Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

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ABSTRACT

OBJECTIVE

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.

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Most cited references 43

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Leprosy now: epidemiology, progress, challenges, and research gaps.

Diana Lockwood, Laura Rodrigues (2011)

Leprosy continues to be a challenge to health worldwide, with about 250,000 new cases being detected every year. Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. A third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services. We review data and make recommendations for research on diagnosis, treatment, and prevention, such as further use of molecular analysis of the Mycobacterium leprae genome, implementation of BCG vaccination, and administration of chemoprophylaxis to household contacts. We also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

Maurício Barreto, G. Kerr, Laura Rodrigues … (2006)

Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. A case-control study in four municipalities. cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (>or=biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.

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Mortality and Case Fatality Due to Visceral Leishmaniasis in Brazil: A Nationwide Analysis of Epidemiology, Trends and Spatial Patterns

Francisco Martins-Melo, Mauricélia Lima, Alberto Novaes Ramos Junior … (2014)

Background Visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil. Methods We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis. Results In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change – APC: 9.4%; 95% confidence interval – CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil. Conclusions Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Saude Publica

Journal ID (iso-abbrev): Rev Saude Publica

Journal ID (publisher-id): rsp

Title: Revista de Saúde Pública

Publisher: Faculdade de Saúde Pública da Universidade de São Paulo

ISSN (Print): 0034-8910

ISSN (Electronic): 1518-8787

Publication date (Electronic): 16 November 2015

Publication date Collection: 2015

Volume: 49

Electronic Location Identifier: 84

Affiliations

[I ]Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil

[II ]Secretaria de Estado da Saúde do Tocantins. Palmas, TO, Brasil

[III ]Instituto Federal de Educação, Ciência e Tecnologia do Ceará. Caucaia, CE, Brasil

[IV ]Division of Tropical Health and Medicine.Anton Breinl Centre for Public Health and College of Public Health, Medical and Veterinary. James Cook University. Townsville, QLD, Australia

[I ] Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil

[II ] Secretaria de Estado da Saúde do Tocantins. Palmas, TO, Brasil

[III ] Instituto Federal de Educação, Ciência e Tecnologia do Ceará. Caucaia, CE, Brasil

[IV ] Division of Tropical Health and Medicine.Anton Breinl Centre for Public Health and College of Public Health, Medical and Veterinary. James Cook University. Townsville, QLD, Australia

Author notes

Correspondence: Lorena Dias Monteiro Secretaria de Estado da Saúde do Tocantins 108 Sul, Alameda 13, Lote 09 77020-116 Palmas, TO, Brasil E-mail: lorenamonteiro3@ 123456hotmail.com

AUTHORS’ CONTRIBUTION

Monteiro LD and Heukelbach J conceived the project and were responsible for ensuring the accuracy and integrity of all parts of this study. Monteiro LD, Martins-Melo FR, Brito AL and Heukelbach J participated in the data analysis and interpretation, article writing, critical review of the intellectual content and final approval of the version to be published.

Based on the doctoral thesis by Lorena Dias Monteiro, titled: “Epidemiologia, distribuição espacial e fatores associados à ocorrência da hanseníase e do desenvolvimento de incapacidades físicas no estado do Tocantins, 2001 a 2012", presented at the Universidade Federal do Ceará in 2015.

The authors declare no conflict of interest.

[Correspondência ]: Lorena Dias Monteiro Secretaria de Estado da Saúde do Tocantins 108 Sul, Alameda 13, Lote 09 77020-116 Palmas, TO, Brasil E-mail: lorenamonteiro3@hotmail.com

CONTRIBUIÇÃO DOS AUTORES

Monteiro LD e Heukelbach J conceberam o projeto e são responsáveis pela garantia da exatidão e integridade de qualquer parte da obra. Monteiro LD, Martins-Melo FR, Brito AL e Heukelbach J participaram da análise e interpretação dos dados, redação do artigo, revisão crítica do conteúdo intelectual e aprovação final da versão a ser publicada.

Baseado na tese de doutorado de Lorena Dias Monteiro, intitulada: “Epidemiologia, distribuição espacial e fatores associados à ocorrência da hanseníase e do desenvolvimento de incapacidades físicas no estado do Tocantins, 2001 a 2012”, apresentada à Universidade Federal do Ceará em 2015.

Os autores declaram não haver conflito de interesses.

Article

Publisher ID: S0034-8910.2015049005866

DOI: 10.1590/S0034-8910.2015049005866

PMC ID: 4650934

PubMed ID: 26603352

SO-VID: 4d3c89a1-6176-4398-8b06-466eca7ccf61

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 19 September 2014

Date accepted : 17 March 2015

Page count

Figures: 6, Tables: 0, Equations: 0, References: 29, Pages: 1

Funding

Funded by: Conselho Nacional de Desenvolvimento Científico

Award ID: 404505/2012

Research funded by the Conselho Nacional de Desenvolvimento Científico (CNPq – (Process 404505/2012).

Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

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CONCLUSIONS

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Most cited references 43

Leprosy now: epidemiology, progress, challenges, and research gaps.

Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

Mortality and Case Fatality Due to Visceral Leishmaniasis in Brazil: A Nationwide Analysis of Epidemiology, Trends and Spatial Patterns

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