02853nas a2200337   4500000000100000008004100001100001400042700001500056700001400071700001500085700002500100700001300125700001400138700001300152700001300165700001500178700001600193700001600209700001300225700001500238700001500253700001300268700001200281700001600293245007200309856007800381300001300459490000700472520202200479022001402501       2017                            d1 aRamos ACV1 aYamamura M1 aArroyo LH1 aPopolin MP1 aChiaravalloti Neto F1 aPalha PF1 aUchoa SAC1 aPieri FM1 aPinto IC1 aFiorati RC1 aQueiroz AAR1 aBelchior AS1 aSantos D1 aGarcia MCC1 aCrispim JA1 aAlves LS1 aBerra T1 aArcêncio R00aSpatial clustering and local risk of leprosy in São Paulo, Brazil.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005381  ae00053810 v113 a<p><strong>BACKGROUND: </strong>Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method.</p>

<p><strong>METHODS: </strong>Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed.</p>

<p><strong>RESULTS: </strong>A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919).</p>

<p><strong>CONCLUSION: </strong>These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.</p>
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