Leprosy in children: a Cuban experience on leprosy control

Abstract

BackgroundChildren are believed to be the most vulnerable group to leprosy. Childhood leprosy reflects disease transmission in the community as well as the efficiency of ongoing disease control programmes. In Cuba, leprosy is not a national health problem; however, new childhood leprosy cases are diagnosed every year.ObjectiveWe summarise the experience of Cuba on childhood leprosy control over the past two decades.ResultsBetween 2000 and 2017, a total of 103 children in Cuba have been diagnosed with leprosy, showing that active transmission of cases remains in 13 of 15 provinces of Cuba. The majority of cases were multibacillary (66%), and 34% were paucibacillary cases. Clinically 60% of children have more than five lesions all over their body. Voluntary reporting was the principal method of case detection. The presence of familial and extrafamilial contact with leprosy cases may be a cause of concern, as it implies continuing transmission of the disease. Only four children had disabilities (one with grade 2 disabilities and three with grade 1 disabilities). A set of national investigations have been developed to intervene in a timely manner. Intervention strategies that combine clinical surveillance and laboratory test could be an option for early detection of childhood leprosy.ConclusionsEarly detection of cases due to effective health education campaigns, regular and complete treatment with MDT, and contact tracing may be important in reducing the burden of leprosy in the community.

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

“…Nevertheless, some studies report a higher proportion of multibacillary cases in the pediatric age similar to our study [39][40][41]. It is worth noting that these findings do not allow predicting trends; however, this indicate that children are in contact with cases of multibacillary leprosy in adults, which is the most frequent form of leprosy in adults in Cuba [17]. In this regard, Narang et al asserts that the risk can be up to 14 times higher when the contact is multibacillary, especially in lepromatous forms of the disease [42].…”

“…Achievement of this noble goal requires reassessing surveillance and control actions in accordance to the goals of the WHO global leprosy strategy 2016-2020 to accelerate actions towards a world without leprosy [16]. Recently, we carried out a study about the Cuban experience in leprosy control activities from 2000 to 2017, in which socio-demographic and epidemiological variables were included along with serology and PCR testing to implement interventions for the early diagnosis of cases of leprosy during childhood [17]. Since childhood leprosy is an epidemiological indicator of persistent community transmission, we were interested in assessing all reported cases of leprosy in children in Cuba from 2012-2019, including new variables and considering a wider epidemiological approach.…”

Hanseníase Na Infância: Uma Série De Casos / Leprosy in Childhood: A Case Series

“…No que diz respeito às características epidemiológicas na população pediátrica, em revisão sistemática realizada por Vieira et al (2018), foi constatado que o principal grupo acometido eram de meninos, entre 10 e 14 anos 11 . No Brasil, segundo o mais recente boletim epidemiológico de janeiro de 2020, os meninos de 0 a 14 anos, são acometidos em 52,3% dos casos 14 . Esses achados concordam com os encontrados nesta presente série de casos.…”

“…As crianças podem desenvolver qualquer forma clínica, como a chamada hanseníase nodular infantil, uma variação da forma tuberculóide que já foi descrita como sendo autolimitada 13 . Contudo, no Brasil, segundo o último Boletim Epidemiológico de Hanseníase de 2020, em relação a classificação operacional, atestou-se que 78,2% dos pacientes foram classificados como multibacilares, onde há a presença de 5 ou mais lesões, sendo preditivo de ocorrência de reações, complicações e sequelas no momento do diagnóstico 14 . Os casos aqui relatados representam variedades menos usuais para a faixa etária, com 4 casos da forma dimorfa e um caso da forma virchowiana, o que fala a favor de uma doença de longa data 15 , coincidindo com os números apresentados pela população adulta.…”

Immune Dysregulation in Childhood Leprosy

“…The only symptom of the disease is sometimes the thickening of the superficial nerves, especially the muscles of the auricular, superciliary and ulnar muscles. 19 Even though previous studies have stated the male dominance in childhood leprosy, a study by Sashidaranpillai et al found surprising female predominance in relapse cases. The higher susceptibility of teenage females to leprosy relapse can be due to hormonal changes and eventual alterations in the immune system with menarche.…”