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LEPROSY AMONG SCHOOLCHILDREN IN THE AMAZON REGION: A CROSS-SECTIONAL STUDY OF ACTIVE SEARCH AND POSSIBLE SOURCE OF INFECTION BY CONTACT TRACING
Schoolchildren
Brazil
Medical risk factors
Human families
Lesions
Schools
Mycobacterium leprae
Author summary: Leprosy is a disease that has long since been eradicated in the developed world, but it still affects poor people in developing countries, such as India, Brazil, and Indonesia. Because the causative agent of the disease may involve the skin and peripheral nerves, the disease can cause physical disabilities and deformities. Although leprosy affects all ages, children under 15 years of age are an important epidemiological marker because infection in that age group indicates active transmission within the community. In our work, we examined 34,547 children from public schools in Manaus, a city in the north of Brazil. In this population, we found 40 new cases of leprosy that were further confirmed by clinical and laboratorial tests. We also examined 196 people who had familiar or close non-familiar contact with the affected children. Among them, we identified the possible source of infection of 21 affected children and found seven new cases of leprosy. Overall, our findings revealed a detection rate of leprosy cases that was 17 times higher than the registered number. This indicates the necessity of identifying active cases of leprosy in order to improve case detection and effectively control the disease.
Autor
Afiliación
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Facultad de Medicina Calixto García. Departamento de Epidemiologia. La Habana, Cuba.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil / Universidade do Estado do Amazonas. Escola de Ciências da Saúde. Manaus, AM, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil / Universidade do Estado do Amazonas. Escola de Ciências da Saúde. Manaus, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Facultad de Medicina Calixto García. Departamento de Epidemiologia. La Habana, Cuba.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil / Universidade do Estado do Amazonas. Escola de Ciências da Saúde. Manaus, AM, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hanseníase. Rio de Janeiro, RJ, Brasil.
Fundação Alfredo da Matta. Departamento de Ensino e Pesquisa. Manuas, AM, Brasil / Universidade do Estado do Amazonas. Escola de Ciências da Saúde. Manaus, AM, Brasil.
Resumen en ingles
Background: The high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing. Methodology/Principal findings: This was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children’s cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate. Conclusions/Significance: This study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization’s goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease’s transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.
Palabras clave en ingles
LeprosySchoolchildren
Brazil
Medical risk factors
Human families
Lesions
Schools
Mycobacterium leprae
Editor
Public Library of Science
Referencia
PEDROSA, Valderiza Lourenço et al. Leprosy among schoolchildren in the Amazon region: a cross-sectional study of active search and possible source of infection by contact tracing. PLoS Neglected Tropical Diseases, v. 12, n. 2, p. 1-12, 26 Feb. 2018.DOI
10.1371/journal.pntd.0006261ISSN
1935-2727Notas
Produção científica do Laboratório de Hanseníase.Author summary: Leprosy is a disease that has long since been eradicated in the developed world, but it still affects poor people in developing countries, such as India, Brazil, and Indonesia. Because the causative agent of the disease may involve the skin and peripheral nerves, the disease can cause physical disabilities and deformities. Although leprosy affects all ages, children under 15 years of age are an important epidemiological marker because infection in that age group indicates active transmission within the community. In our work, we examined 34,547 children from public schools in Manaus, a city in the north of Brazil. In this population, we found 40 new cases of leprosy that were further confirmed by clinical and laboratorial tests. We also examined 196 people who had familiar or close non-familiar contact with the affected children. Among them, we identified the possible source of infection of 21 affected children and found seven new cases of leprosy. Overall, our findings revealed a detection rate of leprosy cases that was 17 times higher than the registered number. This indicates the necessity of identifying active cases of leprosy in order to improve case detection and effectively control the disease.
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