Abstract
BackgroundThe aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases.MethodologyData on new cases reported to the National Leprosy Registry between the years 2003–2018 were extracted. In absence of detailed travel history, cases were considered “autochthonous” or “imported” based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification.Principal findingsData were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast.ConclusionsAutochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of M. leprae is likely to have now effectively stopped in Spain.
Highlights
The aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases
There was a clear decline in incidence rates of autochthonous disease, and patterns consistent
Leprosy has been endemic in Spain for centuries, with four historical areas of high prevalence: the eastern Mediterranean coast, Andalucıa in the south, Galicia in the northwest, and the Canary Islands (Fig 1A)
Summary
Leprosy has been endemic in Spain for centuries, with four historical areas of high prevalence: the eastern Mediterranean coast (which includes the regions of Cataluña, Valencia and Murcia), Andalucıa in the south, Galicia in the northwest, and the Canary Islands (Fig 1A). Throughout the 19th century, the highest prevalence was found in the east coast, but this was surpassed by Andalucıa during the second half of the 20th century[1,2] It is unclear whether the higher prevalence in this region could be attributed to socioeconomic, environmental or other factors. During the second half of the 20th century, incidence rates steadily declined in Spain, paralleling an increase in national gross domestic product[3]. This decline preceded the initiation of short-course multiple drug therapy, in the early 1980s[1]. The prevalence during the year 2018 was 0.0036 cases per 10,000 persons, well below the World Health Organization (WHO) prevalence target for the “elimination of leprosy as a public health problem”[4]
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