Management Of Leprosy Research Articles

A retrospective cohort study of monthly rifampicin, ofloxacin and minocycline in the management of leprosy at the Hospital for Tropical Diseases, London, United Kingdom.

The World Health Organization (WHO) recommends rifampicin, dapsone and clofazimine multi-drug therapy (MDT) for the treatment of leprosy. Severe adverse effects include dapsone hypersensitivity syndrome, skin pigmentation, haemolytic anaemia, and hepatitis. At the Hospital for Tropical Diseases (HTD), London, United Kingdom monthly rifampicin, ofloxacin and minocycline (mROM) is used as first line treatment for leprosy. To determine the clinical outcomes and experiences of individuals treated with mROM. A retrospective study of individuals with leprosy who were prescribed mROM at HTD was conducted. Demographic and clinical data were collected on outcomes including relapses, leprosy reactions, bacterial index (BI) and adverse effects. Individuals were interviewed using a semi-structured questionnaire to understand their experiences of mROM. 29 individuals were identified and 20 interviewed. 26 (89.7%) individuals completed monthly mROM. 9 (31%) had switched from WHO MDT to mROM (five of whom (55.6%) were interviewed). BI reduced significantly following mROM treatment (p = 0.04). 17 individuals (58.6%) experienced a leprosy reaction. One of the 29 (3.4%) relapsed. The relapse rate was 9.5/1000 person years. 49 reports of adverse effects were either mild or moderate. The most frequent adverse effect (14/49) reported was orange discolouration of urine. No adverse effect required hospitalisation or discontinuation of mROM. Most individuals reported that skin lesions improved by the time they had completed mROM. In this small study in a non-endemic setting mROM was safe, effective and acceptable. mROM therapy is associated with improvement in skin lesions, decline in bacterial index and acceptable adverse effects. Larger, prospective, randomised studies are needed to determine whether relapse rates with mROM are equivalent or better than WHO MDT and to provide robust data on the seemingly better adverse effect profile of mROM.

Adverse effects of clofazimine in the management of leprosy. A systematic review

Adverse effects of clofazimine in the management of leprosy. A systematic review

Anti‑phenolic glycolipid‑I seropositivity among household contacts of leprosy patients in Egypt.

Leprosy is a chronic, debilitating disease lacking a definitive diagnostic biomarker. Serum anti-phenolic glycolipid-I (PGL-I) IgM antibody level is considered an important diagnostic and prognostic marker for leprosy patients. However, there is limited evidence on the role of anti-PGL-I IgM antibody level as early predictive biomarker of subclinical infection among Egyptian household contacts of leprosy patients. This study investigates the relationship between specific leprosy risk factors, diagnostic parameters of eighty-three leprosy cases, and serum anti-PGL-I IgM antibody levels in their corresponding household contacts. Our results demonstrate that anti-PGL-I IgM antibody level was significantly higher among contacts when more than four residents shared the same room with a leprosy case (p = 0.032). Additionally, anti-PGL-I IgM antibody level markedly increased in contacts of leprosy cases with disabilities (p = 0.001) or damaged nerves (p = 0.001). Our ROC curve analysis of anti-PGL-I antibody level as a predictor of exposure or infection among contacts revealed a cut-off value of 0.1, with a sensitivity of 75.0% and a specificity of 54.5%, indicating that most exposed household contacts are correctly identified. The overall accuracy of the ROC curve analysis was 72.3%, highlighting the practical utility of anti-PGL-I antibody level as a predictor for exposure or infection among household leprosy contacts. In conclusion, seropositivity of anti-PGL-I antibodies (> 0.1) among household leprosy contacts may be associated with a higher leprosy exposure risk. Continuous monitoring of anti-PGL-I antibody level in household leprosy contacts may potentially contribute to early detection and management of leprosy.

