Evaldo Pinheiro Amaral

Análise espacial da Hanseníase na microrregião de Almenara, MG, Brasil

A hanseniase ainda e considerada um problema de saude publica no Brasil. O objetivo deste estudo e analisar a situacao epidemiologica da hanseniase na microrregiao de Almenara/MG segundo sua distribuicao espacial e suas relacoes com as condicoes socioeconomicas da populacao. Trata-se de um estudo ecologico. Os resultados colocam a microrregiao como uma area hiperendemica e indicam que os servicos de saude nao estao sendo capazes de detectar todos os casos existentes, contribuindo para manter a cadeia de transmissao da doenca. A analise espacial identificou dois clusters, sendo um com coeficientes de deteccao acima e outro abaixo do esperado. Acredita-se que os resultados obtidos servirao para balizar a elaboracao e implementacao de medidas de prevencao e controle da hanseniase na regiao.Hansens disease is still considered a public health problem in Brazil. The objective of this ecological study is to analyze the epidemiological status of Hansens disease in the microregion of Almenara, State of Minas Gerais, according to its spatial distribution and its relations with the socioeconomic conditions of the population. The results of this study classify the microregion as a hyperendemic area and indicate that the health services are not capable of detecting all existing cases, thus contributing to the maintenance of the disease transmission chain. The spatial analysis identified two clusters, one with detection coefficients above and the other below those expected. It is believed that the results of the study will help to establish guidelines for the development and implementation of prevention and control measures for Hansens disease in the region.

Toll-like Receptor 1 N248S Single-Nucleotide Polymorphism Is Associated With Leprosy Risk and Regulates Immune Activation During Mycobacterial Infection

Conflicting findings about the association between leprosy and TLR1 variants N248S and I602S have been reported. Here, we performed case-control and family based studies, followed by replication in 2 case-control populations from Brazil, involving 3162 individuals. Results indicated an association between TLR1 248S and leprosy in the case-control study (SS genotype odds ratio [OR], 1.81; P = .004) and the family based study (z = 2.02; P = .05). This association was consistently replicated in other populations (combined OR, 1.51; P < .001), corroborating the finding that 248S is a susceptibility factor for leprosy. Additionally, we demonstrated that peripheral blood mononuclear cells (PBMCs) carrying 248S produce a lower tumor necrosis factor/interleukin-10 ratio when stimulated with Mycobacterium leprae but not with lipopolysaccharide or PAM3cysK4. The same effect was observed after infection of PBMCs with the Moreau strain of bacillus Calmette-Guerin but not after infection with other strains. Finally, molecular dynamics simulations indicated that the Toll-like receptor 1 structure containing 248S amino acid is different from the structure containing 248N. Our results suggest that TLR1 248S is associated with an increased risk for leprosy, consistent with its hypoimmune regulatory function.

Hanseníase em menores de 15 anos no Vale do Jequitinhonha, Minas Gerais, Brasil

Hansens disease has a slow evolution, which mostly affects the adult population. Detecting cases in children shows that the endemic continues and there is early exposure of the population to the bacillus. This is an ecological study with the objective of analyzing the occurrence of Hansens disease in children under fifteen in the Jequitinhonha Valley through epidemiological and operational indicators. The results show that the endemic continues in the region, demonstrating that the health services are not proactive and must implement specific prevention and control measures for this age group in order to reduce the transmission of the disease and the possible damage it can bring to the life of individuals, especially when it affects them in their childhood.Hansen’s disease has a slow evolution, which mostly affects the adult population. Detecting cases in children shows that the endemic continues and there is early exposure of the population to the bacillus. This is an ecological study with the objective of analyzing the occurrence of Hansen’s disease in children under fifteen in the Jequitinhonha Valley through epidemiological and operational indicators. The results show that the endemic continues in the region, demonstrating that the health services are not proactive and must implement specific prevention and control measures for this age group in order to reduce the transmission of the disease and the possible damage it can bring to the life of individuals, especially when it affects them in their childhood. Descriptors: Leprosy; Epidemiology, descriptive; Prevention & control.

Desenvolvimento de incapacidades físicas decorrentes da hanseníase no Vale do Jequitinhonha, MG

A hanseniase e doenca potencialmente incapacitante. Objetivou-se descrever e analisar a ocorrencia de incapacidades fisicas nos casos de hanseniase da populacao residente no Vale do Jequitinhonha, MG, no periodo de 1998-2006. Trata-se de estudo epidemiologico descritivo. Os dados foram coletados das Fichas de Notificacao de Hanseniase. As informacoes foram processadas no software EPI-INFO, analisadas tendo como referencia os indicadores recomendados pelo Ministerio da Saude e a forca de associacao entre as variaveis (razao de prevalencias). Dos 1 461 casos notificados no periodo, 46,2% foram diagnosticados com alguma incapacidade fisica (12,1% no grau II). Desses, 59,1% eram do sexo masculino; 96,9% em maiores de 15 anos e 93,2% eram multibacilares (valor de p<0,001). Estimou-se prevalencia oculta de 433 casos no periodo de 2002 a 2006. Os resultados evidenciam que o diagnostico da hanseniase nessa regiao esta sendo tardio e apontam para a necessidade de intensificacao das estrategias de prevencao e controle.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansen’s disease in the region is late, revealing the need to intensify prevention and control.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansens disease in the region is late, revealing the need to intensify prevention and control.

