Persisting leprosy transmission despite increased control measures in an endemic cluster in Brazil: the unfinished agenda

摘要

Objective: To provide an evidence base for improvement of leprosy control inBrazil's high transmission areas.Design: We obtained data from municipalities in a major disease cluster fromdatabases for notifiable diseases of four states (Maranha.o, Para′, Tocantins, Piau.′),including notifications from 2001 to 2009. Indicators for monitoring and evaluationof leprosy according to the World Health Organization were evaluated with emphasison the rates of new cases presenting grade-2 disabilities and among children, 15 years of age, indicating late diagnosis and active transmission, respectively.Results: A total of 82,463 leprosy cases were detected in the area (mean annual casedetection rate: 95.9/100,000; RR . 4.56 as compared to the rest of Brazil; 95% CI:4.45– 4.66, P , 0.0001). There was a steady decrease of detection rates in the studyperiod, from 100.8 to 75.6/100,000 inhabitants. In children , 15 years of age, 9,009cases of leprosy were detected (28.40/100,000), significantly more than in the rest ofBrazil (RR . 5.80; 95% CI: 5.39 –6.25, P , 0.0001). New cases with grade-2disabilities/100,000 population maintained a stable trend at a high level (4.43 clustervs. 1.28 rest of country; RR . 3.46; 95% CI: 3.11– 3.84, P , 0.0001), whereas theproportion of new cases with grade-2 was slightly lower than the country's average(5.51% vs. 6.75%; RR . 0.84; 95% CI: 0.81 –0.86, P , 0.0001).