Geospatial analysis of individuals with suspected diagnosis of leprosy and positive qPCR in an endemic region of Minas Gerais

Geospatial analysis of individuals with suspected diagnosis of leprosy and positive qPCR in an endemic region of Minas Gerais | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Geospatial analysis of individuals with suspected diagnosis of leprosy and positive qPCR in an endemic region of Minas Gerais Marcos Daniel Silva Pinheiro, Nathan Guilherme Oliveira, Vladmir Machado Rios, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5318795/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : to evaluate the geographic distribution of individuals with a suspected leprosy diagnosis (SLD) presenting a positive qPCR test residing in Governador Valadares/MG. Methods : Between 2017 and 2021, dermal scraping samples were collected from the earlobes, elbows, and lesions of 200 individuals with SLD examined in CREDEN-PES. A geospatial analysis estimated the coverage of health units. Results : It was found that 108 (54.0%) of the participants were female, with an average age of 55 years, and the majority lived in the urban area of the municipality. The qPCR test was positive in 94 (47.0%) samples evaluated, of which 49 (52.1%) were from female individuals and 45 (47.9%) were males. A heterogeneous distribution of individuals who presented a positive qPCR test in the municipality was observed. However, in the sectors with the highest number of individuals with SLD and positive in the qPCR test, there was a predominance of female, literate, black, or mixed-race residents. Furthermore, 58.8% of individuals with SLD and positive in the qPCR test did not have coverage at a health facility. Conclusion : The lack of health unit coverage in places with more SLD and qPCR-positive individuals indicates the need to expand this coverage and implement active search, diagnostic suspicion, and treating leprosy in Primary Care. This would facilitate user access to the nearest. Health service, thus making Secondary Care (CREDEN-PES) available to perform its role as a Specialized unit . Leprosy Geospatial analysis qPCR diagnosis Figures Figure 1 Figure 2 Figure 3 Background Leprosy is a chronic infectious disease that affects women and men at any age. Its etiological agent is Mycobacterium leprae ( M. leprae )[ 1 ] or Mycobacterium lepromatosis (M. lepromatosis ) [ 2 ], which are mainly tropical for Schwann cells[ 3 , 4 ]. When a diagnosis occurs late, individuals can develop leprosy-related physical disabilities (PD), making this disease a significant public health problem, especially in developing countries in Latin America, Africa, and Asia[ 5 , 6 ]. According to the World Health Organization (WHO), 127,396 new cases of leprosy have been reported worldwide. Of these, 17,979 were reported in Brazil, which corresponds to 93.6% of the number of new cases in the Americas. Brazil is second among the countries with the highest number of cases, behind India [ 7 ]. Therefore, the Brazilian Ministry of Health (MoH) has been making efforts to reduce the burden of the disease in the country through early diagnosis and timely treatment[ 8 ], especially in endemic regions such as the state of Minas Gerais (MG). In 2020, 471 (44.2%) cases already had a degree of FI at the time of diagnosis; in 2021, this number increased to 535 (46.6%), which represents a percentage increase of 13.5% [ 9 ]. Data from the Ministry of Health for the municipality of Governador Valadares, located in the eastern region of Minas Gerais, between 2017 and 2021 show that the city reported an average of 67.2 cases per year, which classifies it as hyperendemic (> 20.00 to 39.99 cases per 100,000 inhabitants). Of the instances notified, 33.6% already had some degree of PD at diagnosis. The detection rate in children under 15 was 8.35% [ 9 ] indicating that new cases are detected late and, therefore, the need to adopt active search strategies [ 10 ]. Many studies have explored the qPCR technique in leprosy and have successfully identified undiagnosed cases or disease outbreak sites that would go unnoticed by conventional techniques[ 11 , 12 , 13 ]. These methods stand out for their high specificity and sensitivity in identifying bacillary DNA in clinical samples. Over the last three decades, advances in the qPCR technique have enabled the development of different approaches to amplify various genetic targets of M. leprae [ 14 ]. The RLEP gene has been recognized for its remarkable sensitivity and specificity for M. leprae , detecting even ten fg of purified DNA from the bacterium[ 15 , 16 ]. At the same time, spatial epidemiology techniques have also significantly contributed to early diagnosis. This is because, in endemic countries such as Brazil, there are differences in the spatial distribution of the disease between regions, states, and especially in the case of municipalities, where the differences are manifested between interurban spaces, being focused on places of greater social inequality and accessibility to health services[ 16 – 21 ]. According to the World Health Organization (WHO, 2004), geospatial analysis is an efficient administrative tool in the leprosy elimination program, and its use is recommended in all endemic countries[ 16 , 22 ]. Thus, this study aimed to analyze the geographical distribution of individuals with suspected leprosy diagnosis (SLD) who were evaluated by the qPCR test and living in the municipality of Governador Valadares/ MG. The sociodemographic aspects of residents in the areas with the highest frequency of positive tests were also considered. Methods Study design This cross-sectional study uses laboratory and sociodemographic data from individuals with SLD seen at the Endemic Diseases Reference Center (CREDEN-PES) in Governador Valadares/MG between January 2017 and July 2021. Dermal scraping samples were collected from the earlobes, elbows, and lesions of 200 individuals with SLD, which were seen at CREDEN-PES. These individuals were referred by other health services, by spontaneous demand, were contacts of an index case, or came from active search actions and had not been