BackgroundThe high rate of leprosy cases among children under 15 years of age in Brazil indicates ongoing transmission within the community. The identification of the new leprosy cases among contacts can help identify the source of infection and interrupt the transmission chain. This study aims to determine the detection rate of previously undiagnosed cases of leprosy among schoolchildren who are under 15 years of age living in Manaus, Amazonas, Brazil, and their possible source of infection by contact tracing.Methodology/Principal findingsThis was a school-based, cross-sectional study in which the identification of active leprosy cases was conducted in 277 out of 622 randomly selected public schools in Manaus, Amazonas, Brazil. Suspected cases of leprosy were referred to the Alfredo da Matta Foundation, a reference center for leprosy in Manaus. A total of 34,547 schoolchildren were examined, and 40 new leprosy cases were diagnosed. Among new cases, 57.5% were males, and 80.0% demonstrated paucibacillary leprosy. A total of 196 of 206 registered contacts were screened, and 52.5% of the newly diagnosed children’s cases had at least one positive household contact. In these contacts, grandparents (52.4%) were the most common co-prevalent cases, while 14.3% were uncles, 9.5% were parents and 9.5% were granduncles. Seven contacts (5.0%), including four siblings of child patients were newly diagnosed. Our data indicate that the prevalence is 11.58 per 10,000, which is 17 times higher than the registered rate.Conclusions/SignificanceThis study suggests that the detection rate of leprosy among schoolchildren may have remained unchanged over the past thirty years. It also indicates that that active case finding is necessary for reaching the World Health Organization’s goals of zero detection among children, especially in endemic areas where the prevalence of leprosy is obscure. Moreover, we assert that all children must have their household contacts examined in order to identify the possible source of infection and interrupt the disease’s transmission. Novel strategies to reinforce contact tracing associated with large-scale strategies of chemo- and immune-prophylaxis should be expanded to prevent the perpetuation of the disease cycle.

This observational study was carried out in the state of Amazonas (Brazil), a huge and remote Rainforest area with only 2.2 inhabitants per square kilometer. This isolation is due to both geographical setting and ethnic-cultural barriers, with the indigenous population representing around 4% (20% of the entire indigenous population of Brazil, 60 ethnic groups and more than 40 languages).The lack of dermatology specialists encourages the few Primary Health Care Doctors (PCD) to apply for asynchronous support on skin disease occurrences through the portal of the Manaus-based Telemedicine and Telehealth Centre (TTC). Subsequently, the TTC counsels the PCD at a distance through his dermatologist-consultants (DC). The performance of such a teleconsultation system was audited by a TTC independent board of experts. They reviewed a 24 months continuous case series by focusing on the quality of PCD applications and DC counseling. The quality of anamnesis, description of physical signs and attached clinical documentation by the PCD was satisfactory in only 56/100, 44/100 and 53/100, respectively. A significantly negative trend (p<0.05) from the first to the second year was also observed. However, the PCD prompted presumptive diagnosis in 87/100, with a 72% of agreement with the DC's final diagnosis. Indicators of good DC performance were: a) the response to the application within 72 h time occurring in 51/100, with a significantly improving trend (P<0.05); and b) the referrals to the health facilities of the capital of the state being recommended in only 13/100. Teleconsultation represents an opportunity for providing access to isolated populations and minorities. Although DC performance is improving, the high turnover of PCDs and the lack of training in e-health at the undergraduate level result in the poor quality of PCD applications. Thus, instruction in e-health tools should be added to the curriculum of the undergraduate program in medicine.