Innovative tracking, active search and follow-up strategies for new leprosy cases in the female prison population

Abstract

Background Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. Methods A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. Findings 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1–numbness (5.6), Q3–anesthetizes areas in the skin (7.5), Q5–Stinging sensation (5.8), and Q7–pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. Interpretation The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.

Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review

“…Prevalence of HIV varied from 1% (Viitanen et al , 2011) to 18.8% (Smith et al , 1991). Silva and colleagues (2021) identified 14 leprosy cases in their sample from Brazil, implying a detection rate of 3.5%.…”

Perfil epidemiológico da hanseníase no município de Divinópolis, Minas Gerais, 2011 a 2019

“…A realização de campanha de busca ativa em unidade prisional feminina brasileira, em que foi utilizado o questionário de suspeição de hanseníase, permitiu realizar o diagnóstico de 14 casos novos de hanseníase, sendo 13 classificadas como multibacilares. 23 Pesquisa evidenciou que muitos médicos brasileiros não conseguem determinar, prontamente, um diagnóstico conclusivo de hanseníase 22 , sendo que na região sudeste, 57,5% dos casos de hanseníase foram detectados por encaminhamento no período de 2015 a 2019 4 . O itinerário terapêutico das pessoas com hanseníase é marcado por um longo caminho e desafios em busca do diagnóstico 19,[24][25] , tanto na rede pública de saúde quanto na privada 25 .…”

“…A hanseníase é uma doença tropical negligenciada 1 que ainda persiste como problema de saúde pública em 23 , sendo que tanto no Plano Nacional 9 e no Estadual 10 da hanseníase existem recomendações para a vigilância da doença independentemente do nível de endemicidade. Mesmo havendo um compromisso político direcionando a construção de uma rede de atenção horizontalizada, hierarquizada, integral e integrada para atenção à saúde de pessoas com hanseníase e seus familiares 9-10 , que têm os serviços de APS como porta preferencial de entrada, pesquisas apontam que existem dificuldades na integração das ações de controle da hanseníase (ACH) nesse ponto de atenção [7][8]11 .…”

Serological Immunoassay for Hansen’s Disease Diagnosis and Monitoring Treatment: Anti-Mce1A Antibody Response Among Hansen’s Disease Patients and Their Household Contacts in Northeastern Brazil

“…Summarizing and aggregating the results from our three previous published studies searching for HD involving prison male/female populations and from the community ( n = 2,133 evaluated individuals) in São Paulo state, the authors found 112 new cases of HD, with new case detection rate (NCDR) 6.5%; macular mild lesion in 93.7%; nerve impairment on palpation in 91.9 and 67% defined as having grade 2 disability (67%). On the other hand, APGL-I titer was positive in only 31.3% of the general population, 30.3% of the non-HD group and 54.4% of HD patients, although it was officially considered high for the non-endemic state, highlighting the hidden presence and the diagnostic challenge of HD and the low sensitivity as diagnostic test for new cases and screening contacts ( 8 , 30 , 31 ).…”