Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil

Autor: Marco Andrey Cipriani Frade, Marcel Nani Leite, Ana Laura Rosifini Alves Rezende, Natália Aparecida de Paula, Norma Tiraboschi Foss, Fred Bernardes Filho, Glauber Voltan, Claudia Maria Lincoln Silva, Josafá Gonçalves Barreto
Rok vydání: 2021
Předmět:
Male
Bacterial Diseases
Epidemiology
RC955-962
Disease
EDUCAÇÃO EM SAÚDE
Geographical locations
Serology
030207 dermatology & venereal diseases
Medical Conditions
0302 clinical medicine
Surveys and Questionnaires
Arctic medicine. Tropical medicine
Prevalence
Medicine and Health Sciences
Medicine
Aged
80 and over
Community Health Workers
Spatial epidemiology
Middle Aged
Mycobacterium leprae
Infectious Diseases
Health Education and Awareness
Community health
Female
Leprosy
Public aspects of medicine
RA1-1270
Brazil
Research Article
Neglected Tropical Diseases
Adult
Adolescent
030231 tropical medicine
Primary care
Disease Surveillance
03 medical and health sciences
Signs and Symptoms
Humans
Primary Care
Aged
business.industry
Public Health
Environmental and Occupational Health
South America
Tropical Diseases
medicine.disease
Health Care
Medical Risk Factors
Relative risk
Lesions
Implementation research
People and places
Clinical Medicine
business
Demography
Zdroj: PLoS Neglected Tropical Diseases, Vol 15, Iss 6, p e0009495 (2021)
PLoS Neglected Tropical Diseases
Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
ISSN: 1935-2735
DOI: 10.1371/journal.pntd.0009495
Popis: Background This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. Methodology/Principal findings Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. Conclusions/Significance Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.
Author summary The prevalence of leprosy in the world and in Brazil is unknown. Although Brazil has effective disease notification systems, the data do not capture reality in the field, due to decreasing leprosy awareness, both in the community and among health professionals. Schools have decreased or stopped teaching about the disease, likely as a result of a massive campaign to eliminate leprosy as a public health problem around the world that focused almost exclusively on dermatological manifestations. The disease is primarily neural, affects mainly the reproductive-age population, and can generate disabilities leading to serious economic impacts on the individual and society. Despite modern diagnostic approaches, diagnosis of leprosy is still focused on clinical observation, given the scarcity of laboratory tests with good performance in terms of sensitivity and specificity. This makes leprosy diagnosis a challenge, especially for mild forms; Mycobacterium leprae can grow slowly and interact variably with the host, making leprosy as a highly complex disease. Only when the leprosy care policy in Jardinópolis municipality, São Paulo state inner, Brazil, was changed to hire a leprosy specialist for surveillance, was it possible to modify leprosy indicators revealing the hidden epidemic in the municipality. This study confirms hidden endemic leprosy in the municipality and informs implementation strategies for primary health teams using the Leprosy Suspicion Questionnaire (LSQ) on symptoms and signs of leprosy. LSQ is a low-cost, highly effective instrument to promote leprosy health education among community health agents and other health team workers, and among communities about the neurological symptoms that precede dermatological leprosy signs. This technique increases the likelihood of early diagnosis and treatment, avoiding disabilities, and consequently effectively halting disease transmission. The LSQ is an effective, low-cost screening tool for detecting new leprosy cases and increasing awareness of leprosy. The LSQ alerts community members and health professionals to detect even mild symptoms/signs of leprosy, a primarily neurological disease. Our data also demonstrate the importance of the leprosy specialist role to train and to supervise health teams to investigate incidence in communities that have long been established as nonendemic. The assumption of nonendemicity can and should change, due to the increase in the number of cases initially, and in view of the chronicity of leprosy and slow future decline. This change will in fact facilitate the much-desired elimination of leprosy as a global public health problem.
Databáze: OpenAIRE
Externí odkaz: