Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

Introduction In 1993, Cuba achieved leprosy elimination according to the World Health Organization’s (WHO) indicator of less than one case per 10,000 population. Despite this achievement, detection of new cases occurs every year among all age groups including children. Detection of new cases in children reveals persistent transmission of the infection. Objective To describe the clinical and epidemiological features of leprosy in individuals younger than 15 years (childhood leprosy) reported to the Cuban National Leprosy Control Program (NLCP) between 2012 and 2019. Methods We conducted a retrospective descriptive study between 2012 and 2019 to assess the clinical and epidemiologic features of individuals under the age of 15 years with a confirmed diagnosis of leprosy reported to the NLCP. We reviewed the NLCP database and collected data to better define the total number of cases of leprosy in adults, children (younger than 15 years). We assessed socio-demographic variables (age, gender, and province of residence) as well as variables of clinical interest including operational classification and staging at diagnosis, bacillary index, grade of disability by WHO staging. Additionally, we evaluated epidemiological variables including passive versus active surveillance of cases, contact investigation focusing specifically in household transmission, and the degree of kinship as well as standing of the child within the focus of transmission when there were additional cases. Results We identified fifty children during the study period corresponding to 3% of the overall cases of leprosy comprising all age groups in Cuba. In the age group younger than 15 years, the majorities of cases was from the Granma province and most were between the ages of 10 and 14 years. Clinically, multibacillary/lepromatous forms were the most common type identified with positive bacillary index. The majority of children diagnosed with leprosy during our study period had a history of a relative with a confirmed diagnosis of leprosy. Conclusions Detection of cases of leprosy in individuals younger than 15 years of age in Cuba demonstrates ongoing transmission of M. leprae in specific geographic hotspots. Its frequency in the early adolescence, the predominant clinical forms, and the mode of detection associated with sources of suspected familiar infection demonstrated that there is a need for further efforts by the NLCP to conduct active surveillance activities among affected communities to identify cases of leprosy earlier with the goal of preventing further household and community transmission.

Structural Relation of Export Assistance Programme and Export Performance Determinants: A Study of Handloom Industry

This study focuses on export assistance determinants and qualitative export performance determinants of the handloom industry. Additionally, the effect of export assistance needs to check on export performance determinants. The study found the determinants from the extensive literature review. A model is proposed based on identified determinants, and the hypotheses developed accordingly. Initially, first-order CFA is applied for validity measures and then second-order CFA due to presence of multicollinearity among the determinants. Second-order CFA analyses the combined effect of all studied determinants with the help of structural equation modelling. The four determinants of export assistance and five determinants of export performance are identified from the extensive literature. The financial support construct influences the export assistance majorly that is represented through high correlation coefficient and mixed response for other determinants. Overall, the combined effect of export assistance is positive on export performance determinants. There is a need to establish the functions of various export assistances based on their characteristics, and this study helps in operational classification of assistance based on identified determinants. Additionally, the impact of individual assistance can measure the changes in the export performance determinants of the handloom industry.

Clinical - epidemiological aspects and spatial analysis of leprosy relapses in an endemic area of Brazil

Objective: to analyze the trend, spatial distribution and factors associated with leprosy recurrence in Sergipe. Methods: this is a population-based ecological study, using spatial analysis and logistic regression techniques. Data from all leprosy recurrences reported to SINAN (Notifiable Diseases Information System) in the state of Sergipe, Brazil, were used from 2007 to 2017. Results: there was a tendency for an increase in recurrences in the period from 2011 to 2017: APC: 14.69 (p-value = 0.003). The recurrence incidence map showed a heterogeneous behavior, with the Moran index (I = 0.16; p-value: 0.0159). The multivariate analysis showed a higher risk of recurrence in adults (aOR = 2.81) and young adults (aOR = 2.85) Conclusion: the risk factors associated with the appearance of recurrences are: the age group, the zone, the operational classification , the clinical form and the degree of disability.

