Características epidemiológicas de la hanseniasis en ancianos y comparación con otros grupos etarios, Brasil (2016-2018)

O objetivo foi descrever indicadores epidemiológicos e características dos casos novos de hanseníase em idosos no Brasil, no triênio 2016-2018, comparando a outros grupos etários. Estudo descritivo de corte transversal com dados do Sistema de Informação de Agravos de Notificação (SINAN). Os casos novos de hanseníase foram categorizados por grupos etários: 60 ou mais, 40-59, 15-39 e menores de 15 anos. Utilizou-se o teste qui-quadrado de Pearson para testar diferenças entre grupos. Foram notificados 81.205 casos novos de hanseníase no Brasil. Desses, 24,1% foram em idosos, 37,7% de 40-59 anos, 31,9% de 15-39 e 6,3% em menores de 15 anos. Nos idosos, foram observadas proporções maiores (p < 0,001) de casos no sexo masculino (60,1%), com classificação operacional multibacilar (81,3%) e com grau 2 de incapacidade física (GIF2) (11,4%) em relação aos outros grupos. Contudo, a proporção de casos novos detectados em idosos, por exame de contatos (4,9%), foi a menor entre todas as faixas etárias (p < 0,001). As taxas médias de detecção e de casos novos com GIF2 no diagnóstico foram maiores entre idosos (25,1/100 mil e 28,6/1 milhão de habitantes, respectivamente) em comparação aos demais grupos etários, para o país, regiões e Unidades da Federação. Foram observadas importantes diferenças nos perfis epidemiológico e clínico da hanseníase nos idosos, em relação às demais faixas etárias, destacando-se maiores proporções de casos multibacilares, de casos novos com GIF2 e baixa detecção por exame de contatos. Evidencia-se a necessidade do controle da hanseníase nessa população, visando a contribuir para a interrupção da transmissão da doença.The article aimed to describe epidemiological indicators and characteristics of new cases of leprosy in elderly Brazilians in 2016-2018, compared to other age groups. A descriptive cross-sectional cohort study was conducted with data from the Information System on Diseases of Notification (SINAN). New leprosy cases were categorized by age groups: 60 or more, 40-59, 15-39, and 15 years of age. Pearson’s chi-square test was used to verify differences between groups. A total of 81,205 new leprosy cases were reported in Brazil. Of these, 24.1% were elderly, 37.7% from 40-59 years, 31.9% from 15-39 years, and 6.3% in individuals under 15 years of age. The elderly showed higher proportions (p < 0.001) of cases in males (60.1%), with multibacillary classification (81.3%), and with physical disability grade 2 (PDG2) (11.4%) when compared to the other groups. However, the proportion of new cases detected in the elderly based on contact testing (4.9%) was the lowest among all the age brackets (p < 0.001). The mean detection rate and rate of new cases with PDG2 at diagnosis were higher among the elderly (25.1/100,000 and 28.6/million inhabitants, respectively) compared to other age groups in Brazil as a whole and in the regions and states. Important differences were seen in the epidemiological and clinical profile of leprosy in the elderly compared to other age brackets, especially higher proportions of multibacillary cases, new cases with PDG2, and low detection by contact testing. The findings highlighted the need for leprosy control in this age group, aimed at contributing to interruption of transmission of the disease.El objetivo fue describir indicadores epidemiológicos y características de los nuevos casos de hanseniasis en ancianos en Brasil, durante el trienio 2016-2018, comparándolos con otros grupos etarios. Se realizó un estudio descriptivo de corte transversal con datos del Sistema de Información sobre Enfermedades de Notificación obligatoria (Sinan). Los nuevos casos de hanseniasis fueron categorizados por grupos etarios: 60 o más, 40-59, 15-39 y menores de 15 años. Se utilizó el test chi-cuadrado de Pearson para probar diferencias entre grupos. Se notificaron 81.205 casos nuevos de hanseniasis en Brasil. De estos, un 24,1% fueron en ancianos, 37,7% de 40-59 anos, 31,9% de 15-39 años y 6,3% en menores de 15 años. En los ancianos, se observaron proporciones mayores (p < 0,001) de casos del sexo masculino (60,1%), con clasificación operacional multibacilar (81,3%) y con grado 2 de incapacidad física (GIF2) (11,4%), respecto a otros grupos. No obstante, la proporción de casos nuevos detectados en ancianos, por examen de contactos (4,9%), fue la menor entre todas las franjas de edad (p < 0,001). Las tasas medias de detección y de casos nuevos con GIF2 en el diagnóstico fueron mayores entre ancianos (25,1/100.000 y 28,6/1 millón de habitantes, respectivamente), en comparación con los demás grupos etarios, respecto al país, regiones y Unidades de la Federación. Se observaron importantes diferencias en el perfil epidemiológico y clínico de la hanseniasis en ancianos, en relación con las demás franjas de edad, destacándose mayores proporciones de casos multibacilares, de casos nuevos con GIF2 y baja detección por examen de contactos. Se evidencia la necesidad del control de la hanseniasis en esa población, con el fin de contribuir a la interrupción de la transmisión de la enfermedad

