Impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil: An ecological and population-based study

Paz, Wandklebson Silva da; Souza, Mariana do Rosário; Tavares, Débora dos Santos; Jesus, Amélia Ribeiro de; Santos, Allan Dantas dos; Carmo, Rodrigo Feliciano do; Souza, Carlos Dornels Freire de; Santos, Márcio Bezerra

doi:10.1016/j.lana.2021.100181

Cited by 37 publications

(55 citation statements)

References 39 publications

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“…The COVID-19 pandemic can be predicted to have a major negative impact in the control of leprosy and other diseases. There was a 41.4% reduction in the detection of new cases of leprosy in Brazil in 2020, when compared to mean values for the previous 4 years ( da Paz et al, 2022 ). New approaches are required to improve early detection of leprosy new cases and latent infections at high risk of evolution to active disease.…”

Section: Discussionmentioning

confidence: 78%

Modulation of the Response to Mycobacterium leprae and Pathogenesis of Leprosy

Cabral

Figueiredo²,

Gandini³

et al. 2022

Front. Microbiol.

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The initial infection by the obligate intracellular bacillus Mycobacterium leprae evolves to leprosy in a small subset of the infected individuals. Transmission is believed to occur mainly by exposure to bacilli present in aerosols expelled by infected individuals with high bacillary load. Mycobacterium leprae-specific DNA has been detected in the blood of asymptomatic household contacts of leprosy patients years before active disease onset, suggesting that, following infection, the bacterium reaches the lymphatic drainage and the blood of at least some individuals. The lower temperature and availability of protected microenvironments may provide the initial conditions for the survival of the bacillus in the airways and skin. A subset of skin-resident macrophages and the Schwann cells of peripheral nerves, two M. leprae permissive cells, may protect M. leprae from effector cells in the initial phase of the infection. The interaction of M. leprae with these cells induces metabolic changes, including the formation of lipid droplets, that are associated with macrophage M2 phenotype and the production of mediators that facilitate the differentiation of specific T cells for M. leprae-expressed antigens to a memory regulatory phenotype. Here, we discuss the possible initials steps of M. leprae infection that may lead to active disease onset, mainly focusing on events prior to the manifestation of the established clinical forms of leprosy. We hypothesize that the progressive differentiation of T cells to the Tregs phenotype inhibits effector function against the bacillus, allowing an increase in the bacillary load and evolution of the infection to active disease. Epigenetic and metabolic mechanisms described in other chronic inflammatory diseases are evaluated for potential application to the understanding of leprosy pathogenesis. A potential role for post-exposure prophylaxis of leprosy in reducing M. leprae-induced anti-inflammatory mediators and, in consequence, Treg/T effector ratios is proposed.

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Section: Discussionmentioning

confidence: 78%

Modulation of the Response to Mycobacterium leprae and Pathogenesis of Leprosy

Cabral

Figueiredo²,

Gandini³

et al. 2022

Front. Microbiol.

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“…Segundo Paz e colaboradores (10) , todos os vinte e seis Estados e o Distrito Federal acompanharam essa tendência de redução das notificações de hanseníase. Os estados do Espírito Santo (88,45%), Roraima (69,61%), Piauí (56,51%), Amazonas (54,19%) e Bahia (52,99%) foram aqueles que apresentaram as maiores reduções, durante o período de 2020 a 2021.…”

Section: Discussionunclassified

Características socioeconomicas e epidemiológicas da hanseníase no Maranhão

Oliveira

Soeiro

Soares

et al. 2023

SaudColetiv (Barueri)

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Objetivo: Avaliar as características sociodemográficas e epidemiológicas da hanseníase no Estado do Maranhão no período de 2015 a 2021. Método: estudo ecológico de série temporal, utilizando os indicadores epidemiológicos do Programa de Controle da Hanseníase, no Estado do Maranhão. Resultados: O perfil dos casos de hanseníase é composto na sua maioria por indivíduos do sexo masculino, com idade entre 30 e 50 anos, pardos, com baixo nível de escolaridade. Observou-se crescimento de novos casos da doença sendo diagnosticados com o grau 2 e de casos multibacilares. Conclusão: A hanseníase no Estado do Maranhão é um grave problema de saúde, principalmente quando se analisa os indicadores de casos que são diagnosticados tardiamente e a situação de pacientes com o grau mais acentuado da doença. Portanto, cabe ao poder público a formulação e implantação de políticas de saúde com vistas à melhoria da capacidade e da qualidade dos serviços prestados, no sentido de potencializar a assistência aos indivíduos com hanseníase.

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“…Social distancing, re‐prioritization of services and disruption to health systems caused by the pandemic have had a major impact on Hansen’s disease new case detection rates in Brazil, which fell by 40% in 2020 compared with the average over the previous 5 years. 4 Missed diagnoses of Hansen’s disease have detrimental public health effects in perpetuating transmission, particularly from multibacillary cases within households and communities, 5 whilst diagnostic delay amplifies the burden of Hansen’s disease for affected persons and public health systems because of the increased risk of lifelong impairments and disabilities. 6 …”

Section: Figurementioning

confidence: 99%

“…1 Social distancing, re-prioritization of services and disruption to health systems caused by the pandemic have had a major impact on Hansen's disease new case detection rates in Brazil, which fell by 40% in 2020 compared with the average over the previous 5 years. 4 Missed diagnoses of Hansen's disease have detrimental public health effects in perpetuating transmission, particularly from multibacillary cases within households and communities, 5 whilst diagnostic delay amplifies the burden of Hansen's disease for affected persons and public health systems because of the increased risk of lifelong impairments and disabilities. 6 Data released recently by the Brazilian Ministry of Health from the national surveillance system for notifiable diseases -SINAN (Sistema de Informac ßão de Agravos de Notificac ßão)show that the impact of COVID-19 on the new case detection rate in our state has continued into 2021, with the average rate for 2020/2021 (6.9/10 000) being roughly half that of the preceding 3 years (12.0/10 000) (Fig.…”

mentioning

confidence: 99%