Os indicadores da hanseníase e as estratégias de eliminação da doença, em município endêmico do Estado do Rio de Janeiro, Brasil The impact of leprosy elimination strategy on an endemic municipality in Rio de Janeiro State, Brazil

As estratégias de controle da hanseníase no mundo vêm sofrendo mudanças na última década, com finalidade de alcançar a meta de eliminação da doença recomendada pela Organização Mundial da Saúde. Atualmente, países mais endêmicos ainda encontram dificuldades de atingir essa meta. O objetivo deste estudo foi descrever as estratégias de eliminação realizadas em Duque de Caxias, município do Estado do Rio de Janeiro, Brasil, com alta endemicidade, e analisar os principais indicadores epidemiológicos e operacionais da doença e sua tendência evolutiva nos últimos 14 anos, a partir do banco de dados oficial de notificação: Sistema de Informação de Agravos de Notificação (SINAN). Estratégias como descentralização do atendimento ao paciente e campanhas localizadas foram associadas ao aumento da detecção de casos mais precoces, e à redução da taxa de prevalência e do tempo de permanência dos pacientes no registro ativo. Um incremento na taxa de detecção anual pode estar relacionado à existência de prevalência oculta ou de indivíduos com infecção assintomática. Novas estratégias complementares necessitam ser formuladas para o alcance da eliminação da doença no município.<br>Various strategies for eliminating leprosy as a public health problem have evolved in the last 20 years. In some countries, especially highly endemic ones, the WHO target rate for leprosy elimination fell far short. The current study aimed to analyze the impact of different strategies for reducing leprosy prevalence in Duque de Caxias, a highly endemic municipality in Rio de Janeiro State, Brazil. The study observed the evolution of traditional operational indicators for the disease and their trends in the last 14 years. The indicators were calculated using the National Communicable Diseases Database (SINAN). Strategies that focused on decentralization of patient care and/or localized campaigns were associated with earlier case detection, reduction in prevalence, and shorter patient time in the active registry. An increase in the annual detection rate could be related to the existence of hidden prevalence or individuals with asymptomatic infection. New complementary strategies are needed to eliminate the disease in Duque de Caxias

Cross-talk between CD8(+) and CD4(+) T cells in experimental cutaneous leishmaniasis: CD8(+) T cells are required for optimal IFN-gamma production by CD4(+) T cells.

Although the importance of CD8(+) T cells for vaccination and immunity to reinfection with Leishmania parasites is well established, their role in primary infections is disputed. In the present study we further characterized the role of CD8(+) T cells in primary L. major infections. We used two groups of L. major infected BALB/c mice: both groups were immunomanipulated to heal and in one group CD8(+) T cells were depleted throughout the course of infection. Our results show that the reversal of healing caused by the absence of CD8(+) T cells did not alter the proliferation of CD4(+) T cells, however, the frequency of CD4(+) T cells expressing IFN-gamma as well as the levels of this cytokine were clearly reduced. These lower levels of IFN-gamma correlated with a higher parasite load. Our results show that transient depletion of CD4(+) T cells allows the establishment of an equilibrium between CD4(+) and CD8(+) T cells and allows CD8(+) T cell activation and effector functions to develop. In addition, our results suggest that cross-talk between CD4(+) and CD8(+) T cells is crucial for the host defence against L. major