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MULTIBACILLARY LEPROSY BY POPULATION GROUPS IN BRAZIL: LESSONS FROM AN OBSERVATIONAL STUDY
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Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Programa de Pós-Graduação em Medicina Tropical. Rio de Janeiro, RJ, Brasil / Secretaria Estadual de Saúde. Hospital Giselda Trigueiro. Natal, RN, Brasil / Universidade Federal do Rio Grande do Norte. Instituto de Medicina Tropical do Rio Grande do Norte. Natal, RN, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Weill Cornell Medical College. Division of Infectious Diseases and Center for Global Health. New York, NY, United States of America.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio Grande do Norte. Instituto de Medicina Tropical do Rio Grande do Norte. Natal, RN, Brasil / Universidade Federal do Rio Grande do Norte. Centro de Biociências. Departamento de Bioquímica. Natal, RN, Brasil / Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT). Natal, RN, Brazil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Desenvolvimento Tecnológico em Saúde. Rio de Janeiro, RJ, Brasil.
Weill Cornell Medical College. Division of Infectious Diseases and Center for Global Health. New York, NY, United States of America.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio Grande do Norte. Instituto de Medicina Tropical do Rio Grande do Norte. Natal, RN, Brasil / Universidade Federal do Rio Grande do Norte. Centro de Biociências. Departamento de Bioquímica. Natal, RN, Brasil / Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT). Natal, RN, Brazil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Abstract
Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control. Methods: A national databank of cases reported in Brazil (2001–2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center
was used to determine factors associated with higher bacillary loads. Results: A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65–69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33–2.38; OR = 1.99, CI95% =
1.96–2.02, respectively). Bacillary load was higher in male and in patients aged 20–39 and 40–59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country. Conclusion: Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.
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