Damien Foundation, Brussels, Belgium.
National Tuberculosis and Leprosy Control Program, Moroni, Comoros.
Int J Infect Dis. 2021 Jul;108:96-101. doi: 10.1016/j.ijid.2021.05.014. Epub 2021 May 12.
To identify patterns of spatial clustering of leprosy.
We performed a baseline survey for a trial on post-exposure prophylaxis for leprosy in Comoros and Madagascar. We screened 64 villages, door-to-door, and recorded results of screening, demographic data and geographic coordinates. To identify clusters, we fitted a purely spatial Poisson model using Kulldorff's spatial scan statistic. We used a regular Poisson model to assess the risk of contracting leprosy at the individual level as a function of distance to the nearest known leprosy patient.
We identified 455 leprosy patients; 200 (44.0%) belonged to 2735 households included in a cluster. Thirty-eight percent of leprosy patients versus 10% of the total population live ≤25 m from another leprosy patient. Risk ratios for being diagnosed with leprosy were 7.3, 2.4, 1.8, 1.4 and 1.7, for those at the same household, at 1-<25 m, 25-<50 m, 50-<75 m and 75-<100 m as/from a leprosy patient, respectively, compared to those living at ≥100 m.
We documented significant clustering of leprosy beyond household level, although 56% of cases were not part of a cluster. Control measures need to be extended beyond the household, and social networks should be further explored.
确定麻风病的空间聚集模式。
我们对科摩罗和马达加斯加的麻风病暴露后预防试验进行了基线调查。我们对 64 个村庄进行了逐户筛查，并记录了筛查结果、人口统计数据和地理坐标。为了识别聚集，我们使用 Kulldorff 的空间扫描统计数据拟合了一个纯粹的空间泊松模型。我们使用常规泊松模型评估了个体水平上患麻风病的风险，作为距离最近已知麻风病患者的函数。
我们发现了 455 名麻风病患者；其中 200 名（44.0%）属于 2735 户包含在一个集群中的家庭。38%的麻风病患者与 10%的总人口居住在距离另一名麻风病患者≤25 米的地方。与居住在≥100 米的人相比，与同一家庭、距离 1-<25 米、25-<50 米、50-<75 米和 75-<100 米的麻风病患者的家庭、距离 1-<25 米、25-<50 米、50-<75 米和 75-<100 米的麻风病患者的诊断为麻风病的风险比分别为 7.3、2.4、1.8、1.4 和 1.7。
我们记录了麻风病的显著聚集超出了家庭层面，尽管 56%的病例不属于一个集群。控制措施需要超出家庭范围，应进一步探索社会网络。
