res Public Health ; 19(1)2021 12 31.
Article in English | MEDLINE | ID: covidwho-1613755

ABSTRACT

This work aimed to apply the ARIMA model to predict the under-reporting of new Hansen's disease cases during the COVID-19 pandemic in Palmas, Tocantins, Brazil. This is an ecological time series study of Hansen's disease indicators in the city of Palmas between 2001 and 2020 using the autoregressive integrated moving averages method. Data from the Notifiable Injuries Information System and population estimates from the Brazilian Institute of Geography and Statistics were collected. A total of 7035 new reported cases of Hansen's disease were analyzed. The ARIMA model (4,0,3) presented the lowest values for the two tested information criteria and was the one that best fit the data, as AIC = 431.30 and BIC = 462.28, using a statistical significance level of 0.05 and showing the differences between the predicted values and those recorded in the notifications, indicating a large number of under-reporting of Hansen's disease new cases during the period from April to December 2020. The ARIMA model reported that 177% of new cases of Hansen's disease were not reported in Palmas during the period of the COVID-19 pandemic in 2020. This study shows the need for the municipal control program to undertake immediate actions in terms of actively searching for cases and reducing their hidden prevalence.


Subject(s)
COVID-19 , Leprosy , Brazil/epidemiology , Humans , Leprosy/epidemiology , Models, Statistical , Pandemics , SARS-CoV-2
7.
Int J Dermatol ; 61(6): 733-738, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1537821

ABSTRACT

Leprosy, also known as Hansen's disease, is an age-old chronic granulomatous infection characterized by prominent cutaneous and neurologic findings. Long known to be caused by Mycobacterium leprae, a new etiologic species was identified and linked in 2008, Mycobacterium lepromatosis. The BCG vaccine with highly variable efficacy may soon be replaced by the first leprosy-specific subunit vaccine LepVax, which has recently moved forward in human trials. Recent evidence supporting theories of zoonotic transmission from armadillos and the less-discussed Eurasian red squirrels has emerged. Knowledge on genetic polymorphisms that may increase leprosy susceptibility, such as the newly uncovered mitochondrial ribosomal protein S5 (MRPS5) polymorphism in the Chinese population, has provided a fresh perspective and direction. Further, we will delineate the latest information on leprosy, including the possible effects of leprosy coinfection with COVID-19, HIV, and HTLV-1, and the shift to newer leprosy therapies and treatment regimens.


Subject(s)
COVID-19 , Leprosy , Animals , Armadillos/microbiology , Humans , Leprosy/epidemiology , Leprosy/microbiology , Mycobacterium leprae/genetics
8.
Rev. Soc. Bras. Med. Trop ; 54: e02512021, 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1329152

ABSTRACT

Abstract INTRODUCTION: Coronavirus disease 2019 (COVID-19) has limited the access of patients with Hansen's disease (HD) to care due to changes in routine health services. METHODS: To ascertain this, we compared the number of HD cases diagnosed before and after the COVID-19 pandemic. RESULTS: The decrease in HD cases in Brazil reached 18,223 (-48.4%), corresponding to an average reduction of 1,518 cases per month during the COVID-19 pandemic. CONCLUSION: Therefore, effective measures should be implemented to minimize the damage and the consequent negative health impact of COVID-19 on the care of HD patients.


Subject(s)
Humans , COVID-19 , Leprosy/epidemiology , Brazil/epidemiology , Pandemics , SARS-CoV-2
9.
PLoS Negl Trop Dis ; 15(7): e0009635, 2021 07.
Article in English | MEDLINE | ID: covidwho-1329131

ABSTRACT

BACKGROUND: Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS: We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE: Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Leprosy/drug therapy , Leprosy/epidemiology , Adrenal Cortex Hormones/therapeutic use , BCG Vaccine/administration & dosage , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19 Testing , Clofazimine/therapeutic use , Cohort Studies , Dapsone/therapeutic use , Humans , Pentoxifylline/therapeutic use , Prospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Survival Analysis , Thalidomide/therapeutic use
10.
Clin Dermatol ; 39(1): 133-138, 2021.
Article in English | MEDLINE | ID: covidwho-1300682

