title: Spatial and temporal epidemiology of Mycobacterium leprae infection among leprosy patients and household contacts of an endemic region in Southeast Brazil.
abstract: BACKGROUND
  Leprosy is a chronic infectious disease that remains a public health problem in low- and middle-income countries. Household contacts of leprosy patients (HHCs) have increased risk of developing disease and are important links in the chain of transmission of Mycobacterium leprae. Based on epidemiological and operational factors, the global elimination strategy depends on the geographic stratification of endemic areas to intensify control activities. The purpose of the study was to integrate epidemiological indicators and serology into the spatial and temporal analysis of M. leprae infection, in order to understanding of the dynamics of transmission, essential information for the control of leprosy.
  
  
  METHODS
  Using location-based technologies and epidemiological data obtained from leprosy cases (N=371) and HHCs (N=53), during a 11year period (2004-2014), we explored the spatial and temporal distribution of diagnosed cases: stratified according their disease manifestation; and of subclinical infection among HHCs: determined by serology (anti-PGL-I ELISA and anti-NDO-LID rapid lateral-flow test); in order to assess the distribution pattern of the disease and the areas of greatest risk of illness, in a highly endemic municipality (Ituiutaba, MG) in the southeast region of Brazil.
  
  
  RESULTS
  Seropositivity among HHCs was: 17% (9/53) for anti-PGL-I ELISA; and 42% for the NDO-LID rapid lateral-flow test. Forty-nine percent of the contacts were seropositive to at least one of the immunological tests.
  
  
  CONCLUSIONS
  We observed substantial spatial heterogeneity of cases throughout the urban perimeter. Even so, four main clusters of patients and three main clusters of subclinical infection were identified.
  
  
  CONCLUSIONS
  Spatio-temporal epidemiology associated to serological assessment can identify high-risk areas imbedded within the overall epidemic municipality, to prioritize active search of new cases as well support prevention strategies in these locations of greater disease burden and transmission. Such techniques should become increasingly useful and important in future action planning of health interventions, as decisions must be made to effectively allocate limited resources.
authors.affiliation: Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil.
authors.forename: Mariana V C
authors.initials: MV
authors.lastname: Nicchio
authors.affiliation: Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil. Electronic address: saraujo@gmx.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Araujo
authors.affiliation: Postgraduate Programs in Environment and Environmental Quality, Institute of Agricultural Sciences, Federal University of Uberlandia, MG, Brazil.
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Martins
authors.affiliation: National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil.
authors.forename: Andressa V
authors.initials: AV
authors.lastname: Pinheiro
authors.affiliation: National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil.
authors.forename: Daniela C
authors.initials: DC
authors.lastname: Pereira
authors.affiliation: Institute of Geography, Federal University of Uberlandia, MG, Brazil.
authors.forename: Angélica
authors.initials: A
authors.lastname: Borges
authors.affiliation: Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Antunes
authors.affiliation: Spatial Epidemiology Laboratory, Federal University of Para, Castanhal, Para, Brazil.
authors.forename: Josafá G
authors.initials: JG
authors.lastname: Barreto
authors.affiliation: Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, MG, Brazil; National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, MG, Brazil.
authors.forename: Isabela Maria B
authors.initials: IM
authors.lastname: Goulart
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000276:immunology; D001938:Brazil / Q000453:epidemiology; D016358:Contact Tracing; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007918:Leprosy / Q000097:blood / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000276:immunology / Q000302:isolation & purification*; D062206:Spatial Analysis; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial
keywords: Epidemiology; Leprosy; Mycobacterium leprae; Serologic tests; Spatial analysis