Cases of leprosy notified in the municipality of Parnaíba, state of Piauí, Brazil, 2007-2016

This study aimed to describe the epidemiological and clinical characteristics of leprosy cases reported in the municipality of Parnaíba, State of Piauí. This was a cross-sectional study of leprosy cases, living in Parnaíba, State of Piauí, reported to the National System of Notifiable Diseases (SINAN), from 2007 to 2016. There were 582 cases of leprosy with hyperendemic detection in the general population in 2008, 2009 and 2016; and under < 15 years of age in 2008, 2014 and 2016, with a predominance of females (53.1%), brown (62.2%), aged 20-64 years (74.7%), complete and incomplete elementary school (56.4%), housewives (20.7%), living in the urban area (87.1%), reported by primary care (69.2%). The most frequent clinical and therapeutic findings were: multibacillary operational classification (53.8%); clinical forms: undetermined (30.6%) and virchowian (24.3%); single lesion (34.8%); no affected nerves (86.7%); degree of disability zero (70.6%); bacilloscopy not performed (26.7%); therapeutic regimen 12 doses (53.7%) and no reaction (70.8%). Regarding the mode of input, predominated new case (88.8%); mode of output, cure (87.9%) and detection mode: spontaneous demand (45.8%). Out of 2,106 registered contacts, 60.6% were examined. Leprosy is endemic to Parnaíba, State of Piauí. It is noteworthy that the hyperendemic detection rates occurred during years when there was intensification of active search for contacts and cases in the population.

Factors associated with cure and abandonment of leprosy treatment: A reflective analysis

To analyze trends, and the main socioeconomic and clinical factors related to treatment abandonment and the cure of leprosy in Sergipe. For the present study, data from all new cases of cure and abandonment of leprosy treatment notified by the health centers of the municipalities to the SINAN (Information System on Notifiable Diseases) in the state of Sergipe, Brazil, from 2007 to 2017, were used. This is an ecological study of cases of cure and abandonment of leprosy treatment, rates were calculated based on the "Guidelines for surveillance, care and elimination of leprosy as a public health problem".using time-series analysis and multivariate logistic regression. Concerning multivariate regression, the young age group presents a higher risk for quitting the treatment (p = 0.429; OR = 2.75). Blacks/browns/indigenous were more likely to abandon treatment (p = 0.482; OR = 1.69), as well as multibacillary individuals (p = 0.541; OR = 2.26). Regarding the cure, the young age group has less chances of cure (OR = 0.34). The same happens for the operational classification; the multibacillary patients have a lower chance of cure (OR = 0.35). Finally, individuals with grade 2 of physical disability are less likely to be cured (OR = 0.54). Health services are noticeably weak, especially when it comes to clinical factors associated with treatment abandonment and a low proportion of cure. Multibacillary (Borderline and Lepromatous) are responsible for the active transmission of leprosy.

Exploratory analysis based on leprosy epidemiological and operational indicators in the city of Governador Valadares/MG/Brazil

Governador Valadares (GV) is a municipality of recognized leprosy hyperendemicity. From 2001 to 2010, the municipal health management invested in a heterogeneous way in the decentralization of control actions to expand access to diagnosis, highlighting the years 2002 and 2004, when training-campaigns took place in the Family’s Health Program. It is an epidemiological study, of a descriptive nature, of a longitudinal type, developed in the city of GV/Minas Gerais/Brazil. The variables collected were: Age group, categorized as <15 years and> 15 years; Gender; Year of notification; Operational classification categorized as paucibacillary and multibacillary; Number of registered household and outside contacts, classified by whole numbers starting with zero (no communications), and mode of entry, as new or not. The estimates obtained from the analysis of municipal indicators reveal that the coefficients of general detection and children under 15 years old remained at hyperendemic levels during the ten years of study with an apparent decrease in general detection to the period studied. Furthermore, according to national parameters, it was observed maintenance of a consistent number of diagnoses in children under 15 and insufficient contact examination coverage. Our study points to the importance of continuing leprosy control actions over time. Observing the findings related to some epidemiological and operational leprosy indicators in GV from 2001 to 2010 makes us aware of a high disease burden. Keywords: Epidemiological parameters, leprosy, operational indicators

The Composition and Concordance of Lactobacillus Populations of Infant Gut and the Corresponding Breast-Milk and Maternal Gut