Distribuição espacial da hanseníase no município de Mossoró/RN, utilizando o Sistema de Informação Geográfica - SIG Spatial Distribuition of hansen disease in the municipality of Mossoró/RN, using the Geographic Infromation System - (GIS)

FUNDAMENTOS/OBJETIVO: O município de Mossoró, no Estado do Rio Grande do Norte, tem um elevado coeficiente de detecção de hanseníase, que passou de 2,78 em 1998 para 5,08 casos novos por 10.000 habitantes em 2002. O registro de casos vem ocorrendo em toda a zona urbana, porém com maior concentração em alguns bairros. Esse trabalho foi realizado utilizando-se o Sistema de Informações Geográficas (SIG) com o objetivo de determinar a localização espacial da doença, buscando um melhor entendimento da endemia no município. MATERIAL E MÉTODOS/CASUÍSTICA: O estudo foi realizado na área urbana de Mossoró e utilizou como bases cartográficas o mapa cadastral da cidade e imagem de satélite Ikonos, além do banco de dados do SINAN (Sistema de Informação de Agravos de Notificação). Foram selecionados 358 casos novos da doença diagnosticados entre 1998 e 2002 para georreferenciamento dos seus endereços usando-se um aparelho GPS (Magellan 320). A análise geográfica foi feita através do ArcView 9.0. RESULTADOS/DISCUSSÃO: Foram localizados os endereços de 281 pacientes (78,5% do total) com grande concentração nos bairros de Barrocas, Santo Antônio, Bom Jardim e Paredões. O mapeamento serviu de base para a realização de campanha para diagnóstico, especialmente direcionada para áreas mais endêmicas, levando ao diagnóstico de 30 casos novos da doença em apenas uma semana (ou 27% de todos os casos novos do município em 2004). CONCLUSÃO: O uso do SIG na hanseníase se mostrou extremamente eficaz, proporcionando o entendimento espacial da distribuição da doença no município e direcionando a execução de ações de controle com importante redução de custos.BACKGROUND / OBJECTIVES: The Municipality of Mossoró, in Rio Grande do Norte State in Brazil, has a high incidence of Hansen's disease (HD). New case detection rate has increased from 2.78 in 1998 to 5.08 new cases per 10.000 population in 2002. New patients have been registered in all urban zones but there is concentration in some areas. This study used Geographic Information Systems (GIS) to determine the spatial localization of HD cases, trying to get a better understanding of epidemiological aspects at the municipal level. MATERIAL AND METHODS: The study was carried out in the urban area of Mossoró and used as its cartographic base the standard map of the city and images from Ikonos Satellite, and SINAN Database (Sistema de Informação de Agravos de Notificação). The addresses of 358 new cases diagnosed from 1998 to 2002 were selected to be geo-referenced using a GPS hand held device (Magellan 320). Geographic analysis was done using ArcView 9.0. RESULTS: 281 addresses (78.5% of the total) were localized showing high concentration of cases in Barrocas, Santo Antônio, Bom Jardim e Paredões neighborhoods. The maps were used to choose an endemic area where a case detection campaign was carried out and had the positive outcome of 30 new cases of HD detected in only one week (equivalent of 27% of all new cases detected in 2004). CONCLUSION: The use of GIS in HD proved to be extremely efficient, revealing the spatial pattern of case distribution and guiding the execution of activities with important cost reduction

