Spatial clustering and local risk of leprosy in São Paulo, Brazil.

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: Antônio Carlos Vieira Ramos, Mellina Yamamura, Luiz Henrique Arroyo, Marcela Paschoal Popolin, Francisco Chiaravalloti Neto, Pedro Fredemir Palha, Severina Alice da Costa Uchoa, Flávia Meneguetti Pieri, Ione Carvalho Pinto, Regina Célia Fiorati, Ana Angélica Rêgo de Queiroz, Aylana de Souza Belchior, Danielle Talita Dos Santos, Maria Concebida da Cunha Garcia, Juliane de Almeida Crispim, Luana Seles Alves, Thaís Zamboni Berra, Ricardo Alexandre Arcêncio
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2017
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.1371/journal.pntd.0005381; https://doaj.org/article/732374ce1e8e49ba84d3259bb1678b99

BACKGROUND:Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. METHODS:Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. RESULTS:A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). CONCLUSION:These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.