Abstract
OBJECTIVESShow that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations.METHODSThe study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA).RESULTSFrom July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases.CONCLUSIONSDuring the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.
Highlights
The new case detection rate (NCDR) was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil
19 states, that is around 50% of the population, are exposed to an endemic pattern ranging from high to hyperendemic (SINAN 2017)
According to some authors (Barbieri et al 2016, Salgado et al 2016), the true number of leprosy cases in the world in endemic countries is unknown, but is generally thought to be between 6-8 fold higher than the reported number of new cases (Kumar et al 2007, Moet et al 2008, Basel et al 2014)
Summary
Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations
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