02607nas a2200289   4500000000100000008004100001653001300042653001300055653000800068100001400076700001500090700002100105700001300126700001300139700001800152700001300170700002400183700001400207700001300221700001500234245008800249856005800337300001100395490000700406520189000413022001402303       2015                            d10aSerology10aChildren10aAge1 aBarreto J1 aBisanzio D1 aCipriani Frade M1 aMoraes T1 aGobbo AR1 aGuimarães LS1 aSilva MB1 aVazquez-Prokopec GM1 aSpencer J1 aKitron U1 aSalgado CG00aSpatial epidemiology and serologic cohorts increase the early detection of leprosy.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647818/   ap. 5270 v153 a<p><strong>Editor's Abstract: </strong></p>

<p>BACKGROUND:<strong> </strong>Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children.</p>

<p>METHODS:<strong> </strong>We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups.</p>

<p>RESULTS:<strong> </strong>Leprosy was detected in 11 (8.2&nbsp;%) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p &lt; .05) compared to our previous findings in randomly selected schools (63/1592; 3.9&nbsp;%). The 2-year follow-up results showed that 22.3 and 9.4&nbsp;% of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p &lt; .01), indicating that a follow-up of 10 seropositives has a &gt;90&nbsp;% probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in "positive houses" compared to "negative houses" (p &lt; .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85&nbsp;% probability to detect at least one new case in 2&nbsp;years.</p>

<p>CONCLUSIONS:<strong> </strong>Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.</p>
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