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PAGES: 822-828 DOI: 10.1590/0074-02760170173 Full paper
Evidence of hidden leprosy in a supposedly low endemic area of Brazil

Fred Bernardes Filho1,+, Natália Aparecida de Paula1, Marcel Nani Leite1, Thania Loyola Cordeiro Abi-Rached1, Sebastian Vernal1, Moises Batista da Silva2, Josafá Gonçalves Barreto2,3, John Stewart Spencer4, Marco Andrey Cipriani Frade1

1Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Dermatologia, Ribeirão Preto, SP, Brasil
2Universidade Federal do Pará, Laboratório de Dermato-Imunologia, Marituba, PA, Brasil
3Universidade Federal do Pará, Laboratório de Epidemiologia Espacial, Castanhal, PA, Brasil
4Colorado State University, Department of Microbiology, Immunology and Pathology, Fort Collins, CO, USA


OBJECTIVES Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations.

METHODS The study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA).

RESULTS From July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio’s phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases.

CONCLUSIONS During the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.

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Financial support: Jardinópolis Municipal Health Department; WHO Implementation Research Team of Faculdade de Medicina de Ribeirão Preto-USP; Center of National Reference in Sanitary Dermatology focusing on Leprosy of Ribeirão Preto Clinical Hospital; MS/FAEPA-FMRP-USP (749145/2010, 767202/2011); CNPq (448741/2014-8).
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Received 1 May 2017
Accepted 30 June 2017