Geographic Information Systems and Applied Spatial Statistics Are Efficient Tools to Study Hansen's Disease (Leprosy) and to Determine Areas of Greater Risk of Disease

Applied Spatial Statistics used in conjunction with geographic information systems (GIS) provide an efficient tool for the surveillance of diseases. Here, using these tools we analyzed the spatial distribution of Hansen's disease in an endemic area in Brazil. A sample of 808 selected from a universe of 1,293 cases was geocoded in Mossoró, Rio Grande do Norte, Brazil. Hansen's disease cases were not distributed randomly within the neighborhoods, with higher detection rates found in more populated districts. Cluster analysis identified two areas of high risk, one with a relative risk of 5.9 (P = 0.001) and the other 6.5 (P = 0.001). A significant relationship between the geographic distribution of disease and the social economic variables indicative of poverty was observed. Our study shows that the combination of GIS and spatial analysis can identify clustering of transmissible disease, such as Hansen's disease, pointing to areas where intervention efforts can be targeted to control disease

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy.

BackgroundThe occurrence of adverse drug events (ADEs) during dapsone (DDS) treatment in patients with leprosy can constitute a significant barrier to the successful completion of the standardized therapeutic regimen for this disease. Well-known DDS-ADEs are hemolytic anemia, methemoglobinemia, hepatotoxicity, agranulocytosis, and hypersensitivity reactions. Identifying risk factors for ADEs before starting World Health Organization recommended standard multidrug therapy (WHO/MDT) can guide therapeutic planning for the patient. The objective of this study was to develop a predictive model for DDS-ADEs in patients with leprosy receiving standard WHO/MDT.MethodologyThis is a case-control study that involved the review of medical records of adult (≥18 years) patients registered at a Leprosy Reference Center in Rio de Janeiro, Brazil. The cohort included individuals that received standard WHO/MDT between January 2000 to December 2021. A prediction nomogram was developed by means of multivariable logistic regression (LR) using variables. The Hosmer-Lemeshow test was used to determine the model fit. Odds ratios (ORs) and their respective 95% confidence intervals (CIs) were estimated. The predictive ability of the LRM was assessed by the area under the receiver operating characteristic curve (AUC).ResultsA total of 329 medical records were assessed, comprising 120 cases and 209 controls. Based on the final LRM analysis, female sex (OR = 3.61; 95% CI: 2.03-6.59), multibacillary classification (OR = 2.5; 95% CI: 1.39-4.66), and higher education level (completed primary education) (OR = 1.97; 95% CI: 1.14-3.47) were considered factors to predict ADEs that caused standard WHO/MDT discontinuation. The prediction model developed had an AUC of 0.7208, that is 72% capable of predicting DDS-ADEs.ConclusionWe propose a clinical model that could become a helpful tool for physicians in predicting ADEs in DDS-treated leprosy patients

Other registered comorbidities of 329 leprosy patients treated at Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil between 2000–2021.

Other registered comorbidities of 329 leprosy patients treated at Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil between 2000–2021.</p

Adverse drug events associated with dapsone among 120 patients with leprosy who were treated at the Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil, between January 2000 and December 2021.

Adverse drug events associated with dapsone among 120 patients with leprosy who were treated at the Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil, between January 2000 and December 2021.</p

Sociodemographic, clinical and laboratorial characteristics of 329 patients with leprosy who were treated at the Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil, between January 2000 and December 2021.

Sociodemographic, clinical and laboratorial characteristics of 329 patients with leprosy who were treated at the Souza Araujo outpatient clinic (ASA), Rio de Janeiro, Brazil, between January 2000 and December 2021.</p

Final logistic regression model after backward elimination.

Final logistic regression model after backward elimination.</p