Spatial epidemiology and serologic cohorts increase the early detection of leprosy.
Spatial epidemiology and serologic cohorts increase the early detection of leprosy.
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DOI：
10.1186/s12879-015-1254-8
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发表时间：
2015-11-16
影响因子：
3.7
通讯作者：
Salgado CG
中科院分区：
文献类型：
--
作者：
Barreto JG;Bisanzio D;Frade MA;Moraes TM;Gobbo AR;de Souza Guimarães L;da Silva MB;Vazquez-Prokopec GM;Spencer JS;Kitron U;Salgado CG
在一些特定的高负担地区，麻风病仍然是一个重要的公共卫生问题，包括在巴西亚马逊地区，麻风病在儿童中高度流行。我们选择了两所位于最危险地区（麻风病聚集区或高流行人口普查区）的公立小学，对他们的学生进行临床评估。我们还跟踪了抗PGL-I血清阳性和阴性的个人和家庭2年，以比较两组的麻风发病率。在高风险地区的134名学童中有11名（8.2%）发现麻风。与我们先前在随机选择的学校中的发现（63/1592; 3.9%）相比，患病率的差异具有统计学意义（p <0.05）。2年随访结果显示，血清阳性和血清阴性个体分别有22.3%和9.4%发展为麻风（p = 0.027）。血清反应阳性者发生显性疾病的几率是阴性者的2.7倍（p <0.01），表明对10名血清反应阳性者进行随访，有> 90%的概率在2年内发现至少一例新病例。与“阴性房屋”相比，“阳性房屋”中临床麻风病的几率也更高（p <0.05），这表明对至少有一名血清反应阳性居民的家庭中的10人进行随访，有85%的概率在2年内发现至少一例新病例。应采用有针对性的筛查，包括利用空间分析结果规划的学校监测和基于血清学数据的有针对性的家庭和个人连续监测，以增加新麻风病例的早期发现。
Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children. We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups. Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in “positive houses” compared to “negative houses” (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years. Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.