02082nas a2200289   4500000000100000008004100001653002100042653001200063653001900075653001000094653001100104100001600115700001300131700001300144700001900157700001300176700001300189700001400202700001400216700002100230245007500251856007300326300001200399490000800411520135900419022001401778       2017                            d10aLow endemic area10aleprosy10aHidden leprosy10aELISA10aBrazil1 aBernardes F1 aPaula NA1 aLeite MN1 aAbi-Rached TLC1 aVernal S1 aSilva MB1 aBarreto J1 aSpencer J1 aCipriani Frade M00aEvidence of hidden leprosy in a supposedly low endemic area of Brazil.  uhttp://www.scielo.br/pdf/mioc/v112n12/0074-0276-mioc-112-12-0822.pdf  a822-8280 v1123 a<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>
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