Abstract
BackgroundLeprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin.MethodsLeprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes.ResultsOverall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01).ConclusionsThe disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.Graphical
Highlights
Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established
Founded in 1979 in the Brazilian Amazon basin, Alta Floresta had an urban area of 29.5 km2 and an estimated population of 51 615 inhabitants in 2018, of which 87% were living in the urban area across 69 census tracts
Epidemiological profile From 2016 to 2018, 304 new leprosy cases were identified in the municipality of Alta Floresta, including 266 (87.5%) in the urban area, of which 258 (96.9%) could be georeferenced
Summary
Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin. The Ministry of Health (MoH) manages specific programs to eliminate/control NTDs including leprosy. Mato Grosso state was historically classified as hyperendemic and remains the Brazilian state with the highest new case detection rate (NCDR). In 2019, Mato Grosso reported 129.3 cases per 100 000 inhabitants, almost 10 times more than the national NCDR, which stands at 13.2 per 100 000 inhabitants [2, 3]. All cases of leprosy are treated within the Unified Health System (Sistema Único de Saúde—SUS) with national coverage [4]
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