de Carsalade G Y, Receveur M C, Ezzedine K, Saget J, Achirafi A, Bobin P, Malvy D
Service des urgences, Centre hospitalier de Mayotte, 97600 Mayotte.
Bull Soc Pathol Exot. 2008 Feb;101(1):32-5.
Mayotte, a French territory island located in the Indian Ocean near Madagascar, remains a leprosy endemic area. In 2006, leprosy was still a problem of public health with a prevalence of 3.94 per 10,000 inhabitants. There is practically no formal consensus about active screening (AS) on an index case. According to teams and their related staffs, the AS concerns intradomicilary contact individuals (IDC) restrictively or extended to extra-domicilary social and professional contacts. Date, number and frequency of these investigations depend on each team. Between 1997 and 2003, there was no AS planned in Mayotte, but all index case individuals have been encouraged to propose a screening to their relatives through specific campaign information and education. This procedure allowed to identify 10 new cases of leprosy infection among the IDC. Concurrently 12 IDC cases have been diagnosed by health workers. In 2003, we performed a postponed AS within IDC of every Mahorais case registered by passive detection between 1997 and 2003. 325 IDC have been examined and 15 new cases have been detected. All these new cases showed early leprosy features: 14 were paucibacillary forms, among which 9 cases with an isolated cutaneous lesion (7 had an infracentimetric lesion). One patient had multibacillary disease although he presented with an isolated skin lesion which developed within the 6 previous months. None presented with disability. Our results suggest that passive detection even reinforced by repeated individual information and education about leprosy is neither appropriate nor effective. The postponed AS seems to favour an increased self-esteem and a better involvement of the index patient in sanitary education together with the screening of his relatives. In the Mayotte background, the postponed AS has not been associated with a significant delay for diagnosis. Although WHO recommandations are to abandon immediate AS of IDC and to promote self-screening for leprosy our study suggests an intermediate position, namely delayed active screening for an enhanced effective detection.
马约特岛是位于印度洋靠近马达加斯加的一个法国领土岛屿，仍是麻风病流行地区。2006年，麻风病仍是一个公共卫生问题，每万名居民中的患病率为3.94。对于对索引病例进行主动筛查（AS），实际上没有正式的共识。根据各团队及其相关工作人员的说法，主动筛查严格限于家庭内接触者（IDC），或者扩大到家庭外的社会和职业接触者。这些调查的日期、数量和频率取决于每个团队。1997年至2003年期间，马约特岛没有计划进行主动筛查，但通过特定的宣传和教育活动，鼓励所有索引病例个体向其亲属提议进行筛查。这一程序使得在家庭内接触者中发现了10例新的麻风病感染病例。同时，卫生工作者诊断出12例家庭内接触者病例。2003年，我们对1997年至2003年期间通过被动检测登记的每一例马约特岛病例的家庭内接触者进行了延迟主动筛查。检查了325名家庭内接触者，发现了15例新病例。所有这些新病例都表现出早期麻风病特征：14例为少菌型，其中9例有孤立的皮肤病变（7例病变小于1厘米）。一名患者患有多菌型疾病，尽管他仅有一个在过去6个月内出现的孤立皮肤病变。无人出现残疾情况。我们的结果表明，即使通过反复的关于麻风病的个人宣传和教育加强了被动检测，也既不合适也无效。延迟主动筛查似乎有利于增强自尊，并使索引患者更好地参与卫生教育以及对其亲属的筛查。在马约特岛的背景下，延迟主动筛查并未导致诊断出现显著延迟。尽管世界卫生组织的建议是放弃对家庭内接触者的立即主动筛查，并推广麻风病自我筛查，但我们的研究表明了一种中间立场，即延迟主动筛查以提高有效检测率。
