Abstract
ABSTRACTOBJECTIVE To describe the spatial patterns of leprosy in the Brazilian state of Tocantins.METHODS This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN – Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran’s indexes.RESULTS A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran’s index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins.CONCLUSIONS We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.
Highlights
Control of leprosy transmission is a difficult task in many countries, including Brazil
We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins
Surveillance and control measures should be prioritized in these high-risk municipalities
Summary
Control of leprosy transmission is a difficult task in many countries, including Brazil. In 2012, approximately 233,000 new cases were reported worldwide, and this large number has mobilized governments and institutions to prioritize improvement of control measures.[12,29] Seventeen percent of the total of leprosy cases in the world occur on the American continent; Brazil is responsible for 93.0% of these cases.[29] In Brazil, the spatial distribution of leprosy is heterogeneous. The Northern, Midwestern and Northeastern regions Brazil have a high burden of the disease.[2,22] Most highrisk districts are concentrated in states that are part of the Brazilian Amazon, a highly endemic area.[21,22]
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