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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.86 no.3 Rio de Janeiro May/June 2011
SBD-RESP in active search for leprosy cases*
Joel Carlos LastóriaI; Marilda Aparecida Milanez Morgado de AbreuII
IFaculty Member - Professor (PhD), Department of Dermatology and Radiotherapy, Botucatu Medical School - São Paulo State University (UNESP) - Botucatu (SP), Brazil
IIPhD - Professor of Dermatology at Universidade do Oeste Paulista (UNOESTE) and Head of the Dermatology Service at Hospital Regional de Presidente Prudente - São Paulo (SP), Brazil
BACKGROUND: The Brazilian Society of Dermatology of the State of Sao Paulo (SBD-RESP), supported by the Sao Paulo State Foundation Against Leprosy and acting jointly with Sao Paulo State Services of Dermatology, accredited by the Brazilian Society of Dermatology, launched the campaign "SBD-RESP in active search for leprosy cases".
OBJECTIVES: To assist the National Leprosy Control Program in eliminating Hansen's disease.
METHODS: All of the Sao Paulo State Services of Dermatology, accredited by the Brazilian Society of Dermatology, were invited to join the campaign. The 17 Services which accepted to participate received a spreadsheet of data and models of informative materials about the disease. The campaign lasted from May to July 2010. At the end of the campaign, each Service sent the spreadsheet data for statistical analysis.
RESULTS: 1,718 people were examined and 90 cases of Hansen's disease were diagnosed. Most of the individuals infected were male and white and presented similar percentages of multibacillary and paucibacillary groups. Twelve percent had a family history of leprosy. The highest number of cases was detected in Sao Paulo city, followed by the region of Presidente Prudente, located in the countryside of Sao Paulo State. The detection rate in children younger than 15 years old was 4%.
CONCLUSION: The campaign results show the importance of the SBD-RESP initiative. It is suggested that similar actions be repeated and extended to other regional offices of the Brazilian Society of Dermatology.
Keywords: Communicable disease prevention; Diagnosis; Epidemiology; Leprosy;
The prevalence of leprosy registered by the World Health Organization at the end of the first quarter of 2010 was 38,179 cases in Brazil, with 37,610 new cases detected in 2009. Of these cases, 21,414 were multibacillary and 2,669 affected children younger than 15 years old.1 The strategy of the National Leprosy Control Program (PNCH) is based on early detection and prompt treatment of new cases in order to eliminate sources of infection and prevent sequelae. Integrated services and partnerships sustain actions to control the endemic disease. 2
The Brazilian Society of Dermatology of the State of São Paulo (SBD-RESP), supported by the São Paulo State Foundation Against Leprosy and acting jointly with the São Paulo State Services of Dermatology, accredited by the Brazilian Society of Dermatology, launched the campaign "SBD-RESP in active search for leprosy cases", with the aim of helping to eliminate the disease.
All Services of Dermatology in the state of São Paulo, accredited by the Brazilian Society of Dermatology, were invited to participate by means of a letter. The 17 Services that participated in the campaign received a data spreadsheet, elaborated for the campaign, and models of informative material about the disease, which were donated by the São Paulo State Health Secretariat. The advertisement of the campaign was advised by a communications company hired by the SBD-RESP. Each Head of Service appointed a local coordinator, who was responsible for conducting the campaign in the Service. The campaign was carried out in a personalized way in each Service between the months of May and July 2010. At the end of this time period, each Service sent the spreadsheet with data on the respective observed cases for statistical analysis.
A total of 1,718 people were examined. The results of the analysis in terms of the number of people examined per region of the state of São Paulo and respective accredited Services are found in Chart 1.
It is observed from Table 1 that the Service in São Jose do Rio Preto examined the largest number of people (25% of the total).
Among the people examined, there were predominantly females (61%) compared to males (39%). Of these individuals, 59% were white, 33% were mixed-raced (pardo), 7% were black and 1% was yellow (East Asians). In terms of age, 6% were younger than 14 years old, 15% were between 15 and 30 years old, 22% were between 31 and 45, 30% were between 46 and 60 and 27% were older than 61. Ninety percent of these individuals had no family history of leprosy.
In total, 90 cases of leprosy were diagnosed, 59% of males and 41% of females; of these 61% were white, 31% were mixed-raced (pardo), 6% were black and 2% were yellow (East Asians). Twelve percent had a family history of leprosy. The percentage of diagnosed cases according to age and clinical form of the disease are presented in Graphs 1 and 2 respectively.
