Individuals who are missed during household contact examinations

Introduction: During household contacts surveillance, as part of leprosy control, many individuals resident in the household may miss their examinations. This may occur if they are absent when the health worker visits the home, because they have permanently left the household or if they joined the household after diagnosis of the index cases, so were not listed as contacts. Methods: We investigated the size of this problem in the context of a study of new case detection amongst household contacts (HHCs). Results: During the Routine Surveillance Period (RSP), which was 2 years for PB index households and 5 years for MB index households, 3·6% HHCs were absent at every Examination, 1·5% HHCs left, and incomers increased the number of HHCs by 22%. The demographic profiles of absentees, leavers and incomers differed from that of HHCs assessed. Absentees and most leavers could not be reviewed. Only 0·15% of incomers were diagnosed as new cases of leprosy. Conclusion: Staff undertaking household contact examinations (HCEs) should not forget these groups who need to be advised about their risk of developing leprosy, albeit a low risk.