Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
JAMA Dermatol. 2020 Jun 1;156(6):640-648. doi: 10.1001/jamadermatol.2020.0653.
Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries.
To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018.
Clinical characteristics of the primary case and sociodemographic factors of the household contact.
Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects.
Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42).
The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.
尽管在降低全球发病率方面取得了进展，但在低收入和中等收入国家，麻风病控制仍然是一个挑战。
估计以前诊断为麻风病患者的家庭接触者中新发麻风病的检出率，并调查其相关的危险因素。
设计、地点和参与者：本项基于人群的队列研究纳入了在巴西 1 亿人口队列中注册的家庭，该队列与全国麻风病登记处相关联；数据收集于 2007 年 1 月 1 日至 2014 年 12 月 31 日。每个家庭单位的以前诊断为麻风病患者的家庭接触者从初次病例检出时开始随访，直至随后病例检出或 2014 年 12 月 31 日为止。数据分析于 2018 年 5 月至 12 月进行。
初次病例的临床特征和家庭接触者的社会人口学因素。
麻风病的发病率，估计为每 100000 名有风险的家庭接触者（风险人年）中新发麻风病的检出率。使用多水平混合效应逻辑回归评估随后发生麻风病病例与暴露风险因素之间的关联，允许州和家庭特定的随机效应。
在 17876 例麻风病患者中，有 42725 名家庭接触者（22449 名[52.5%]为女性；平均[标准差]年龄为 22.4[18.5]岁），总体上，100000 人年的新发麻风病检出率为 636.3（95%CI，594.4-681.1），100000 人年的新发麻风病检出率为 521.9（95%CI，466.3-584.1），年龄小于 15 岁的儿童。多菌型麻风病患者的家庭接触者患麻风病的可能性更高（调整后的比值比[OR]，1.48；95%CI，1.17-1.88），50 岁及以上的接触者的可能性更高（调整后的 OR，3.11；95%CI，2.03-4.76）。麻风病的检出与未受过教育或学龄前教育水平呈负相关（调整后的 OR，0.59；95%CI，0.38-0.92）。对于儿童，男孩的可能性更高（调整后的 OR，1.70；95%CI，1.20-2.42）。
本项巴西基于人群的队列研究的结果表明，麻风病患者的家庭接触者可能具有更高的麻风病风险，尤其是在有现有多菌型病例和老年接触者的家庭中。似乎需要针对这一人群的公共卫生干预措施，如接触者筛查。
