Hyperendemicity, heterogeneity and spatial overlap of leprosy and cutaneous leishmaniasis in the southern Amazon region of Brazil

Neglected tropical diseases characterized by skin lesions are highly endemic in the state of Mato Grosso, Brazil. We analyzed the spatial distribution of leprosy and Cutaneous Leishmaniasis (CL) and identified the degree of overlap in their distribution. All new cases of leprosy and CL reported between 2008 and 2017 through the national reporting system were included in the study. Scan statistics together with univariate Global and Local Moran's I were employed to identify clusters and spatial autocorrelation for each disease, with the spatial correlation between leprosy and CL measured by bivariate Global and Local Moran's I. Finally, we evaluated the demographic characteristics of the patients. The number of leprosy (N = 28,204) and CL (N = 24,771) cases in Mato Grosso and the highly smoothed detection coefficients indicated hyperendemicity and spatial distribution heterogeneity. Scan statistics demonstrated overlap of high-risk clusters for leprosy (RR = 2.0; P <0.001) and CL (RR = 4.0; P <0.001) in the North and Northeast mesoregions. Global Moran's I revealed a spatial autocorrelation for leprosy (0.228; P = 0.001) and CL (0.311; P = 0.001) and a correlation between them (0.164; P = 0.001). Both diseases were found to be concentrated in urban areas among men aged 31-60 years, of brown-skinned ethnicity and with a low educational level. Our findings indicate a need for developing integrated and spatially as well as socio-demographically targeted public health policies

Minimal essential data to document contact tracing and single dose rifampicin (SDR) for leprosy control in routine settings

In leprosy control there is a renewed interest in active case finding, which is increasingly being combined with chemoprophylactic interventions to try and reduce M. leprae transmission. The Leprosy Post-Exposure Prophylaxis (LPEP) programme, currently ongoing in eight endemic countries, pilots the provision of single-dose rifampicin (SDR) to eligible contacts of leprosy patients. LPEP has developed a surveillance system including data collection, reporting and regular monitoring for every participating country. This system is still largely programmespecific to LPEP. To facilitate continuity after completion of the project phase and start-up in other interested countries, we aim at identifying the minimal set of data required to appropriately document contact tracing activities and SDR administration for leprosy control in a routine setting. We describe four indicators for the index case (plus four already routinely collected) and seven indicators for household/neighbour screening, and community surveys. We propose two generic forms to capture all relevant information required at field and district level to follow-up on individuals or data if needed, provide gu

Leprosy post-exposure prophylaxis with single-dose rifampicin

_Objective:_ Leprosy post-exposure prophylaxis with single-dose rifampicin (SDRPEP) has proven effective and feasible, and is recommended by WHO since 2018. This SDR-PEP toolkit was developed through the experience of the leprosy postexposure prophylaxis (LPEP) programme. It has been designed to facilitate and standardise the implementation of contact tracing and SDR-PEP administration in regions and countries that start the intervention. _Results:_ Four tools were developed, incorporating the current evidence for SDRPEP and the methods and learnings from the LPEP project in eight countries. (1) th

Single lesion as an indicator to monitor the leprosy trend to elimination in hyperendemic areas Lesão única como indicador de monitoramento de tendência de eliminação da hanseníase em áreas hiperendêmicas

INTRODUCTION: Prevalence and detection rates of leprosy are not sufficient to show the real magnitude of changes in epidemiological patterns. OBJECTIVES: Evaluate the feasibility and usefulness of the proportion of new leprosy patients with a single skin lesion (SSL) as a potential indicator of the elimination of leprosy. METHODS: We conducted a retrospective study based on secondary data analyzing newly reported cases of leprosy between 1997 and 2002, in the city of Palmas, Tocantins, Brazil. Patients with a single lesion were compared to remaining patients, and the odds ratio was used as measure of association. RESULTS: Out of the 1,303 new cases of leprosy, 481 (36.9%) had a SSL. An increasing time-trend was observed in the proportion of new cases detected with a single lesion, which grew from 20.3% in 1999 to 49.1% in 2002 (linear trend p<.001) while a reduction in the number of new cases was observed simultaneously after 1999. The proportion of patients with a single lesion was higher in women, young age, paucibacillary, tuberculoid and indeterminate clinical forms, residents of urban areas, those with negative baciloscopy, with macular lesions, without physical disabilities, and mainly detected in primary health care units. CONCLUSIONS: These findings confirm that the proportion of patients with a SSL can be used as a sensitive and feasible indicator to assess the progress of the elimination of leprosy in hyperendemic areas.<br>INTRODUÇÃO: As taxas de detecção e prevalência de hanseníase não são suficientes para mostrar a real magnitude de mudanças nos padrões epidemiológicos da doença. OBJETIVOS: Avaliar a aplicabilidade e utilidade da medida de proporção de casos de hanseníase com lesão única de pele como potencial indicador de avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas. METODOLOGIA: Estudo retrospectivo baseado na análise de dados secundários de casos novos de hanseníase notificados entre 1997 e 2002 na cidade de Palmas, estado de Tocantins, Brasil. Os registros de pacientes com lesão única foram comparados àqueles registrados com mais de uma lesão. Odds ratio foi utilizado como medida de associação. RESULTADOS: De um total de 1.303 casos novos de hanseníase notificados, 481 (36,9%) apresentavam lesão única de pele. Verificou-se tendência de incremento na proporção de casos de casos novos diagnosticados com lesão única variando de 20,3% em 1999 para 49,1% em 2002 (p < 0,001), simultaneamente à redução do registro de número de casos novos após 1999. Maior proporção de pacientes com lesão única de pele foi verificada em pacientes do sexo feminino, menores de 15 anos, paucibacilares nas formas clínicas tuberculóide e indeterminada, com baciloscopia negativa, com lesões do tipo mácula, sem incapacidades físicas e diagnosticados em unidades básicas de saúde. CONCLUSÕES: Os resultados confirmam que a proporção de pacientes com lesão única de pele pode ser utilizada como indicador na avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas