02358nas a2200229   4500000000100000008004100001653001200042653001100054100001300065700001900078700001400097700001400111700001800125700001700143700001200160245009600172856007800268300001300346490000700359520174800366022001402114       2017                            d10aleprosy10aBrazil1 aNobre ML1 aIllarramendi X1 aDupnik KM1 aHacker MA1 aCosta Nery JA1 aJeronimo SMB1 aSarno E00aMultibacillary leprosy by population groups in Brazil: Lessons from an observational study.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005364  ae00053640 v113 a<p><strong>BACKGROUND: </strong>Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control.</p>

<p><strong>METHODS: </strong>A national databank of cases reported in Brazil (2001-2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center was used to determine factors associated with higher bacillary loads.</p>

<p><strong>RESULTS: </strong>A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65-69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33-2.38; OR = 1.99, CI95% = 1.96-2.02, respectively). Bacillary load was higher in male and in patients aged 20-39 and 40-59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country.</p>

<p><strong>CONCLUSION: </strong>Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.</p>
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