diagnosed with leprosy at the time of the study. Location of the study Figure 1 shows the municipality of Governador Valadares, located in the east of the state of Minas Gerais in the southeastern region of Brazil. According to data from the Brazilian Institute of Geography and Statistics (IBGE), in 2022, the municipality had an estimated population of 257,171 individuals, of which 253,300 were distributed in 183 neighborhoods [ 23 ]. At the time of the study, the municipality had a Health Care Department (DAS) responsible for organizing primary and secondary health care. Primary Health Care (PHC) is the user's preferred gateway to the Unified Health System (SUS), which in Governador Valadares was made up of 61 Family Health Teams (ESF), 10 Basic Health Units (UBS), and 11 Family Health Support Centers (NASF). Among the secondary services is the Reference Center for Endemic Diseases and Special Programs (CREDEN-PES), which aims to provide specialized care for leprosy, tuberculosis, and leishmaniasis. This service receives individuals referred from primary services, other secondary care services, the private sector (hospitals and medical clinics) and those on spontaneous demand. A multi-professional team monitors all patients and their contacts, whether under treatment or not. DNA extraction The qPCR data was published in 2024, and the dermal scraping samples were stored at − 20ºC and taken to the Lauro de Souza Lima Institute, Bauru, São Paulo. DNA samples were extracted using the PuriLink kit (Thermo Fischer Scientific) and then submitted to the qPCR assay using the TaqMan® qPCR amplification system, targeting the 449pb RLEP gene region of M. leprae. Samples with Cycle Threshold (Ct) less than or equal to 37 were considered positive. Spatial Analysis and Statistics The territorial unit adopted was the census tract, corresponding to the minor subdivision for which the IBGE provides sociodemographic information [ 24 , 25 ]. Spatial studies show that selecting micro-areas, such as census tracts, makes identifying priority sites for interventions possible, helping to improve the understanding of disease transmission in small áreas [ 19 , 26 , 27 ]. The following information from the 2010 IBGE census was selected: (i) average number of residents, (ii) average nominal income, (iii) number of rented households, (iv) number of households supplied by rainwater stored in cisterns, (v) number of men, (vi) number of women, (vii) number of literate people, (viii) number of white, (ix) black, (x) brown, (xi) yellow and (xii) indigenous residents. The data was organized in a Microsoft Excel spreadsheet. Classic normality tests were then applied, followed by the Mann-Whitney test to compare the Mean of the variables in the census tracts about the number of qPCR-positive cases, using GraphPad Prism 9.5.0 software (trial test), considering a p-value < 0.05 to be significant. Estimates of the coverage areas of the health units were also carried out[ 28 ] using a geospatial analysis divided into three methodological steps: (i) identification of the census sectors adjacent to the ESFs using the neighborhood matrix technique, considering only the first-order neighbors[ 29 ]; (ii) network analysis with a point-based interpolation algorithm (ESF), to choose the sectors that were logistically closest to these health units[30], and (iii) grouping of the census sectors as long as the population did not exceed a total of 4. 500 people, as recommended by the Primary Care Policy (PNAB) .500 people, as recommended by the National Primary Care Policy (PNAB)[ 28 , 29 , 31 ]. The addresses of individuals with SLD were transformed into geographical coordinates (DDºMM'S''X/Y) using Google Earth Pro software and analyzed using the open-source Quantum GIS 3.14 Pi software. The shapefiles of census tracts, streets , and sociodemographic information were obtained from the IBGE website[ 23 , 25 ]. The data on the location coordinates of the FHS was collected from the National Register of Health Establishments (CNES), made available by the SUS Information Technology Department (DATASUS)[ 32 ]. Results Between 2017 and 2021, 200 individuals with SLD were assessed at CREDEN-PES. Of these, 108 (54.0%) were female, and 92 (46.0%) were male. The average age was 55 years (df = 16.8) and 195 (97.5%) lived in the urban area of the municipality. The qPCR test was positive in 94 (47.0%) of the samples evaluated, of which 49 (52.1%) were female and 45 (47.9%) male. Figure 2 illustrates the distribution of SLD individuals in the Governador Valadares census tracts. It was possible to observe a heterogeneous distribution of the participants in this study in the municipality (2a). However, in the sectors with the highest number of qPCR-positive SLD individuals, there was a predominance of residents who were literate (p = 0.0405, Fig. 2 b), black (p = 0.0072, Fig. 2 c) or brown (p = 0.0020, Fig. 2 d) and female (p = 0.0451, Fig. 2 e). Figure 3 shows that approximately 70% of the urban area of Governador Valadares is covered by a health unit. These areas were home to 41.2% of the SLD individuals who tested positive in the qPCR test. The Grã-duquesa (northwest region), Lourdes (central region), Santa Rita (south region), and Santos Dumont (southeast region) neighborhoods had 58.8% of SLD-positive qPCR individuals. However, they were not included in any coverage area with a health unit. The estimated average distance traveled by all the individuals assessed to the nearest ESF was 0.515 km, while the distance to CREDEN-PES was 3.77 km. Discussion In this study, the identification of 58.8% of individuals with SDH, positive for qPCR and living outside the coverage area of a health unit highlights the importance of carrying out and maintaining active search actions in these regions in order to promote the interruption of the leprosy transmission chain and carry out effective treatment. Although the role of CREDEN-PES helps confirm suspected cases. Training professionals to carry out early diagnosis in primary services is a priority. Governador Valadares stood out for its pioneering spirit in setting up health services to encourage