Association of IL10 Polymorphisms and Leprosy: A Meta-Analysis

Leprosy is a chronic infectious disease that depends on the interplay of several factors. Single nucleotide polymorphisms (SNPs) in host immune related genes have been consistently suggested as participants in susceptibility towards disease. Interleukin-10 (IL-10) is a crucial immunomodulatory cytokine in mycobacterial pathogenesis and especially the -819C>T SNP (rs1800871) has been tested in several case-control studies indicating association with leprosy risk, although a recent consensus estimate is still missing. In this study, we evaluated the association of the -819C>T SNP and leprosy in two new Brazilian family-based populations. Then, we performed meta-analysis for this polymorphism summarizing published studies including these Brazilian family-based groups. Finally, we also retrieved published studies for other distal and proximal IL10 polymorphisms: -3575 T>A (rs1800890), -2849 G>A (rs6703630), -2763 C>A (rs6693899), -1082 G>A (rs1800896) and -592 C>A (rs1800872). Results from meta-analysis supported a significant susceptibility association for the -819T allele, with pooled Odds Ratio of 1.22 (CI = 1.11–1.34) and P-value = 3x10–5 confirming previous data. This result remained unaltered after inclusion of the Brazilian family-based groups (OR = 1.2, CI = 1.10–1.31, P-value = 2x10–5). Also, meta-analysis confirmed association of -592 A allele and leprosy outcome (OR = 1.24, CI = 1.03–1.50, P-value = 0.02). In support of this, linkage disequilibrium analysis in 1000 genomes AFR, EUR, ASN and AMR populations pointed to r2 = 1.0 between the -592C>A and -819C>T SNPs. We found no evidence of association for the other IL10 polymorphisms analyzed for leprosy outcome. Our results reinforce the role of the -819C>T as a tag SNP (rs1800871) and its association with leprosy susceptibility.

Hansen's Disease in children under fifteen years-old in Jequitinhonha Valley, Minas Gerais, Brazil

Hansens disease has a slow evolution, which mostly affects the adult population. Detecting cases in children shows that the endemic continues and there is early exposure of the population to the bacillus. This is an ecological study with the objective of analyzing the occurrence of Hansens disease in children under fifteen in the Jequitinhonha Valley through epidemiological and operational indicators. The results show that the endemic continues in the region, demonstrating that the health services are not proactive and must implement specific prevention and control measures for this age group in order to reduce the transmission of the disease and the possible damage it can bring to the life of individuals, especially when it affects them in their childhood.Hansen’s disease has a slow evolution, which mostly affects the adult population. Detecting cases in children shows that the endemic continues and there is early exposure of the population to the bacillus. This is an ecological study with the objective of analyzing the occurrence of Hansen’s disease in children under fifteen in the Jequitinhonha Valley through epidemiological and operational indicators. The results show that the endemic continues in the region, demonstrating that the health services are not proactive and must implement specific prevention and control measures for this age group in order to reduce the transmission of the disease and the possible damage it can bring to the life of individuals, especially when it affects them in their childhood. Descriptors: Leprosy; Epidemiology, descriptive; Prevention & control.

Physical disabilities resulting from hansen's disease in Vale do Jequitinhonha/State of Minas Gerais, Brazil

A hanseniase e doenca potencialmente incapacitante. Objetivou-se descrever e analisar a ocorrencia de incapacidades fisicas nos casos de hanseniase da populacao residente no Vale do Jequitinhonha, MG, no periodo de 1998-2006. Trata-se de estudo epidemiologico descritivo. Os dados foram coletados das Fichas de Notificacao de Hanseniase. As informacoes foram processadas no software EPI-INFO, analisadas tendo como referencia os indicadores recomendados pelo Ministerio da Saude e a forca de associacao entre as variaveis (razao de prevalencias). Dos 1 461 casos notificados no periodo, 46,2% foram diagnosticados com alguma incapacidade fisica (12,1% no grau II). Desses, 59,1% eram do sexo masculino; 96,9% em maiores de 15 anos e 93,2% eram multibacilares (valor de p<0,001). Estimou-se prevalencia oculta de 433 casos no periodo de 2002 a 2006. Os resultados evidenciam que o diagnostico da hanseniase nessa regiao esta sendo tardio e apontam para a necessidade de intensificacao das estrategias de prevencao e controle.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansen’s disease in the region is late, revealing the need to intensify prevention and control.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansens disease in the region is late, revealing the need to intensify prevention and control.