The maternal gut is the principal source of commensal bacteria in the infant gut during the lactation stage, where breast milk acts as an intermediary for the transfer of potential probiotic bacteria consortia, including Lactobacillus. This study aimed to characterize the bacterial communities in human milk, maternal, and infant feces in a small yet very homogeneous cohort of 25 healthy mother–infant pairs in northwestern China (n = 25, infant age from 7 days to 2 years), with special emphasis on the cooccurrence and vertical transfer of Lactobacillus phylotypes at the species or strain level in mother-breast milk-infant triads. Accurate sequencing analysis revealed that among 73 Lactobacillus zero-radius operational classification units (ZOTUs) identified, 58 belonging to 18 recognized species or species groups were distributed in all three types of samples. Lactobacillus ruminis, L. mucosae and L. gasseri-johnsonii as true residents were the most represented in all three ecosystems, whereas the content of Lactobacillus phylotypes commonly developed as probiotics was not dominant. While the numbers of Lactobacillus species in breast milk and infant feces were greater than that in maternal feces, principal coordinates analysis (PCoA) based on beta diversity, coupled with the frequency of isolates determined by culture methods, showed that the Lactobacillus community in the infant gut was more similar to that in the maternal gut than to that in breast milk, suggesting that the gut is niche selective for Lactobacillus populations. In addition, identical strains of L. ruminis, L. paracasei, L. mucosae and L. salivarius were isolated from multiple mother–infant pairs, supporting the hypothesis that vertical transfer of bacteria via breastfeeding contributes to the initial establishment of the microbiota in the developing infant intestine.

Temporal analysis of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil: 2001-2013

The study carried out a temporal analysis and description of the epidemiological profile of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil, from 2001 to 2013. It was a temporal study based on secondary data from the Notifiable Diseases Information System (SINAN). In this study, the variables were analyzed: municipality of residence; number of cases diagnosed per year from 2001 to 2013; age; schooling; race / skin color; operational classification (paucibacillary or multibacillary); clinical form (indeterminate, tuberculoid, dimorphic, virchowian); and degree of disability, assessed at the time of notification and upon medical discharge: Degrees 0, I and II. The data were plotted in a spreadsheet (Microsoft Excel ©) and subsequently analyzed according to the descriptive statistical measure of association and the adhesion test was measured by the Bioestat 5.0 software. For the time trend analysis, it adopted the simple polynomial regression model, the variable time centralization to avoid autocorrelation between the terms of the equations. It was detected a total of 3,519 cases in Aracaju region. The predominant form paucibacillar. Clinical tuberculoid form of leprosy was the most frequent. The temporal analysis showed a declining trend to statistical significance (p <0.05). The multibacillary predominated in the municipalities of Barra dos Coqueiros and Our Lady of Socorro. The results showed that the population did not have access to adequate health program and the Ministry of Health's strategies did not meet the goal of WHO for the elimination of leprosy.

Epidemiological and spatial characterization of leprosy in Aracaju, Sergipe, Brazil

Leprosy is a chronic infection, being considered a serious public health problem due to its magnitude and high disabling potential. In this perspective, this study aimed to analyze the epidemiological profile of leprosy patients and spatial characteristics of the disease in Aracaju, Sergipe, Brazil. This was an ecological, descriptive and analytical study of 559 leprosy patients from Aracaju, from 2011 to 2015. All information was obtained from Information System for Notifiable Injuries, Ministry of Health of Brazil. Descriptive and analytical statistical analyzes and spatial characterization methods were used. A decreasing tendency in the detection of leprosy cases during the study period was observed, with the relative frequency going from 23% (n = 129) in 2011 to 14.5% (n = 81) in 2015. The tuberculoid form was the most common (28.2%, n = 158), followed by dimorphic (24.5%, n = 137), undetermined (21.5%, n = 120) and lepromatous (20.6%; n = 115). The multibacillary operational classification also corresponded to the majority of notifications (52.4%, n = 293), with the associated factors age ≥ 16 years (OR = 2.42, 95% CI = 1.12-5.25) and male gender (OR = 2.74, 95% CI = 1.94-3.86) (p <0.05). A high risk cluster for the illness and the higher density of the mean detection incidence by the Kernel estimate was more concentrated in the central-northern portion of Aracaju. Statistical analysis allowed a better understanding of the epidemiological profile of leprosy patients and the identification of critical areas for illness and spread of the disease.