High-risk spatiotemporal patterns of leprosy in the southeastern region of Yunnan province from 2010 to 2022: an analysis at the township level

BackgroundDespite being preventable and curable, leprosy remains endemic in some undeveloped regions, including China. Wenshan Zhuang and Miao Autonomous Prefecture (Wenshan prefecture) currently bears the highest leprosy burden in China. In this ecological study, we aimed to analyze the epidemiological characteristics as well as identify and visualize the high-risk townships of Wenshan prefecture using the most updated leprosy data from 2010 to 2022.MethodsGeographical information system combined with spatial scan statistics was used for newly detected leprosy cases abstracted from the Leprosy Management Information System in China. Global Moran’s I index was used to uncover the spatial pattern of leprosy at the township level. Spatial scan statistics, encompassing purely temporal, purely spatial, spatial variation in temporal trends, and space-time analysis, were implemented for detecting the risk clusters.ResultsBetween 2010 and 2022, Wenshan prefecture detected 532 new leprosy cases, comprising 352 (66.17%) males and 180 (33.83%) females. The aggregated time primarily occurred between October 2010 and March 2014. The distribution pattern of newly detected leprosy cases was spatially clustered. We identified four high-risk spatial clusters encompassing 54.51% of the new cases. Furthermore, spatial variation in temporal trends highlighted one cluster as a potential high-risk area. Finally, two space-time clusters were detected, and the most likely cluster was predominantly located in the central and northwest regions of Wenshan prefecture, spanning from January 2010 to September 2013.ConclusionsIn this ecology study, we characterized the epidemiological features and temporal and spatial patterns of leprosy in Wenshan prefecture using the most recent leprosy data between 2010 and 2022. Our findings offer scientific insights into the epidemiological profiles and spatiotemporal dynamics of leprosy in Wenshan prefecture. Clinicians and policymakers should pay particular attention to the identified clusters for the prevention and control of leprosy.

Exploring the therapeutic and prophylactic potential of bedaquiline in leprosy.

Leprosy remains a significant public health concern despite major strides in treatment and control efforts. The Global Leprosy Strategy 2021-2030 and the National Strategic Plan for Leprosy 2023-2027 majorly focus on facilitating action to reach the goal of zero leprosy. Exploration of new treatment regimens is emphasized as one of the verticals of the multipronged approach for reaching the aforementioned goals. This becomes particularly pertinent in the wake of growing evidence for resistance to the drugs currently being used in the management of leprosy. Repurposed molecules present a very good approach in this direction. The present review aims to explore the potential of bedaquiline, a drug used for multidrug-resistant tuberculosis, as a potential addition to the therapeutic armamentarium of leprosy. Through this narrative review, the authors attempt to look into the available proof of concept, clinical evidence, potential risks, and possible ways forward with bedaquiline in leprosy.

Dapsone-induced haemolysis among leprosy patients on MDT from an endemic area of central India.

Haemolysis due to dapsone as a part of MDT in leprosy patients has been long recognized. However, the frequency and severity of this side effect and factors associated with it have not been well documented. We planned to determine the frequency of dapsone-induced haemolysis in leprosy patients on MDT and various risk factors associated with it. This was a hospital-based retrospective analysis, conducted on 36 treatment completed or partially treated or on treatment leprosy patients in a tertiary care centre in Chhattisgarh. Out of 36 patients, 83.3% showed a fall in haemoglobin from the baseline value (pre-treatment values). Dapsone was stopped in 33.3% of patients with a significant fall in haemoglobin. We found that the mean haemoglobin concentration for all patients fell from 13.05(+/-1.8) g/dl to 11.8(+/-1.9) g/dl (P < 0.05) which was statistically significant. A total of 25% of patients were labelled as confirmed cases of dapsone-induced haemolysis as per our definition. Our results underline the need to incorporate haematological investigations in leprosy management protocol, especially in primary care settings where the majority of leprosy patients are managed.