ABSTRACT

Wanda Blenska (1911-2014), a Polish physician, established a leprosy treatment center in the village of Buluba in Uganda in 1951, which lasted until 1993. Through her efforts, the village for lepers in Buluba, established in 1934, which had previously been a place of isolation conducted by the Little Sisters of St. Francis in Uganda, became such an important leprosy treatment and research center that eventually the facility was able to cooperate with similar centers in India and South Africa. It then became affiliated with research institutes in London and Amsterdam; the Borstel Research Institute near Hamburg, Germany; and the World Health Organization. Blenska developed a working relationship with the government of Uganda and contributed to changes in the government provision of health care for lepers by creating a network of leprosy treatment stations throughout the country. Through her efforts, public health education and leprosy prophylaxis became available for thousands of people, effectively changing the national attitude toward this disease. In 1994, one of the buildings of the St. Francis hospital complex in Buluba was named in her honor (The Wanda Blenska Training Centre).


Subject(s)
Leprosy , Delivery of Health Care , Female , Government , Humans , India , Leprosy/drug therapy , Leprosy/epidemiology , Leprosy/prevention & control , Uganda/epidemiology
11.
Int J Dermatol ; 60(8): 1003-1006, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1280318

ABSTRACT

This study analyzed the impact of the COVID-19 pandemic on the detection of new cases of leprosy in the state of Bahia, Brazil. The periods January-September 2019 and January-September 2020 were compared. There was a 44.40% reduction in the diagnosis of leprosy when comparing the two periods (1,705 in 2019 and 948 in 2020). There was a reduction in the number of municipalities with reported cases: 251 municipalities in 2019 and 202 in 2020, expressing a reduction of 24.25%. Considering only the months following the arrival of the virus (April-September), the reduction was 51.10%. An inverse correlation was observed between the number of new cases of leprosy and the cumulative number of cases of COVID-19 (Spearman's correlation coefficient = -0.840; P < 0.001) and the number of new monthly cases of COVID-19 (Spearman's correlation coefficient = -0.817; P < 0.001). A slight increase was also observed in the proportion of multibacillary cases in the state (70.38% in 2019 and 72.69% in 2020) as well as in the proportion of individuals with the degree of physical disability not assessed at diagnosis, whose proportion rose from 16.39% in 2019 to 22.53% in 2020. The negative impact of COVID-19 in tackling leprosy should be seen as a warning sign for health and political authorities.


Subject(s)
COVID-19 , Leprosy , Brazil/epidemiology , Endemic Diseases , Humans , Leprosy/diagnosis , Leprosy/epidemiology , Pandemics , SARS-CoV-2
12.
Trans R Soc Trop Med Hyg ; 115(12): 1456-1461, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1254842

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. METHODS: We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. RESULTS: Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. DISCUSSION: This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.


Subject(s)
COVID-19 , Leprosy , Cross-Sectional Studies , Drug Therapy, Combination , Humans , Leprostatic Agents , Leprosy/diagnosis , Leprosy/drug therapy , Leprosy/epidemiology , Pandemics/prevention & control , Referral and Consultation , SARS-CoV-2 , Surveys and Questionnaires
13.
PLoS Negl Trop Dis ; 14(10): e0008819, 2020 10.
Article in English | MEDLINE | ID: covidwho-958088
14.
Postgrad Med J ; 96(1140): 633-638, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-751465

ABSTRACT

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.


Subject(s)
Coronavirus Infections/epidemiology , Ethics, Medical/history , Health Care Rationing/ethics , Hospitals/history , Pandemics/history , Pneumonia, Viral/epidemiology , Quarantine/history , Betacoronavirus , COVID-19 , Cholera/epidemiology , Cholera/history , Health Workforce , Hippocratic Oath , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , History, Medieval , Humans , Leprosy/epidemiology , Leprosy/history , Plague/epidemiology , Plague/history , Resource Allocation , SARS-CoV-2 , United States/epidemiology
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