@article{article,
  keywords = {active case finding, clustering, leprosy, spatial analysis},
  author = {Ortu{\~n}o-Guti{\'e}rrez N and Mzembaba A and Ramboarina S and Andriamira R and Baco A and Braet S and Younoussa A and Cauchoix B and Salim Z and Amidy M and Grillone S and Rasamoelina T and Cambau E and Geluk A and de Jong B and Richardus JH and Hasker EC},
  title = {Exploring clustering of leprosy in the Comoros and Madagascar: a geospatial analysis.},
  abstract = {<p><b>OBJECTIVES: </b>To identify patterns of spatial clustering of leprosy.</p><p><b>DESIGN: </b>We performed a baseline survey for a trial on post-exposure prophylaxis for leprosy in Comoros and Madagascar. We screened 64 villages, door-to-door, and recorded results of screening, demographic data and geographic coordinates. To identify clusters, we fitted a purely spatial Poisson model using Kulldorff{\textquoteright}s spatial scan statistic. To assess at the individual level the risk of suffering from leprosy as a function of distance to the nearest known leprosy patient, we used a regular Poisson model.</p><p><b>RESULTS: </b>We identified 455 leprosy patients, 200 (44.0\%) belonging to 2,735 households included in a cluster. Thirty-eight percent of leprosy patients versus ten percent of the population live within 25 meters of another leprosy patient. The risk ratios for being diagnosed with leprosy were 7.3 (5.1-10.4), 2.4 (1.7-3.4), 1.8 (1.3-2.5), 1.4 (1.0-2.1) and 1.7 (1.1-2.4) respectively for those living in the same household, at 1-<25 m, at 25-<50 m, at 50-<75 m and at 75-<100 m, compared to those living at >=100 m.</p><p><b>CONCLUSIONS: </b>We documented significant clustering of leprosy beyond the household-level, though 56\% of cases were not part of a cluster. Control measures need to be extended beyond the household and social networks should be further explored.</p>},
  year = {2021},
  journal = {International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases},
  month = {05/2021},
  issn = {1878-3511},
  url = {https://www.ijidonline.com/action/showPdf?pii=S1201-9712\%2821\%2900415-X},
  doi = {10.1016/j.ijid.2021.05.014},
  language = {eng},
}