Estudo epidemiológico de 107 focos familiares de hanseníase no município de Duque de Caxias - Rio de Janeiro, Brasil

Abstract

BACKGROUNDS -ultibacillary patients are the major source of infection in leprosy. Nevertheless, the risk is higher in household contacts between multibacillary patients than paucibacillary patients and in the general population. Household contacts are in close genetic relationship with the index case-patient. OBJECTIVE: To evaluate epidemiological data of the following variables: age, gender, education level, genetic proximity, and type of contact with the index case-patient (household or not) in 107 families with leprosy. METHODS: Home visits were conducted to clinically examine family members. The medical charts of index case-patients and co-prevalent cases were reviewed. RESULTS: The controlled analysis of variables such as type of contact and genetic proximity revealed that household contacts and first-degree kinship are independently associated with a higher chance of contracting the disease. CONCLUSION: Household contacts are often genetically closer to the index case-patient. To investigate the independent relevance of these risks in leprosy surveillance contact studies has been a challenge. Our results confirm literature data that show the influence of genetics in the susceptibility to leprosy per se. Keywords: Epidemiology; Genetics; Leprosy; Leprosy/epidemiology Resumo: FUNDAMENTOS -Os pacientes multibacilares (MB) são a principal fonte de infecção na hanseníase e esse risco é maior nos contatos domiciliares dos pacientes MB do que nos contatos dos paucibacilares (PB) e na população em geral. Entretanto, os contatos domiciliares são os mais próximos do caso-índice (CI), em termos genéticos. OBJETIVO: Analisar dados epidemiológicos das variáveis: sexo, idade, anos de estudo, grau de parentesco com o CI e tipo de contato residencial (intradomiciliar ou peridomiciliar) com o CI em 107 famílias de hanseníase. MÉTODOS: Foram realizadas visitas domiciliares para exame clínico dos familiares. Os prontuários dos CIs e de seus coprevalentes (contatos familiares que também tiveram hanseníase) foram revistos. RESULTADOS: A análise controlada das variáveis tipo de contato e grau de parentesco revelou que o contato domiciliar e o parentesco de primeiro grau estão independentemente associados a uma probabilidade maior de adoecer. CONCLUSÃO: Os contatos domiciliares, em geral, são os mais próximos do caso, em termos genéticos, e aferir a magnitude desses riscos separadamente tem sido um desafio nos estudos de vigilância de contatos em hanseníase. Os resultados deste estudo confirmam os dados da literatura, demonstrando a influência genética no desfecho da hanseníase per se.

Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality

“…A study addressing lost (24) . Other studies reinforce the potential for follow-up of contacts, despite operational difficulties (25) . The strategy to reduce the burden of leprosy and extent of disease control as a public health problem at the national level necessarily involves the qualified approach of leprosy case contacts (2,4,15,20,25) .…”

“…Other studies reinforce the potential for follow-up of contacts, despite operational difficulties (25) . The strategy to reduce the burden of leprosy and extent of disease control as a public health problem at the national level necessarily involves the qualified approach of leprosy case contacts (2,4,15,20,25) . Appropriate investigation of the contacts is essential, since it contributes to a decisive interference in the transmission dynamics of the disease (20) .…”

“…In addition, early diagnosis enables a positive effect on the natural history of the disease, especially at primary and secondary prevention levels (2,18,20) , thereby reducing the chance of disability and deficiency, which ultimately has a strong social, economic and psychological impact (3) . Qualified dermato-neurological examination is essential for the detection of leprosy, since the diagnosis of this disease is eminently clinical (2,(8)(9)14,25) . However, it was observed in this study that most of the contacts interviewed reported not having undergone such a complete evaluation.…”

“…It has been observed that the main action developed in contact surveillance is BCG vaccination, without the complete dermato-neurological examination. Only BCG vaccine is indicated when any suspicion of leprosy is excluded; If the patient presents signs and symptoms characteristic of the disease, it should be followed up with investigation and diagnosis, rather than administer BCG (2,8,14,(24)(25) . Regarding the BCG vaccine, it was also observed that most of the contacts were advised on its indication.…”

Perfil socioepidemiológico e clínico de idosos afetados por hanseníase: contribuições para a enfermagem Social-epidemiologic and clinical profile of elderly people affected by leprosy: contributions to nursing

“…The increased risk of illness among contacts can be linked to family genetic susceptibility and physical proximity to the index case. 15 Proper investigation of contacts contributes to the interruption of transmission of leprosy chain as early treat diagnosed cases, avoiding the spread of the bacillus and the installation of disabilities.…”