Spacial analysis of Leprosy in the microregion of Almenara, MG, Brazil

A hanseniase ainda e considerada um problema de saude publica no Brasil. O objetivo deste estudo e analisar a situacao epidemiologica da hanseniase na microrregiao de Almenara/MG segundo sua distribuicao espacial e suas relacoes com as condicoes socioeconomicas da populacao. Trata-se de um estudo ecologico. Os resultados colocam a microrregiao como uma area hiperendemica e indicam que os servicos de saude nao estao sendo capazes de detectar todos os casos existentes, contribuindo para manter a cadeia de transmissao da doenca. A analise espacial identificou dois clusters, sendo um com coeficientes de deteccao acima e outro abaixo do esperado. Acredita-se que os resultados obtidos servirao para balizar a elaboracao e implementacao de medidas de prevencao e controle da hanseniase na regiao.Hansens disease is still considered a public health problem in Brazil. The objective of this ecological study is to analyze the epidemiological status of Hansens disease in the microregion of Almenara, State of Minas Gerais, according to its spatial distribution and its relations with the socioeconomic conditions of the population. The results of this study classify the microregion as a hyperendemic area and indicate that the health services are not capable of detecting all existing cases, thus contributing to the maintenance of the disease transmission chain. The spatial analysis identified two clusters, one with detection coefficients above and the other below those expected. It is believed that the results of the study will help to establish guidelines for the development and implementation of prevention and control measures for Hansens disease in the region.

Desarrollo de incapacidades físicas resultantes de la enfermedad de hansen en el Valle de Jequitiñoña, MG

A hanseniase e doenca potencialmente incapacitante. Objetivou-se descrever e analisar a ocorrencia de incapacidades fisicas nos casos de hanseniase da populacao residente no Vale do Jequitinhonha, MG, no periodo de 1998-2006. Trata-se de estudo epidemiologico descritivo. Os dados foram coletados das Fichas de Notificacao de Hanseniase. As informacoes foram processadas no software EPI-INFO, analisadas tendo como referencia os indicadores recomendados pelo Ministerio da Saude e a forca de associacao entre as variaveis (razao de prevalencias). Dos 1 461 casos notificados no periodo, 46,2% foram diagnosticados com alguma incapacidade fisica (12,1% no grau II). Desses, 59,1% eram do sexo masculino; 96,9% em maiores de 15 anos e 93,2% eram multibacilares (valor de p<0,001). Estimou-se prevalencia oculta de 433 casos no periodo de 2002 a 2006. Os resultados evidenciam que o diagnostico da hanseniase nessa regiao esta sendo tardio e apontam para a necessidade de intensificacao das estrategias de prevencao e controle.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansen’s disease in the region is late, revealing the need to intensify prevention and control.Leprosy is potentially debilitating. The present study aims at describing and assessing the occurrence of physical disabilities in cases of leprosy in the population of the Vale do Jequitinhonha/MG, in the period 1998-2006. It is an epidemiological descriptive study and the data were collected from the Leprosy Notification Forms. This information was processed using EPI-INFO and analyzed, based on the indicators recommended by the Ministry of Health and the force of association between variables. Of the 1461 cases notified, 46.2% were diagnosed with some kind of physical disability (12.1% degree II). Of these, 59.1% were male; 96.9% of the people were over 15 years old, and 93.2% were multibacillary (p < 0.001). A hidden prevalence of 433 cases was estimated in the period 2002-2006. The results show that the diagnosis of Hansens disease in the region is late, revealing the need to intensify prevention and control.

Análisis espacial de la Lepra en la microregión de Almenara, MG, Brasil

A hanseniase ainda e considerada um problema de saude publica no Brasil. O objetivo deste estudo e analisar a situacao epidemiologica da hanseniase na microrregiao de Almenara/MG segundo sua distribuicao espacial e suas relacoes com as condicoes socioeconomicas da populacao. Trata-se de um estudo ecologico. Os resultados colocam a microrregiao como uma area hiperendemica e indicam que os servicos de saude nao estao sendo capazes de detectar todos os casos existentes, contribuindo para manter a cadeia de transmissao da doenca. A analise espacial identificou dois clusters, sendo um com coeficientes de deteccao acima e outro abaixo do esperado. Acredita-se que os resultados obtidos servirao para balizar a elaboracao e implementacao de medidas de prevencao e controle da hanseniase na regiao.Hansens disease is still considered a public health problem in Brazil. The objective of this ecological study is to analyze the epidemiological status of Hansens disease in the microregion of Almenara, State of Minas Gerais, according to its spatial distribution and its relations with the socioeconomic conditions of the population. The results of this study classify the microregion as a hyperendemic area and indicate that the health services are not capable of detecting all existing cases, thus contributing to the maintenance of the disease transmission chain. The spatial analysis identified two clusters, one with detection coefficients above and the other below those expected. It is believed that the results of the study will help to establish guidelines for the development and implementation of prevention and control measures for Hansens disease in the region.