title: Genetic, household and spatial clustering of leprosy on an island in Indonesia: a population-based study.
abstract: BACKGROUND
  It is generally accepted that genetic factors play a role in susceptibility to both leprosy per se and leprosy type, but only few studies have tempted to quantify this. Estimating the contribution of genetic factors to clustering of leprosy within families is difficult since these persons often share the same environment. The first aim of this study was to test which correlation structure (genetic, household or spatial) gives the best explanation for the distribution of leprosy patients and seropositive persons and second to quantify the role of genetic factors in the occurrence of leprosy and seropositivity.
  
  
  METHODS
  The three correlation structures were proposed for population data (n = 560), collected on a geographically isolated island highly endemic for leprosy, to explain the distribution of leprosy per se, leprosy type and persons harbouring Mycobacterium leprae-specific antibodies. Heritability estimates and risk ratios for siblings were calculated to quantify the genetic effect. Leprosy was clinically diagnosed and specific anti-M. leprae antibodies were measured using ELISA.
  
  
  RESULTS
  For leprosy per se in the total population the genetic correlation structure fitted best. In the population with relative stable household status (persons under 21 years and above 39 years) all structures were significant. For multibacillary leprosy (MB) genetic factors seemed more important than for paucibacillary leprosy. Seropositivity could be explained best by the spatial model, but the genetic model was also significant. Heritability was 57% for leprosy per se and 31% for seropositivity.
  
  
  CONCLUSIONS
  Genetic factors seem to play an important role in the clustering of patients with a more advanced form of leprosy, and they could explain more than half of the total phenotypic variance.
authors.affiliation: KIT (Koninklijk Instituut voor de Tropen/Royal Tropical Institute), KIT Biomedical Research, Meibergdreef 39, 1105 AZ Amsterdam, The Netherlands. m.bakker@kit.nl
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Bakker
authors.forename: Linda
authors.initials: L
authors.lastname: May
authors.forename: Mochammad
authors.initials: M
authors.lastname: Hatta
authors.forename: Agnes
authors.initials: A
authors.lastname: Kwenang
authors.forename: Paul R
authors.initials: PR
authors.lastname: Klatser
authors.forename: Linda
authors.initials: L
authors.lastname: Oskam
authors.forename: Jeanine J
authors.initials: JJ
authors.lastname: Houwing-Duistermaat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005192:Family Health; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007918:Leprosy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009166:Mycobacterium leprae / Q000302:isolation & purification; D011156:Population Density; D012698:Serologic Tests