@article{30865,
  keywords = {Low endemic area, leprosy, Hidden leprosy, ELISA, Brazil},
  author = {Bernardes F and Paula NA and Leite MN and Abi-Rached TLC and Vernal S and Silva MB and Barreto J and Spencer J and Cipriani Frade M},
  title = {Evidence of hidden leprosy in a supposedly low endemic area of Brazil.},
  abstract = {<p><strong>OBJECTIVES: </strong>Show that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations.</p>

<p><strong>METHODS: </strong>The study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA).</p>

<p><strong>RESULTS: </strong>From July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases.</p>

<p><strong>CONCLUSIONS: </strong>During the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.</p>
},
  year = {2017},
  journal = {Memorias do Instituto Oswaldo Cruz},
  volume = {112},
  pages = {822-828},
  issn = {1678-8060},
  url = {http://www.scielo.br/pdf/mioc/v112n12/0074-0276-mioc-112-12-0822.pdf},
  doi = {10.1590/0074-02760170173},
  language = {eng},
}