Chart 2 shows the results of the analysis regarding number of diagnosed cases per region of the state of São Paulo and its respective accredited Services. The percentage of cases detected per region in the state of São Paulo can be seen in Graph 3.
Figure 1 illustrates the distribution of the number of leprosy cases detected during the campaign on the map of the state of São Paulo.
The Southeast region of Brazil has already achieved the goal of elimination of leprosy (prevalence rate in 2005: 0.60 per 10,000 inhabitants); however, the distribution of the disease, as in the entire country, is uneven in the areas of this region, including São Paulo state. 3 The detection rate of new cases in this state was 5.21 per 100,000 inhabitants in 2008, with 2,318 registered cases, 4 downward trend, and a rate below that of Brazil and the Southeast region.5 The majority ( 42%) of the municipalities present detection rates lower than 2 cases/100,000 inhabitants, but 25% still have high endemicity. The municipalities in areas bordering the states of Mato Grosso do Sul, Minas Gerais and Parana are in this situation, with President Venceslau in first place, followed by Caraguatatuba and Jales. 4 Other municipalities with high rates are Araçatuba, Barretos and Presidente Prudente. In accordance with these data, the campaign detected a large number of cases in the region of Presidente Prudente, but also showed high rates in sectors of the capital, noticeably 19 cases diagnosed by the Service of the Clinics Hospital of the Medicine College of the University of São Paulo during an action carried out in the Community of Brasilândia.
As observed in Brazil, the distribution of cases detected during the campaign was greater among males and the percentage of multibacillary and paucibacillary reached similar levels. The percentage of detection in children younger than 15 years old was 4%, similar to the rate of 3.8% reported in the state of São Paulo in 2007. 2
The 90 cases detected, besides the possible existence of additional cases among household contacts, show the importance of the SBD-RESP initiative. The Services of Dermatology, accredited by the Brazilian Society of Dermatology, have a large number of highly skilled dermatologists apt to diagnose leprosy. It is suggested that similar actions be undertaken in the future by the subsequent administrations of the SBD- RESP and that they be extended to other regional offices of the Brazilian Society of Dermatology.
The SBD- RESP thanks the dedication of various collaborators from the participating Services of Dermatology whose contribution to the health of the Brazilian population was inestimable. It also thanks the support of the São Paulo State Foundation Against Leprosy, the São Paulo State Secretariat of Health for donating the models of informative material on leprosy, and Ms. Deise Silva de Lira Marques and Mr. Dirceu Arantes Filho for their technical support to the campaign.
This report by the Brazilian Society of Dermatology of the State of São Paulo shows the results of the campaign "SBD-RESP in active search for leprosy cases," carried out by the accredited Services of Dermatology of this state during the 2010 administration of the SBD-RESP. It was drafted by the coordinators of the campaign, Dr. Marilda Aparecida Milanez Morgado de Abreu and Dr. Joel Carlos Lastória.
Brazilian Society of Dermatology of the State of São Paulo (SBD-RESP), Management 2010
President: Joel Carlos Lastória
Vice President: Flavia Addor
Secretary: Sergio Henrique Hirata
Treasurer: Sergio Schalka
Scientific Coordinator: Mauro Enokihara
Communications Coordinator: Francisco M. Paschoal
Campaign Coordinators: Marilda Aparecida Milanez Morgado de Abreu and Carlos Joel Lastória
1. World Health Organization [Internet]. Global leprosy situation, 2010. Weekly Epidemiological Record. 2010[cited 2011 May 05];85:337-48. Available from: http://www.who.int/wer/2010/wer8535.pdf [ Links ]
2. Ministério da Saúde. Vigilância em Saúde: situação epidemiológica da hanseníase no Brasil; 2008 [acesso 15 Jul 2010]. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/boletim_novembro.pdf. [ Links ]
4. Ministério da Saúde. Sistema Nacional de Vigilância em Saúde Relatório de Situação. Brasília-DF; 2009. [acesso 03 Maio 2010]. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/003_sp_relatorio_de_situacao.pdf [ Links ]
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Received on 03.03.2011.
Approved by the Advisory Board and accepted for publication on 03.03.11.
Conflict of interest: None
Financial funding: Coordinated by the Brazilian Society of Dermatology, São Paulo State (RESP-SBD) and Paulista Foundation Against Leprosy, Health Secretariat of São Paulo State.
* Work conducted at the Brazilian Society of Dermatology of the State of São Paulo (SBD-RESP) - São Paulo (SP), Brazil.