decentralization at the state and federal levels. However, over the years, there has been a significant failure in the early diagnosis of leprosy due to the high turnover of trained professionals and the lack of coverage areas, making it difficult for the population to access health services. Despite numerous attempts to decentralize diagnosis and treatment, CREDEN-PES remains overloaded with this task[ 33 , 34 , 35 ]. Around 41% of new leprosy cases occur in individuals with incomplete primary education, and when added to the illiterate, they represent the majority of new cases 8 . However, in this study, census tracts with SLD individuals with a higher literacy level had the highest proportion of positive qPCR tests[ 36 ]. The presence of individuals with a higher literacy level and positive qPCR in the census tracts may be related to a better understanding of the disease and a more effective search for health services. Another possibility is that leprosy in Governador Valadares may be associated with specific socio-economic factors, regardless of educational level, increasing the risk of contracting the disease. Investigating new social variables could contribute to a better understanding of these factors. A greater number of women in the census tracts were also associated with SLD individuals, and positive qPCR results indicated that further research in the municipality is needed to understand better the relationship between genders and the search for leprosy-related healthcare. A qualitative study highlighted that women tend to be more aware of the dermatological signs associated with leprosy, which are crucial in raising awareness among their spouses and family members[ 37 ]. In addition, another study of active case finding revealed a There is a strong predominance of women, showing that this event is related to those who declare themselves as "housewives," which makes them more present in their homes and more likely to participate in these actions[ 38 ]. Around 30% of Governador Valadares' urban area needs health coverage. This situation directly impacts the population's health and undoubtedly contributes to the high incidence of new leprosy cases[ 36 , 39 ]. This study also found that 41.2% of the SLD individuals who tested positive for qPCR lived in an area covered by a health unit. However, it was found that these participants traveled to CREDEN-PES for consultations. Areas of PHC coverage and geographical accessibility to services are essential for quality care for the population[ 36 ]. Difficulties in accessing health facilities impose obstacles to early diagnosis and treatment and favor the development of physical disability in leprosy[ 40 ]. It is important to note that not all individuals who test positive in the qPCR test result in a manifestation of the disease[ 14 ]. However, constant surveillance of these individuals with SLD is necessary through good coverage of health units with well-trained teams. A previous study found that qPCR-positive individuals were 5.14 times more likely to become ill than those with negative results[ 24 ]. This study's limitations include the absence of information on the nature of the contacts of leprosy cases (intra/extra-household or none), the type of work activity, and which health services made the referrals. This information is essential to accurately delineate the sociodemographic profile of individuals with SLD in Governador Valadares. However, even with the scarcity of information, spatial analysis using public domain data from the IBGE was effective in pinpointing the priority regions (Grã-duquesa, Lourdes, Santa Rita, and Santos Dumont neighborhoods) to be strategically investigated through active search in Governador Valadares. Conclusions The lack of coverage of health units in places with more SLD and qPCR-positive individuals indicates the need to expand this coverage and implement active search, suspected diagnosis, and treatment of leprosy in Primary Care. This would facilitate the user's access to the nearest health service, making secondary care (CREDEN-PES) available to play its role as a specialized unit. Abbreviations SDH: diagnostic suspicion of leprosy PCR: Polymerase Chain Reaction CREDEN-PES: Centro de Referência em Doenças Endêmicas e Programas Especiais PD: Physical disabilities WHO: World Health Organization MS: Brazilian Ministry of Health MG: Minas Gerais TCLE: Free and Informed Consent Form IBGE: Brazilian Institute of Geography and Statistics DAS: Department of Health Care PHC: Primary Health Care SUS: Single Health System ESF: Family Health Teams UBS: Basic Health Units NASF: Family Health Support Centers Declarations Ethical considerations The study was approved by the Ethics Committee of the Federal University of Juiz de Fora, CAAE 67528922.6.1001.5147. All the participants signed the Informed Consent Form (ICF) at the evaluation. 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B., et. al. ; Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil; PLOS Neglected Tropical Diseases; jun; 2021. PEREIRA, Waltair Maria Martins et al. Leprosy in a metropolis of the Brazilian Amazon: primary health care coverage and its relationship with the clinical profile and spatiotemporal distribution of the disease in Belém, state of Pará, Brazil, from 2006 to 2015. Pan-Amazonian Health Journal, v. 10, p. 14-14, 2019. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5318795","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369848774,"identity":"ba9abed4-a2d5-474f-a634-2d963a03c168","order_by":0,"name":"Marcos Daniel Silva Pinheiro","email":"","orcid":"","institution":"Federal University of Juiz de Fora - Governador Valadares Campus/PMBqBM","correspondingAuthor":false,"prefix":"","firstName":"Marcos","middleName":"Daniel Silva","lastName":"Pinheiro","suffix":""},{"id":369848775,"identity":"7043d2f0-1a1c-4289-9f99-0293bc16d5cb","order_by":1,"name":"Nathan Guilherme Oliveira","email":"","orcid":"","institution":"Lauro de Souza Lima Institute","correspondingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"Guilherme","lastName":"Oliveira","suffix":""},{"id":369848776,"identity":"888f28e0-7afe-49a2-a875-033c7ad97166","order_by":2,"name":"Vladmir Machado Rios","email":"","orcid":"","institution":"Federal University of Juiz de Fora - Governador Valadares Campus","correspondingAuthor":false,"prefix":"","firstName":"Vladmir","middleName":"Machado","lastName":"Rios","suffix":""},{"id":369848777,"identity":"837d9438-3e79-4d5d-9654-d62fa0b14464","order_by":3,"name":"Lucas Kenji Takeishi","email":"","orcid":"","institution":"Federal University of Juiz de Fora - Governador Valadares Campus","correspondingAuthor":false,"prefix":"","firstName":"Lucas","middleName":"Kenji","lastName":"Takeishi","suffix":""},{"id":369848778,"identity":"06ef94fd-17ba-4806-a622-882c6c3097e3","order_by":4,"name":"Lavínia Cássia Ferreira Batista","email":"","orcid":"","institution":"Lauro de Souza Lima Institute","correspondingAuthor":false,"prefix":"","firstName":"Lavínia","middleName":"Cássia Ferreira","lastName":"Batista","suffix":""},{"id":369848779,"identity":"5ead16f3-d2ad-4b67-84e2-5f0a8402031b","order_by":5,"name":"Alexandre Castelo Branco","email":"","orcid":"","institution":"CREDEN-PES","correspondingAuthor":false,"prefix":"","firstName":"Alexandre","middleName":"Castelo","lastName":"Branco","suffix":""},{"id":369848780,"identity":"b0eca9c9-8db1-4709-8987-b76caa98524e","order_by":6,"name":"Jessica K. Fairley","email":"","orcid":"","institution":"Emor University","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"K.","lastName":"Fairley","suffix":""},{"id":369848781,"identity":"83c3e035-54c8-43af-abe0-3ee1e1abcf80","order_by":7,"name":"Lorena Bruna Pereira Oliveira","email":"","orcid":"","institution":"Vale do Rio Doce University - Governador Valadares","correspondingAuthor":false,"prefix":"","firstName":"Lorena","middleName":"Bruna Pereira","lastName":"Oliveira","suffix":""},{"id":369848783,"identity":"a19c1e6f-7ffc-42e8-aea2-f256eb0b0f09","order_by":8,"name":"Ida Maria Foschiane Dias Baptista","email":"","orcid":"","institution":"Lauro de Souza Lima Institute","correspondingAuthor":false,"prefix":"","firstName":"Ida","middleName":"Maria Foschiane Dias","lastName":"Baptista","suffix":""},{"id":369848786,"identity":"b66b8c6c-56fe-44b3-b30f-62781ff3b9b7","order_by":9,"name":"Lucia Alves Oliveira Fraga","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABI0lEQVRIie2RMUvEMBSAXwnUJW3XgFzPPyCkBIqD1L9iCXhLz1lQsNNNvbu1/RednFMC10Xp2rEiOHWoixSpYooICoXeKNgPHi+85CPvJQATE38QU4UAOFFJq/qCDYC/N/Ggon8pRCVE+wLbS4Gfih+OKoQ/ivaG+FtL6k375i3S/CGrGvDs49DYNYPKBc2iHfGTmKNkveHL9P6SOzFw5gqTx4NKAALrhNHSkmBEaJmKwD3EIPw7gdlwYwFk3QdhZ4VE2nt0u6BFPa5IY0VsChwh3MpzWo7dgp+pnG2ITUqlzMLcScqaOTFVs0iTDynWAX96qV9PsbVVjdXd9dwsAqdqrjzbzddy8JV/oa0AjkS/6v8IjQuKDmAe7nVyYmJi4h/xCV/mX7FFqZWrAAAAAElFTkSuQmCC","orcid":"","institution":"Federal University of Juiz de Fora - Governador Valadares Campus/PMBqBM","correspondingAuthor":true,"prefix":"","firstName":"Lucia","middleName":"Alves Oliveira","lastName":"Fraga","suffix":""}],"badges":[],"createdAt":"2024-10-23 12:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5318795/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5318795/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67487850,"identity":"89c71618-48c9-4901-b981-c7675980d039","added_by":"auto","created_at":"2024-10-25 14:34:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":245316,"visible":true,"origin":"","legend":"\u003cp\u003eLocation of the Basic Health Units and the Reference Center for Endemic Diseases and Special Programs (CREDEN-PES) in the urban area of Governador Valadares.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5318795/v1/1513a0299ee9922c12996dd8.png"},{"id":67487851,"identity":"13602d39-1c2c-4808-9037-a62248b16a89","added_by":"auto","created_at":"2024-10-25 14:34:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":463112,"visible":true,"origin":"","legend":"\u003cp\u003eSpatial distribution of individuals with a suspected leprosy diagnosis (SLD and positive qPCR) about demographic characteristics of the Governador Valadares census tract. *p\u0026lt;0.05; *** p\u0026lt;0.01.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5318795/v1/fa2e20ec10190d3c2a1de1c9.png"},{"id":67487852,"identity":"e8c2c3b0-9bc2-4337-a559-e722d9b173dc","added_by":"auto","created_at":"2024-10-25 14:34:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":343154,"visible":true,"origin":"","legend":"\u003cp\u003eSpatial distribution of individuals with a suspected leprosy diagnosis (SDH), positive or negative in the qPCR test living in areas covered by Primary Health Units in Governador Valadares.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5318795/v1/a9e4e717c24d70ecc7325aad.png"},{"id":81297813,"identity":"313dda88-d938-489c-99f3-7dc6784e5c3f","added_by":"auto","created_at":"2025-04-24 13:16:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1524939,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5318795/v1/b48f891c-9b2d-4ce9-bf9c-e3e109cad106.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Geospatial analysis of individuals with suspected diagnosis of leprosy and positive qPCR in an endemic region of Minas Gerais","fulltext":[{"header":"Background","content":"\u003cp\u003eLeprosy is a chronic infectious disease that affects women and men at any age. Its etiological agent is \u003cem\u003eMycobacterium leprae\u003c/em\u003e (\u003cem\u003eM. leprae\u003c/em\u003e)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] or \u003cem\u003eMycobacterium lepromatosis (M. lepromatosis\u003c/em\u003e) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], which are mainly tropical for \u003cem\u003eSchwann\u003c/em\u003e cells[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. When a diagnosis occurs late, individuals can develop leprosy-related physical disabilities (PD), making this disease a significant public health problem, especially in developing countries in Latin America, Africa, and Asia[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the World Health Organization (WHO), 127,396 new cases of leprosy have been reported worldwide. Of these, 17,979 were reported in Brazil, which corresponds to 93.6% of the number of new cases in the Americas. Brazil is second among the countries with the highest number of cases, behind India [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, the Brazilian Ministry of Health (MoH) has been making efforts to reduce the burden of the disease in the country through early diagnosis and timely treatment[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], especially in endemic regions such as the state of Minas Gerais (MG). In 2020, 471 (44.2%) cases already had a degree of FI at the time of diagnosis; in 2021, this number increased to 535 (46.6%), which represents a percentage increase of 13.5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData from the Ministry of Health for the municipality of Governador Valadares, located in the eastern region of Minas Gerais, between 2017 and 2021 show that the city reported an average of 67.2 cases per year, which classifies it as hyperendemic (\u0026gt;\u0026thinsp;20.00 to 39.99 cases per 100,000 inhabitants). Of the instances notified, 33.6% already had some degree of PD at diagnosis. The detection rate in children under 15 was 8.35% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] indicating that new cases are detected late and, therefore, the need to adopt active search strategies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany studies have explored the qPCR technique in leprosy and have successfully identified undiagnosed cases or disease outbreak sites that would go unnoticed by conventional techniques[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These methods stand out for their high specificity and sensitivity in identifying bacillary DNA in clinical samples.\u003c/p\u003e \u003cp\u003eOver the last three decades, advances in the qPCR technique have enabled the development of different approaches to amplify various genetic targets of \u003cem\u003eM. leprae\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The RLEP gene has been recognized for its remarkable sensitivity and specificity for \u003cem\u003eM. leprae\u003c/em\u003e, detecting even ten fg of purified DNA from the bacterium[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the same time, spatial epidemiology techniques have also significantly contributed to early diagnosis. This is because, in endemic countries such as Brazil, there are differences in the spatial distribution of the disease between regions, states, and especially in the case of municipalities, where the differences are manifested between interurban spaces, being focused on places of greater social inequality and accessibility to health services[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. According to the World Health Organization (WHO, 2004), geospatial analysis is an efficient administrative tool in the leprosy elimination program, and its use is recommended in all endemic countries[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Thus, this study aimed to analyze the geographical distribution of individuals with suspected leprosy diagnosis (SLD) who were evaluated by the qPCR test and living in the municipality of Governador Valadares/ MG. The sociodemographic aspects of residents in the areas with the highest frequency of positive tests were also considered.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study uses laboratory and sociodemographic data from individuals with SLD seen at the Endemic Diseases Reference Center (CREDEN-PES) in Governador Valadares/MG between January 2017 and July 2021. Dermal scraping samples were collected from the earlobes, elbows, and lesions of 200 individuals with SLD, which were seen at CREDEN-PES. These individuals were referred by other health services, by spontaneous demand, were contacts of an index case, or came from active search actions and had not been diagnosed with leprosy at the time of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLocation of the study\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the municipality of Governador Valadares, located in the east of the state of Minas Gerais in the southeastern region of Brazil. According to data from the Brazilian Institute of Geography and Statistics (IBGE), in 2022, the municipality had an estimated population of 257,171 individuals, of which 253,300 were distributed in 183 neighborhoods [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAt the time of the study, the municipality had a Health Care Department (DAS) responsible for organizing primary and secondary health care. Primary Health Care (PHC) is the user's preferred gateway to the Unified Health System (SUS), which in Governador Valadares was made up of 61 Family Health Teams (ESF), 10 Basic Health Units (UBS), and 11 Family Health Support Centers (NASF).\u003c/p\u003e \u003cp\u003eAmong the secondary services is the Reference Center for Endemic Diseases and Special Programs (CREDEN-PES), which aims to provide specialized care for leprosy, tuberculosis, and leishmaniasis. This service receives individuals referred from primary services, other secondary care services, the private sector (hospitals and medical clinics) and those on spontaneous demand. A multi-professional team monitors all patients and their contacts, whether under treatment or not.\u003c/p\u003e\n\u003ch3\u003eDNA extraction\u003c/h3\u003e\n\u003cp\u003eThe qPCR data was published in 2024, and the dermal scraping samples were stored at \u0026minus;\u0026thinsp;20\u0026ordm;C and taken to the Lauro de Souza Lima Institute, Bauru, S\u0026atilde;o Paulo. DNA samples were extracted using the PuriLink kit (Thermo Fischer Scientific) and then submitted to the qPCR assay using the TaqMan\u0026reg; qPCR amplification system, targeting the 449pb RLEP gene region of \u003cem\u003eM. leprae.\u003c/em\u003e Samples with \u003cem\u003eCycle Threshold\u003c/em\u003e (Ct) less than or equal to 37 were considered positive.