01861nas a2200193   4500000000100000008004100001260001200042100001400054700001200068700001400080700001200094700001300106245009000119856005500209300000900264490000700273520137300280022001401653       2021                            d  c01/20211 aHacker MA1 aSales A1 aDuppre NC1 aSarno E1 aMoraes M00aLeprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients.  uhttps://www.nature.com/articles/s41598-021-81643-4  a19470 v113 a<p>Reduction in incidence has been associated with the introduction of novel approaches, like chemo/immune-prophylaxis. Incidence determined through follow-up cohort studies can evaluate the implementation of these innovative policies towards control and prevention. We have assessed the incidence in our contacts cohort over past 33 years, considering the effect of demographic and clinical variables. Survival analysis was used to estimate the risk of leprosy. A total of 9024 contacts were evaluated, of which 192 developed leprosy, resulting in an overall incidence of 1.4/1000 person-years. The multivariate analysis showed that the major risk factors were (i) contact from MB index cases and (ii) consanguinity (iii) intra household contact. Lower risk was detected for contacts with BCG scar who were revaccinated. There was a significant decrease in accumulated risk between the 2011-2019 period compared with 1987, probably linked to the improvement in laboratory tools to monitor contacts, thereby providing early diagnosis of contacts at intake and reduction of transmission. Our findings suggest that a combination of contact surveillance and tracing, adequate neurodermatological examination, and availability of molecular tools is highly effective in supporting early diagnosis, while a second dose of the BCG vaccination can exert extra protection.</p>  a2045-2322