02613nas a2200337   4500000000100000008004100001260001300042653002400055653001600079653001100095653002100106653002700127653001600154653001100170653001400181653001200195653002500207653001700232100001400249700002300263700001500286700001400301700001700315700001400332245012200346856007300468300001000541490000700551520170300558022001402261       2008                            d  c2008 Jan10aAntigens, Bacterial10aBCG Vaccine10aBrazil10aEndemic Diseases10aFamily Characteristics10aGlycolipids10aHumans10aIncidence10aleprosy10aMycobacterium leprae10aRisk Factors1 aGoulart I1 aBernardes Souza DO1 aMarques CR1 aPimenta V1 aGonçalves M1 aGoulart L00aRisk and protective factors for leprosy development determined by epidemiological surveillance of household contacts.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223848/pdf/0372-07.pdf  a101-50 v153 a<p>Household contacts of leprosy patients are the group with the highest risk of developing the disease, and although many risk or prevention factors have been identified, they have not been employed in leprosy-monitoring programs. This investigation aimed to establish the relative risks or the preventive effects of the presence of BCG vaccination, the Mitsuda test, and the ML-Flow assay. Household contacts (1,396) were monitored for a 5-year period. Twenty-eight contacts (2%) developed leprosy and had their clinical and operational classifications established. All immunological tests were performed, and intradermal BCG vaccination was given after the BCG scar count. Of the affected contacts, 75% developed the disease in the first year, and 71.4% were classified as having paucibacillary forms. Contacts of lepromatous leprosy patients presented a 3.8-fold-higher risk of developing leprosy. BCG vaccination and the Mitsuda test showed a protective effect against leprosy of 0.27 (at least one scar) and 0.16 (>7 mm), respectively, and the positive ML-Flow test indicated a relative risk approximately sixfold higher for occurrence of the disease. All unfavorable combinations of two and three assays generated significant risk values that ranged from 5.76 to 24.47, with the highest risk given by the combination of no BCG scar, negative Mitsuda test, and positive ML-Flow test. We suggest that the BCG vaccination may be given to stimulate Mitsuda test positivity, reducing the patient's risk of developing multibacillary forms. The high significance of these tests may have a great impact on programs to monitor contacts and should be used to improve early detection and treatment.</p>  a1556-679X