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BMC Infect Dis. 2015 Nov 16;15:527. doi: 10.1186/s12879-015-1254-8.

Spatial epidemiology and serologic cohorts increase the early detection of leprosy.

Author information

1
Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. jbarreto@ufpa.br.
2
Universidade Federal do Pará, Campus Castanhal, Marituba, Pará, Brazil. jbarreto@ufpa.br.
3
Department of Environmental Sciences, Emory University, Atlanta, GA, USA. donal.bisanzio@gmail.com.
4
Divison of Dermatology of Internal Medicine Department of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. mandrey@fmrp.usp.br.
5
Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. taniafarma@gmail.com.
6
Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. angelik.gobbo@gmail.com.
7
Unidade de Referência Especializada em Dermatologia Sanitária Dr. Marcello Candia, Marituba, Pará, Brazil. layanaguimaraes@hotmail.com.
8
Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. moises@ufpa.br.
9
Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil. moises@ufpa.br.
10
Department of Environmental Sciences, Emory University, Atlanta, GA, USA. gmvazqu@emory.edu.
11
Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA. John.Spencer@colostate.edu.
12
Department of Environmental Sciences, Emory University, Atlanta, GA, USA. ukitron@emory.edu.
13
Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Av. João Paulo II, 113. Bairro Dom Aristides, Marituba, CEP: 67200-000, , Pará, Brazil. csalgado@ufpa.br.
14
Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil. csalgado@ufpa.br.

Abstract

BACKGROUND:

Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children.

METHODS:

We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups.

RESULTS:

Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in "positive houses" compared to "negative houses" (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years.

CONCLUSIONS:

Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.

PMID:
26573912
PMCID:
PMC4647818
DOI:
10.1186/s12879-015-1254-8
[Indexed for MEDLINE]
Free PMC Article

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