\u003c/p\u003e\n\u003ch3\u003eSpatial Analysis and Statistics\u003c/h3\u003e\n\u003cp\u003eThe territorial unit adopted was the census tract, corresponding to the minor subdivision for which the IBGE provides sociodemographic information [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Spatial studies show that selecting micro-areas, such as census tracts, makes identifying priority sites for interventions possible, helping to improve the understanding of disease transmission in small \u0026aacute;reas [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe following information from the 2010 IBGE census was selected: (i) average number of residents, (ii) average nominal income, (iii) number of rented households, (iv) number of households supplied by rainwater stored in cisterns, (v) number of men, (vi) number of women, (vii) number of literate people, (viii) number of white, (ix) black, (x) brown, (xi) yellow and (xii) indigenous residents. The data was organized in a Microsoft Excel spreadsheet. Classic normality tests were then applied, followed by the Mann-Whitney test to compare the Mean of the variables in the census tracts about the number of qPCR-positive cases, using GraphPad Prism 9.5.0 software (trial test), considering a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 to be significant. Estimates of the coverage areas of the health units were also carried out[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e] using a geospatial analysis divided into three methodological steps: (i) identification of the census sectors adjacent to the ESFs using the neighborhood matrix technique, considering only the first-order neighbors[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e]; (ii) network analysis with a point-based interpolation algorithm (ESF), to choose the sectors that were logistically closest to these health units[30], and (iii) grouping of the census sectors as long as the population did not exceed a total of 4. 500 people, as recommended by the Primary Care Policy (PNAB) .500 people, as recommended by the National Primary Care Policy (PNAB)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe addresses of individuals with SLD were transformed into geographical coordinates (DD\u0026ordm;MM'S''X/Y) using Google Earth Pro software and analyzed using the open-source Quantum GIS 3.14 Pi software. The \u003cem\u003eshapefiles of census tracts, streets\u003c/em\u003e, and sociodemographic information were obtained from the IBGE website[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The data on the location coordinates of the FHS was collected from the National Register of Health Establishments (CNES), made available by the SUS Information Technology Department (DATASUS)[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween 2017 and 2021, 200 individuals with SLD were assessed at CREDEN-PES. Of these, 108 (54.0%) were female, and 92 (46.0%) were male. The average age was 55 years (df\u0026thinsp;=\u0026thinsp;16.8) and 195 (97.5%) lived in the urban area of the municipality. The qPCR test was positive in 94 (47.0%) of the samples evaluated, of which 49 (52.1%) were female and 45 (47.9%) male.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the distribution of SLD individuals in the Governador Valadares census tracts. It was possible to observe a heterogeneous distribution of the participants in this study in the municipality (2a). However, in the sectors with the highest number of qPCR-positive SLD individuals, there was a predominance of residents who were literate (p\u0026thinsp;=\u0026thinsp;0.0405, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb), black (p\u0026thinsp;=\u0026thinsp;0.0072, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec) or brown (p\u0026thinsp;=\u0026thinsp;0.0020, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed) and female (p\u0026thinsp;=\u0026thinsp;0.0451, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ee).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that approximately 70% of the urban area of Governador Valadares is covered by a health unit. These areas were home to 41.2% of the SLD individuals who tested positive in the qPCR test. The Gr\u0026atilde;-duquesa (northwest region), Lourdes (central region), Santa Rita (south region), and Santos Dumont (southeast region) neighborhoods had 58.8% of SLD-positive qPCR individuals. However, they were not included in any coverage area with a health unit. The estimated average distance traveled by all the individuals assessed to the nearest ESF was 0.515 km, while the distance to CREDEN-PES was 3.77 km.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the identification of 58.8% of individuals with SDH, positive for qPCR and living outside the coverage area of a health unit highlights the importance of carrying out and maintaining active search actions in these regions in order to promote the interruption of the leprosy transmission chain and carry out effective treatment. Although the role of\u003c/p\u003e \u003cp\u003eCREDEN-PES helps confirm suspected cases. Training professionals to carry out early diagnosis in primary services is a priority.\u003c/p\u003e \u003cp\u003eGovernador Valadares stood out for its pioneering spirit in setting up health services to encourage decentralization at the state and federal levels. However, over the years, there has been a significant failure in the early diagnosis of leprosy due to the high turnover of trained professionals and the lack of coverage areas, making it difficult for the population to access health services. Despite numerous attempts to decentralize diagnosis and treatment, CREDEN-PES remains overloaded with this task[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAround 41% of new leprosy cases occur in individuals with incomplete primary education, and when added to the illiterate, they represent the majority of new cases\u003csup\u003e8\u003c/sup\u003e. However, in this study, census tracts with SLD individuals with a higher literacy level had the highest proportion of positive qPCR tests[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe presence of individuals with a higher literacy level and positive qPCR in the census tracts may be related to a better understanding of the disease and a more effective search for health services. Another possibility is that leprosy in Governador Valadares may be associated with specific socio-economic factors, regardless of educational level, increasing the risk of contracting the disease. Investigating new social variables could contribute to a better understanding of these factors.