Leprosy in the Modern Age: clinical diagnosis and challenges in the 21st Century

The bacterium Mycobacterium leprae is the source of leprosy, also known as Hansen's disease, which is mainly transmitted through person-to-person contact and has a long incubation period of 2–6 years. The disease primarily affects the skin and peripheral nerves, often resulting in long-term disability and severe social stigma. The purpose of this review is to provide an up-to-date analysis of leprosy, focusing on recent discoveries in genetics, susceptibility factors, and carriers of the disease. These results have implications for patient outcomes and management of leprosy. Historical diagnostic and therapeutic efforts have focused primarily on adult leprosy, but pediatric leprosy remains understudied. This review aims to fill this gap by providing updated diagnostic and treatment recommendations for adults and children with leprosy. We summarize clinical, bacteriological, and immunological methods for diagnosing leprosy and also consider contemporary issues facing clinicians and patients, including their impact on migration and disease spread. Directions for future research are also highlighted, emphasizing the need for innovative approaches to diagnosis and treatment. As advances in knowledge continue to progress, renewed focus on the control, prevention, and eradication of leprosy is critical to improving global health outcomes.

History of leprosy in Mexico: from the 15th century to the21st century

Leprosy is an infectious disease transmitted by the bacterium Mycobacterium leprae. While it’s not a new disease, its incidence over time has changed, and in some places, it has been eradicated. However, in other areas, it is still considered a public health problem, and Mexico is one of them. Throughout global history, diagnostic, therapeutic, prevention, control, and surveillance strategies have been implemented to reduce its incidence. Currently, our country is attached to various national and international programs for managing this disease, aiming to reduce its prevalence and eventually eradicate it. Nevertheless, many socioeconomic factors have hindered the complete achievement of these goals, which have been modified but not entirely eliminated. The purpose of this review was to conduct a retrospective analysis of leprosy management in Mexico, aiming to present the current situation to raise awareness of the potential seriousness of this disease becoming a public health priority again. This review also seeks to promote new research to identify the cause of the recent increase in cases over the past year. It includes a historical breakdown of the epidemiological trends of this disease in the country, as well as the various therapeutic and diagnostic measures and their impact in the current context.

A Promising Nature Gift Acalypha hispida: A Review

Acalypha hispida is classified within the taxonomic family Euphorbiaceae. It is a tropical shrub and an annual plant that is colloquially referred to as the chenille plant or Red hot cat tail. The species under consideration is indigenous to the southern Pacific region, specifically the Malay Archipelago and many islands within the East Indies. The plant is frequently used as a decorative element in outdoor and indoor settings. Historically, the leaves have been recognized for their laxative and diuretic properties and employed in the therapeutic management of leprosy and gonorrhea. Various plant components are additionally employed in treating infectious diarrhea respiratory ailments and as an expectorant for asthma. A. hispida has been documented to possess many pharmacological properties, including anti-inflammatory, antioxidant, hypoglycemic, antimicrobial, antifungal, trypanocidal, and cytotoxic effects. The analysis of A. hispida provides a comprehensive overview of its pharmacological properties, chemical composition, biological effects, and toxicological investigation. This review presents a comprehensive overview of the research conducted on the plant, aiming to provide current and relevant information for future investigations.

Leprosy: Comprehensive insights into pathology, immunology, and cutting-edge treatment strategies, integrating nanoparticles and ethnomedicinal plants.

Mycobacterium leprae is the causative agent responsible for the chronic disease known as leprosy. This condition is characterized by dermal involvement, often leading to peripheral nerve damage, sensory-motor loss, and related abnormalities. Both innate and acquired immunological responses play a role in the disease, and even in individuals with lepromatous leprosy, there can be a transient increase in T cell immunity during lepromatous reactions. Diagnosing of early-stage leprosy poses significant challenges. In this context, nanoparticles have emerged as a promising avenue for addressing various crucial issues related to leprosy. These include combatting drug resistance, mitigating adverse effects of conventional medications, and enhancing targeted drug delivery. This review serves as a comprehensive compilation, encompassing aspects of pathology, immunology, and adverse effects of multidrug delivery systems in the context of leprosy treatment. Furthermore, the review underscores the significance of ethnomedicinal plants, bioactive secondary metabolites, and nanotherapeutics in the management of leprosy. It emphasizes the potential to bridge the gap between existing literature and ongoing research efforts, with a profound scope for validating traditional claims, developing herbal medicines, and formulating nanoscale drug delivery systems that are safe, effective, and widely accepted.

Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study.

Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.

Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: A protocol for a randomized double-blind, controlled Phase 2 trial in Indonesia (MetLep Trial).

The clinical management of leprosy is complicated by leprosy reactions (LR) causing irreversible nerve damage and disabilities. LR often require long-term use of corticosteroids causing serious side effects. Adjunct host-directed therapy (HDT) is a potentially attractive strategy in leprosy to prevent LR and associated immunopathology, modulate immunological memory that protects against recurrence, and thereby reduce nerve damage, disability and corticosteroid-associated morbidities. Metformin, a well-tolerated, safe and cheap anti-hyperglycaemic drug, is repurposed as HDT in auto-immune and infectious diseases, like tuberculosis (TB). Metformin use in people with diabetes is associated with reduced risks of TB-infection, progression to active TB, treatment failure and TB-mortality. Given the similarities both mycobacteria share, we hypothesize that among persons with multibacillary (MB) leprosy, adjunctive metformin may prevent/mitigate LR. We will perform a double-blind controlled proof-of-concept trial in which people with newly diagnosed multibacillary leprosy will be randomized (1:1) to metformin hydrochloride 1000mg extended release once daily versus placebo for 24 weeks in addition to standard-of-care WHO MB multidrug therapy (MDT) during 48 weeks. We aim to enrol 166 participants aged between 18 and 65 years, across five clinical sites in two leprosy endemic areas in Indonesia. Primary outcomes are the proportion of participants experiencing a LR and the frequency of (serious) adverse events. Secondary outcomes are the severity and time to first LR, the cumulative corticosteroid usage, and quality of life. The total study follow-up is 48 weeks. LR signify the most important cause of irreversible nerve damage leading to anatomical deformities and disabilities, imposing a social and financial burden on those affected. Our study aims to evaluate the efficacy, tolerability and safety of adjunct metformin added to MDT in persons with multibacillary leprosy, and explore its effects on clinical and immunological outcomes. NCT05243654 (17/02/2022).

Mức độ tàn tật ở bệnh nhân phong tại tỉnh Bình Thuận và một số yếu tố liên quan

Objectives: Determine the level of disability in leprosy patients in Binh Thuan province and some related factors. Methods: Cross-sectional study was conducted on 369 disabled leprosy patients in Binh Thuan province in 2022. Results: The rate of level 2 disability in leprosy patients is very high (90.5%) and there are many diverse types of disability. Education level is inversely proportional to the rate of level 2 disability; Patients with a low standard of living had a 1.25 times higher rate of level 2 disability (95% CI: 1.10 - 1.42). Stigma from family members increases the odds of disability by 1.16 times (95% CI: 1.08 - 1.24) and discrimination by people around increases the odds by 1.18 times (95% CI: 1.10 - 1.1 times). ,25). Inadequate knowledge of hand disability care is 1.43 times higher (95% CI: 1.18 - 1.74); Incorrect knowledge of foot disability care was 1.32 times higher (95% CI: 1.16 - 1.50). Conclusions: The rate of grade 2 disability in leprosy patients is high; Stigma from family members, the community, and low patient knowledge are factors related to grade 2 disability. Therefore, it is necessary to promote communication for families and the community to reduce stigma. for leprosy patients. Improve the consulting skills of commune-level leprosy specialists to care for, advise and improve knowledge of leprosy patients in disability care. Keywords: Leprosy disability, leprosy management, leprosy disability in Binh Thuan.

