血清学标志物与空间分析联合用于麻风病流行病学监测
[Combined use of serologic markers and spatial analysis for epidemiological surveillance of leprosyUso conjunto de los marcadores serológicos y del análisis espacial en la vigilancia epidemiológica de la lepra].
作者信息
Ribeiro Gabriela de Cássia, Barreto Josafá Gonçalves, Bueno Isabela de Caux, Costa Bruna Oliveira, Lana Francisco Carlos Félix
机构信息
Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM) Departamento de Enfermagem Diamantina (MG) Brasil Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Departamento de Enfermagem, Diamantina (MG), Brasil.
Universidade Federal do Pará (UFPA) Laboratório de Epidemiologia Espacial (LabEE) Castanhal (PA) Brasil Universidade Federal do Pará (UFPA), Laboratório de Epidemiologia Espacial (LabEE), Castanhal (PA), Brasil.
出版信息
Rev Panam Salud Publica. 2021 Nov 19;45:e129. doi: 10.26633/RPSP.2021.129. eCollection 2021.
OBJECTIVE
To evaluate the combined use of serologic markers and spatial analysis to increase the sensitivity of leprosy epidemiological surveillance.
METHOD
This cross-sectional study was performed with neighbors of leprosy cases and neighbors and family members of schoolchildren with a positive anti-phenolic glycolipid I (PGL-I) test in Diamantina, state of Minas Gerais, Brazil. Neighbors were those living within a 100-m radius of schoolchildren or leprosy cases. Data collection included a semi-structured interview, dermatologic examination, and rapid ML Flow test. All residential addresses were georeferenced. Multivariate regression and spatial analysis were performed with anti-PGL-I seropositivity as the dependent variable.
RESULTS
The study included 1 491 individuals: 1 009 (67.7%) family members and neighbors of schoolchildren with positive serology test and 482 (32.3%) neighbors of leprosy cases. Of the total, 421 (28.2%) were positive for anti-PGL-I. Seropositivity was higher among family members and neighbors of seropositive schoolers ( < 0.001), among people with family income of 1 minimum wage ( < 0.001), among the youngest participants ( < 0.001), and among those living in homes with one to five rooms ( = 0.007). The seropositivity rate was higher in the geographic area corresponding to seropositive schoolchildren ( < 0.001), that is, the spot with the highest number of cases was different from the spot with the highest rate of seropositivity.
CONCLUSIONS
The combined use of serologic markers and spatial analysis allowed us to easily identify operational weaknesses of services and a possible occult leprosy endemism in the municipality's urban census tracts. Tracing of social contact and neighbors, active search, educational campaigns, school surveys, and territorial analyses facilitate the early diagnosis of leprosy.
目的
评估血清学标志物与空间分析联合使用对提高麻风病流行病学监测敏感性的作用。
方法
本横断面研究的对象为巴西米纳斯吉拉斯州迪亚曼蒂纳市麻风病患者的邻居，以及抗酚糖脂I（PGL-I）检测呈阳性的学童的邻居和家庭成员。邻居是指居住在学童或麻风病患者半径100米范围内的人。数据收集包括半结构化访谈、皮肤科检查和快速ML Flow检测。所有居住地址均进行了地理定位。以抗PGL-I血清学阳性为因变量进行多变量回归和空间分析。
结果
该研究纳入了1491人：1009人（67.7%）为血清学检测呈阳性的学童的家庭成员和邻居，482人（32.3%）为麻风病患者的邻居。其中，421人（28.2%）抗PGL-I呈阳性。血清学阳性率在血清学阳性学童的家庭成员和邻居中更高（<0.001），在家庭收入为1个最低工资的人群中更高（<0.001），在最年轻的参与者中更高（<0.001），以及在居住在一至五个房间房屋中的人群中更高（=0.007）。在血清学阳性学童对应的地理区域中，血清学阳性率更高（<0.001），即病例数最多的地点与血清学阳性率最高的地点不同。
结论
血清学标志物与空间分析联合使用使我们能够轻松识别服务中的操作弱点以及该市城市普查区可能存在的隐匿性麻风病流行情况。追踪社会接触者和邻居、主动搜索、开展教育活动、进行学校调查以及区域分析有助于麻风病的早期诊断。
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