\u003c/p\u003e \u003cp\u003eA greater number of women in the census tracts were also associated with SLD individuals, and positive qPCR results indicated that further research in the municipality is needed to understand better the relationship between genders and the search for leprosy-related healthcare.\u003c/p\u003e \u003cp\u003eA qualitative study highlighted that women tend to be more aware of the dermatological signs associated with leprosy, which are crucial in raising awareness among their spouses and family members[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In addition, another study of active case finding revealed a\u003c/p\u003e \u003cp\u003eThere is a strong predominance of women, showing that this event is related to those who declare themselves as \"housewives,\" which makes them more present in their homes and more likely to participate in these actions[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAround 30% of Governador Valadares' urban area needs health coverage. This situation directly impacts the population's health and undoubtedly contributes to the high incidence of new leprosy cases[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This study also found that 41.2% of the SLD individuals who tested positive for qPCR lived in an area covered by a health unit. However, it was found that these participants traveled to CREDEN-PES for consultations.\u003c/p\u003e \u003cp\u003eAreas of PHC coverage and geographical accessibility to services are essential for quality care for the population[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Difficulties in accessing health facilities impose obstacles to early diagnosis and treatment and favor the development of physical disability in leprosy[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is important to note that not all individuals who test positive in the qPCR test result in a manifestation of the disease[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, constant surveillance of these individuals with SLD is necessary through good coverage of health units with well-trained teams. A previous study found that qPCR-positive individuals were 5.14 times more likely to become ill than those with negative results[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study's limitations include the absence of information on the nature of the contacts of leprosy cases (intra/extra-household or none), the type of work activity, and which health services made the referrals. This information is essential to accurately delineate the sociodemographic profile of individuals with SLD in Governador Valadares.\u003c/p\u003e \u003cp\u003eHowever, even with the scarcity of information, spatial analysis using public domain data from the IBGE was effective in pinpointing the priority regions (Gr\u0026atilde;-duquesa, Lourdes, Santa Rita, and Santos Dumont neighborhoods) to be strategically investigated through active search in Governador Valadares.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe lack of coverage of health units in places with more SLD and qPCR-positive individuals indicates the need to expand this coverage and implement active search, suspected diagnosis, and treatment of leprosy in Primary Care. This would facilitate the user's access to the nearest health service, making secondary care (CREDEN-PES) available to play its role as a specialized unit.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSDH:\u0026nbsp;diagnostic\u0026nbsp;suspicion\u0026nbsp;of\u0026nbsp;leprosy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePCR: Polymerase Chain Reaction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCREDEN-PES: Centro de Refer\u0026ecirc;ncia em Doen\u0026ccedil;as End\u0026ecirc;micas e Programas Especiais\u003c/p\u003e\n\u003cp\u003ePD: Physical disabilities\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMS: Brazilian Ministry of Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMG: Minas Gerais\u003c/p\u003e\n\u003cp\u003eTCLE: Free and Informed Consent Form\u003c/p\u003e\n\u003cp\u003eIBGE: Brazilian Institute of Geography and Statistics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDAS: Department of Health Care\u003c/p\u003e\n\u003cp\u003ePHC: Primary Health Care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSUS: Single Health System\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eESF: Family Health Teams\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUBS: Basic Health Units\u003c/p\u003e\n\u003cp\u003eNASF: Family Health Support Centers\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the Federal University of Juiz de Fora, CAAE 67528922.6.1001.5147. All the participants signed the Informed Consent Form (ICF) at the evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support:\u003c/strong\u003e FAPEMIG, CNPq, Emory University/Atlanta/USA\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.D.S.P, L.B.P.O and L.A.O.F, organization of writing and processing of information, bibliographical research, evaluation and general analysis of dataM.D.S.P, N.G.O, L.C.F.B. and I.M.F.D.B, Molecular and geospatial analysis, statistical data;J.K.F. and L.A.O.F., general coordination of projects and writing.L.K.T. and V.M.R, collecting data from patient records;A.C.B., clinical assessment of patients.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eAcknowledgement: CREDEN-PES staff for their support in carrying out this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVirmond M, Grzybowski A, Virmond L. Leprosy: A glossary. 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Dis. 2 (2008) https://doi.org/10.1371/journal.pntd.0000328.\u003c/li\u003e\n\u003cli\u003eMontenegro ACD, Werneck GL, Kerr-Pontes LRS, Barreto ML, Feldmeier H. Spatial analysis of the distribution of leprosy in the State of Cear\u0026aacute;, Northeast Brazil. Mem Inst Oswaldo Cruz 2004;99:683-6. https://doi.org/10.1590/S0074-02762004000700003.\u003c/li\u003e\n\u003cli\u003eFine PEM. Global leprosy statistics: a cause for pride, or frustration?; Lep. Rev.; n 77, p.297; 2006.