Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

Souza, Carlos Dornels Freire de; Rocha, Viviane Silva; Santos, N. F. A.; Leal, Thiago Cavalcanti; Paiva, João Paulo Silva de; Oliveira, Cristiane Costa Cunha; Martins-Filho, Paulo Ricardo; Magalhães, Mônica Avelar Figueiredo Mafra; Cuevas, Luís E.; Santos, Victor Santana

doi:10.1111/jdv.15596

Cited by 28 publications

(30 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, leprosy risk among household contacts was similar across geographic location or socioeconomic conditions of households, which differed from previous studies. 8,25,26 However, given that the households affected by leprosy in the 100 Million Brazilian Cohort were more likely to have low-income circumstances, 8 the sample in the present study was relatively homogeneously composed of individuals of limited resources, which may have limited our ability to differentiate any health outcomes associated with socioeconomic status. 27 The high proportion of cases associated with exposure to leprosy cases within the household compared with exposure outside of household suggests that household contacts with low-income status may benefit from targeted and effective strategies to prevent transmission, such as strengthening screening of contacts.…”

Section: Discussionmentioning

confidence: 90%

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Despite progress toward reducing global incidence, leprosy control remains a challenge in low-and middle-income countries. OBJECTIVE To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018. EXPOSURES Clinical characteristics of the primary case and sociodemographic factors of the household contact. MAIN OUTCOMES AND MEASURES Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state-and household-specific random effects. RESULTS Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR] , 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42). CONCLUSIONS AND RELEVANCE The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.

show abstract

Section: Discussionmentioning

confidence: 90%

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The gradual increase in the number of reported cases after 2012 and 2013, might be due to the roll out of extra case nding surveys, intended to reach the case inclusion targets for the intervention studies that started in those years (24). The heterogeneous spatial epidemiological patterns of leprosy incidence that are shown in this study, are also known to be present in India (20,40,41) and Brazil (42)(43)(44)(45)(46)(47)(48).…”

Section: Discussionmentioning

confidence: 75%

Geospatial Epidemiology of Leprosy in Northwest Bangladesh: A 20-year Retrospective Observational Study

Bulstra

Blok

Alam³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms of these areas remain not fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a high endemic country. Methods: Data were used from four high-endemic districts in northwest Bangladesh, including 20,623 registered cases (among ~7 million population) between January 2000 and April 2019. Incidences per union were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000-2009, 2005-2014 and 2010-2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e. relative risk (RR) of one to two), medium (i.e. RR of two to three), and strong (i.e. RR higher than three) hotspots.Results: New case detection rates dropped from 44/100,000 in 2000 to 10/100,000 in 2019. Statistically significant hotspots were identified during all timeframes, and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1,930 cases among less than 1% of the population), significantly more child cases (i.e. below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions: Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that hotspots have higher active transmission and are not solely the result of active case finding strategies.

show abstract

“…Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Transmission occurs by very close and prolonged coexistence with non-treated multibacillary leprosy patients [1]. Patients have distinct clinical forms, affecting mainly the skin and the nerves, causing lesions resulting from in ammatory processes [2,3].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Myeloid-Derived Suppressor Cells and Annexin A1 in Multibacillary Leprosy and Reactional Episodes

Damazo

Silva

Cavalcante

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Patients have distinct clinical forms, and host´s immunological response regulate those manifestations. In this work, the presence of the myeloid-derived suppressor cell and the regulatory protein annexin A1 is described in patients with multibacillary leprosy and with type 1 and 2 reactions. Methods: Patients were submitted to skin biopsy for histopathological analysis to obtain bacilloscopic index. Immunofluorescence was used to detect myeloid-derived suppressor cells and annexin A1.Results: The data demonstrated that the presence of granulocytic and monocytic myeloid-derived suppressor cells in leprosy patients. The high number of monocytic myeloid-derived suppressor cells were observed in lepromatous leprosy and type 2 reactional patients with Bacillus Calmette–Guérin (BCG) vaccination scar. The presence of annexin A1 was observed in all myeloid-derived suppressor cells. In particularly, the monocytic myeloid-derived suppressor cell in the lepromatous patients has higher levels of this protein when compared to the reactional patients. This data suggest that the higher expression of this protein may be related to regulatory response against a severe infection, contributing to anergic response. In type 1 reactional patients, the expression of annexin A1 was reduced. Conclusions: Myeloid-derived suppressor cell are present in leprosy patients and annexin A1 might be regulated the host response against Mycobacterium leprae.

show abstract

Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

Cited by 28 publications

References 31 publications

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil

Geospatial Epidemiology of Leprosy in Northwest Bangladesh: A 20-year Retrospective Observational Study

Analysis of the Myeloid-Derived Suppressor Cells and Annexin A1 in Multibacillary Leprosy and Reactional Episodes

Contact Info

Product

Resources

About