New strategies for active finding of leprosy cases in the Amazonian region

Abstract

Introduction:The use of the Self-Image Form (SIF) expands the identifi cation of active leprosy cases to neighbors of index cases. Methods: The SIF was used to screen two groups: case (neighbors of index cases of leprosy) and control (individuals residing next to houses without leprosy) group. A specialist investigated suspected leprosy cases for disease confi rmation. Results: New cases of leprosy were diagnosed in the case group (n = 7, 8.6%), but not the control group. Conclusions: The new surveillance strategy is inexpensive, effi cient, and feasible within a primary health strategy. Future studies can help improve the use of the SIF.Keywords: Leprosy. Surveillance. Amazônia. Public Health.Leprosy is a chronic infectious disease caused by Mycobacterium leprae that signifi cantly affects public health in Brazil. In the Americas, Brazil accounts for 90% of leprosy cases and ranks second globally in the absolute number of cases and incidence (47,000 new cases/year) (1) . Leprosy affects people of any age but is more prevalent among adults (2) . It has a broad range of clinical manifestations, with opposing stable poles at the extremes and unstable intermediate forms that can acquire the clinical and immune features of either pole, depending on the presence of risk factors (3) . It affects the skin, mucous membranes, and peripheral nerves, and the bacilli spread to the peripheral nerves and skin in a few infected individuals.Leprosy is transmitted by upper airway secretions via intimate contact between healthy and untreated infected individuals. The incubation period lasts two to fi ve years (4) . The most susceptible population includes the family contacts of multibacillary cases, followed by extra-domiciliary contacts and the contacts of paucibacillary cases (5) .For active case fi nding among contacts, the Brazilian Ministry of Health (BMH) recommends interviewing and performing physical examinations for all household contacts of leprosy patients (index cases). In this study, we sought to broaden the scope of such active case fi nding by using the BMH's SelfImage Form (SIF) and including the neighbors of index cases. The SIF is a one-page form that is completed by the patient or the parents and collects information about the symptoms and clinical signs of leprosy as well as who has had contact with the patients with leprosy. If the information provided on the form is suspicious for leprosy, the patient is examined by a specialist, and complementary tests are performed.The aim of this study was to determine if the surveillance of extra-domiciliary contacts (neighbors) and use of the SIF increase the reporting of leprosy cases, thereby contributing to the development of simple, low-cost, and easy-to-apply tools for the epidemiological surveillance of leprosy that are applicable within the context of a primary health strategy (PHS).In the municipality of Monte Negro (63º 10' 00 W, 12º 40' S), which is in the State of Rondônia in the north of Brazil, there are approximately 14,091 inhabitants (6) . Fort...

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“…This approach is aimed at including a higher number of contacts by encouraging contacts to self-screen and screen their family members, using a form with instructions and illustrations to give guidance to the self-screening process [ 43 ]. People who self-screen as ‘positive’ are requested to consult a health worker to confirm or rule out leprosy [ 32 , 44 ].…”

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