Leprosy Health Promotion during COVID-19 Pandemic in Indonesia

Introduction: The COVID-19 pandemic has forced many conventional -face-to-face health promotion events to be conducted in an adaptive manner to keep healthcare in promotion, prevention, and even curative measures delivered to healthcare providers and patients. The same applies to leprosy, where Indonesia is still ranked as the third largest country with leprosy burden. This study aims to give rise to newer methods of health promotion on leprosy during this COVID-19 pandemic. Methods: Online training and case presentation workshop in the form of a KATAMATAKU webinar [MOU1] and live streaming via YouTube were held in August 2020. There were 120 general practitioners, 30 nurses, and 35 healthcare providers who registered and joined this event.[MOU2] Pre- and post-test [MOU3] were conducted to evaluate the participants' knowledge about the topics lectured during this training[MOU4] . Pre- and post-test were conducted using an online form, and all participants needed to answer several questions from each session. Participants were evaluated before the webinar began and after all sessions. We assessed the different scores from the pre- and post-test. Results: In the general practitioner group, median scores were 68 (27 – 95) and 82 (50 – 100) for pre- and post-test scores, respectively, with a mean difference between post and pre-test of 14.23+9.72. In nurses and other health care providers, the median for the pre-test score was 56 (22-89), and the post-test was 72 (39 – 100), with a mean difference between the post and pre-test of 18.93+10.27. Conclusion: In the pandemic situation, online seminars can be chosen as an effective method for health promotion to increase health care provider's knowledge. Pre- and post-test can be performed to evaluate participant's knowledge after the training. Regular training using online methods can be held in order to maintain participants' knowledge. We hope it can impact all health providers to continue their participation in the management of leprosy.

Assessing Nerve Conduction Velocity as a Diagnostic and Prognostic Indicator in Leprosy Patients: A Cross-Sectional Study.

Introduction Hansen's disease is a condition in which patients develop peripheral neuropathy. In 1873, G. H. A. Hansen discovered Mycobacterium leprae, the causative agent of leprosy, a chronic infectious disease. These bacteria influence the peripheral nerves, which is likely to cause neuropathy. Sensory nerve conduction studies were performedin leprosy patients on the upper limb nerves of 30 patients in the rural area of the Wardha district in the Indian population. Methods In this study, we recruited 30 leprosy patients fromthe Department of Dermatology and A.V.B.R. Hospital, Sawangi Wardha. The patient's nerve conduction velocity (NCV) tests were carried out in the Department of Physiology at J. N. Medical College, Wardha. NCVs were obtained during these three years, beginning in 2009, while performing sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV). The latency, amplitude, and NCV parameters were recorded, and the data collection period ended in 2011. In this study, we measured both MNCVand SNCV. Results In our study, impairment of conductional velocity was observed. In leprosy patients, the MNCV values of latency, amplitude, and conductional velocity were 6.61, 3.89, and 46.92 m/s, respectively, whereas the SNCV values were 3.005, 25.17, and 38 m/s, respectively. Based on the results, it appears that the maximal sensory nerve involvement was recorded at 38 m/s conductional velocity.In NCVs, increased latency and decreased conductional velocity were found across the study. Conclusion It was concluded that nerve conduction studies are one of the non-invasive techniques for early diagnosis and management of leprosy. This study should be repeated with a larger sample size and should be multicentric.

Target product profiles: leprosy diagnostics.

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention.

The Burden of Leprosy Reaction in the Post-Elimination Era: A Study from Gresik City, Indonesia

Background: The attention of leprosy management has shifted to reduce the burden of leprosy complications, including leprosy reactions. Leprosy reaction is the predominant cause of nerve impairment that leads to disability and lowers the quality of life of the affected. Purpose: The aim of this study was to provide primary data about leprosy reaction epidemiology, risk factor, and outcomes in the post-elimination era. Methods: A cross-sectional study was held in a general hospital in Gresik City, Indonesia, to give clinical demography, risk factors, and outcomes of leprosy reaction. Result: New leprosy reaction cases remain detected each year. There were 57 (58.8%) out of 97 leprosy patients who had a reactional episode. The incidence of leprosy reactions has been increasing in the last three years. The multibacillary (MB) group and type 2 reactions dominated leprosy reactions, which mostly occurred in the young adult population. Some of the leprosy reaction patients had developed a complication due to prolonged steroid usage. Conclusion: Leprosy cases in a young population with a high risk of developing reaction episodes need collaboration in the management to prevent deformity in youth.

