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Background: Leprosy is among the Neglected Tropical Diseases (NTDs), and is an endemic public health problem in high-risk clusters throughout Brazil. Leprosy is caused by the intracellular bacteria Mycobacterium leprae, affecting the skin and peripheral nerve function. The disease can cause significant disabilities through nerve damage and secondary infection. Nasal mucosa is considered the primary transmission site due to the presence of active bacilli. However, transmission continues to remain unclear. Environmental risk has also been considered, as leprosy has been found in local water and soil sources in endemic areas, and leprosy mycobacteria can survive outside of the body for up to 60 days. While household contact with multibacillary cases (>5 lesions) remains the primary risk factor for leprosy, genetic relationships are thought to be a risk independent of physical contact. Socioeconomic factors and conditions of poverty, such as inadequate housing and sanitation, poor nutrition and household density, also related to leprosy contact proximity, have been found to be risk factors in Brazil and other countries. These factors can increase the risk for both leprosy transmission and onset of leprosy symptoms, particularly when factors associated with poverty compromise immune response. Migration is considered to be a social determinant of NTDs, including leprosy. Social disparities and conditions associated with migration place non-immune migrants at risk for infection when exposed to disease. Migration can additionally influence the distribution of disease through movement of baciliferous individuals into previously non-endemic areas. Thus, leprosy control may be hindered by increased transmission and distribution due to migration. In Brazil, leprosy new case incidence at 1.77/10.000 inhabitants nationally remains above the World Health Organization elimination goal of |