A retrospective clinico epidemiological study of leprosy cases treated at tertiary care hospital Tirupur

Leprosy is a chronic communicable disease caused by Mycobacterium Leprae. The disease mainly affects the skin, peripheral nerves, mucosal surfaces of the upper respiratory tract, and eyes. Aim is to describe the clinical-epidemiological profile, and type of MDT given for leprosy cases treated at tertiary care hospital Tirupur. A Retrospective study was done by obtaining records of all leprosy patients from the OP Leprosy registration card for a duration of one year from April 2021 – March 2022 were included in the study. The details of patients such as clinical and epidemiological profile were noted and descriptive analysis was done. During the study period, 35 cases of leprosy were included in the study. Majority of the cases were in age group 18 – 45 years. Male female sex ratio was found to be 2.5:1 and no childhood leprosy was recorded. Lepromatous leprosy was the most common type noted in this study. MB MDT was given in most patients. Grade 1 disability was recorded highly than grade 2. Type 1 reaction was found to be more and majority of the cases were noted in local group compared to migratory group. The present study provides an insight into the disease burden as well as the effectiveness of the health-related services at a tertiary care hospital, Tirupur. The study also highlights the early diagnosis and management of leprosy and the importance of the surveillance activity, thereby minimizing the risks of leprosy in Tirupur.

Type II Reaction Erythema Nodosum Leprosum: A Case Report

Leprosy, or Hansen's disease, is a chronic granulomatous infectious disease caused by Mycobacterium leprae. This is a case of a 25-year-old male from Micronesia who presented to a hospital in the Midwest with a two-week history of a widespread, nodular, erythematous, painful rash most severe on his lower extremities and sparing only his hands and feet. In addition to the cutaneous manifestations, the patient met the criteria for Systemic Inflammatory Response Syndrome (SIRS) due to his presentation of tachycardia, tachypnea, leukocytosis, and elevated inflammatory markers. A short course of antibiotics, including Piperacillin-Tazobactam and Vancomycin, and IV steroids were started on admission. A skin biopsy taken from the center and edge of a lesion on the patient’s right arm demonstrated acute and chronic granulomatous superficial and deep inflammation with abundant acid-fast bacilli consistent with lepromatous leprosy from a Mycobacterium leprae infection. Once the National Hansen's Disease Center was contacted previous therapies were stopped and a multidrug therapy, consisting of Rifampin, Moxifloxacin, Minocycline, Methotrexate, and Prednisone was started. The multidrug therapy promptly resulting in substantial clinical improvement over the subsequent months. This case emphasizes the significance of early recognition, accurate diagnosis, and timely initiation of appropriate treatment in leprosy management, even in unlikely regions such as the Midwestern United States.

Spatiotemporal pattern of leprosy in southwest China from 2010 to 2020: an ecological study

BackgroundDespite many efforts to control leprosy worldwide, it is still a significant public health problem in low- and middle-income regions. It has been endemic in China for thousands of years, and southwest China has the highest leprosy burden in the country.MethodsThis observational study was conducted with all newly detected leprosy cases in southwest China from 2010 to 2020. Data were extracted from the Leprosy Management Information System (LEPMIS) database in China. The Joinpoint model was used to determine the time trends in the study area. Spatial autocorrelation statistics was performed to understand spatial distribution of leprosy cases. Spatial scan statistics was applied to identify significant clusters with high rate.ResultsA total of 4801 newly detected leprosy cases were reported in southwest China over 11 years. The temporal trends declined stably. The new case detection rate (NCDR) dropped from 4.38/1,000,000 population in 2010 to 1.25/1,000,000 population in 2020, with an average decrease of 12.24% (95% CI: −14.0 to − 10.5; P < 0.001). Results of global spatial autocorrelation showed that leprosy cases presented clustering distribution in the study area. Most likely clusters were identified during the study period and were frequently located at Yunnan or the border areas between Yunnan and Guizhou Provinces. Secondary clusters were always located in the western counties, the border areas between Yunnan and Sichuan Provinces.ConclusionsGeographic regions characterized by clusters with high rates were considered as leprosy high-risk areas. The findings of this study could be used to design leprosy control measures and provide indications to strengthen the surveillance of high-risk areas. These areas should be prioritized in the allocation of resources.