\u003c/li\u003e\n\u003cli\u003eAmaral EP, Lana FCF. Spatial analysis of leprosy in the micro-region of Almenara, MG, Brazil. Rev Bras Enferm 2008;61:701-7. https://doi.org/10.1590/S0034-71672008000700008.\u003c/li\u003e\n\u003cli\u003eBlok DJ, de Vlas SJ, Richardus JH. Finding undiagnosed leprosy cases. The Lancet Infectious Diseases 2016;16:1113. https://doi.org/10.1016/S1473-3099(16)30370-X.\u003c/li\u003e\n\u003cli\u003eOgunsumi DO, Lal V, Puchner KP, van Brakel W, Schwienhorst-Stich E-M, Kasang C, Chukwu, J. \u003cem\u003eet.al\u003c/em\u003e, Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey. PLoS Negl Trop Dis 2021;15:e0009769. DOI: 10.1371/journal.pntd.0009769.\u003c/li\u003e\n\u003cli\u003eZhang D, Li H, Zheng Q, Bi R, Xu M, Wang D, \u003cem\u003eet.al. \u003c/em\u003eMapping leprosy-associated coding variants of interleukin genes by targeted sequencing. Clinical Genetics 2021;99:802-11. DOI: 10.1111/cge.13945.\u003c/li\u003e\n\u003cli\u003eWHO - World Health Organization. Elimination of Leprosy as a Public Health Problem. Available at: http:// www.who.int/lep/lasupdate27june2005. Accessed November 4, 2004.\u003c/li\u003e\n\u003cli\u003eIBGE. IBGE Automatic Recovery System - SIDRA n.d. https://sidra.ibge.gov.br/territorio.\u003c/li\u003e\n\u003cli\u003eBrazilian Institute of Geography and Statistics. Cut-outs for statistical purposes 2022. https://www.ibge.gov.br/geociencias/downloads-geociencias.html (accessed on: 13/01/2022).\u003c/li\u003e\n\u003cli\u003eSouza, E. A. D., Ferreira, A. F., Boigny, R. N., Alencar, C. H., Heukelbach, J., Martins- Melo, \u003cem\u003eet al.; \u003c/em\u003eLeprosy and gender in Brazil: trends in an endemic area of the Northeast region, 2001-2014. Revista de Sa\u0026uacute;de P\u0026uacute;blica, 52, 20 2018.\u003c/li\u003e\n\u003cli\u003eCosta, J. V., Silveira, L.0020V. A., Donal\u0026iacute;sio, M. R. R.; Spatial analysis of count data with excess zeros applied to the study of dengue incidence in Campinas, S\u0026atilde;o Paulo, Brazil; Cad. Sa\u0026uacute;e P\u0026uacute;blica; Rio de Janeiro; n32, v. 8; 2016. https://doi.org/10.1590/0102- 311X00036915.\u003c/li\u003e\n\u003cli\u003eRocha, T.A.H., Almeida, D.G., Amaral, P.V.M., Silva, N.C., Thomaz, E.B.A.F., Queiroz R.C. de S, \u003cem\u003eet.al.\u003c/em\u003e; Proposal for a methodology to estimate the area of potential coverage by primary care teams. Revista Panamericana de Salud P\u0026uacute;blica 2019;43:1. https://doi.org/10.26633/RPSP.2019.47.\u003c/li\u003e\n\u003cli\u003eAnselin L. Contiguity-Based Spatial Weights n.d. https://geodacenter.github.io/workbook/4a_contig_weights/lab4a.html.\u003c/li\u003e\n\u003cli\u003eStadt Wien. Iso-Area as Contours (from layer) n.d. https://root676.github.io/IsoAreaAlgs.html#:~:text=Iso%2DArea%20as%20Contours%20(fro m%20layer)\u0026amp;text=stackexchange.com).You%20may%20use%20UTM%2DCoordinate%20z ones%20matching%20your%20analysis%20area,provided%20by%20a%20vector%20layer.\u003c/li\u003e\n\u003cli\u003eBrazil, Ministry of Health. Ordinance 2.436 of September 21, 2017. Available at: \u0026lt; https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html\u0026gt;; accessed on: 23/03/2024.\u003c/li\u003e\n\u003cli\u003eBrazil, Ministry of Health, Data sus. Cadastro Nacional de Estabelecimentos de Sa\u0026uacute;de n.d. http://cnes.datasus.gov.br/pages/estabelecimentos/consulta.jsp.\u003c/li\u003e\n\u003cli\u003eMorais, S. G.; Malaquias, L. C. C., Branco, A. C., Escalda, P. M. F., Lana, F. C. F.; Evaluation of leprosy control actions in the municipality of Governador Valadares, Brazil, from 2001 to 2006; Hansenologia Internationalis; v.35, n 2, p. 17-25; 2010.\u003c/li\u003e\n\u003cli\u003eLanza, F. M.; Evaluation of primary care in leprosy control: validation of instruments and analysis of the performance of endemic municipalities in the State of Minas Gerais. 2014. 311f. PhD Thesis in Nursing - School of Nursing, Federal University of Minas Gerais. Federal University of Minas Gerais, Belo Horizonte, 2014.\u003c/li\u003e\n\u003cli\u003eCorr\u0026ecirc;a, C. M.; Evaluation of the hanseniasis control program in the municipality of Governador Valadares, Minas Gerais, Brazil. 2016. 162 f. Master\u0026apos;s Dissertation in Nursing - Federal University of Minas Gerais School of Nursing. Federal University of Minas Gerais, Belo Horizonte, 2016.\u003c/li\u003e\n\u003cli\u003eNIITSUMA, E. N. A., \u003cem\u003eet al.\u003c/em\u003e; Factors associated with leprosy in contacts: systematic review and meta-analysis; Rev. Bras. Epidemio.; n24; 2021. https://doi.org/10.1590/1980-549720210039.\u003c/li\u003e\n\u003cli\u003eBRAZIL. Ministry of Health. Health Surveillance Secretariat. Epidemiological Bulletin, Bras\u0026iacute;lia, January 2022. Available at: https://www.gov.br/saude/pt-br/centrais-de- conteudo/publicacoes/boletins/epidemiologicos/especiais/2022/boletim-epidemiologico-de- hanseniase-_-25-01-2022.pdf. accessed on: 10/07/2023.\u003c/li\u003e\n\u003cli\u003eOliveira NG. Epidemiological, spatial and qualitative parameters of the leprosy profile in an endemic municipality in the Alto Pantanal - MT 2020.\u003c/li\u003e\n\u003cli\u003eFilho, F. B., \u003cem\u003eet. al.\u003c/em\u003e; Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner S\u0026atilde;o Paulo, Brazil; PLOS Neglected Tropical Diseases; jun; 2021.\u003c/li\u003e\n\u003cli\u003ePEREIRA, Waltair Maria Martins et al. Leprosy in a metropolis of the Brazilian Amazon: primary health care coverage and its relationship with the clinical profile and spatiotemporal distribution of the disease in Bel\u0026eacute;m, state of Par\u0026aacute;, Brazil, from 2006 to 2015. Pan-Amazonian Health Journal, v. 10, p. 14-14, 2019.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Leprosy, Geospatial analysis, qPCR, diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-5318795/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5318795/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: to evaluate the geographic distribution of individuals with a suspected leprosy diagnosis (SLD) presenting a positive qPCR test residing in Governador Valadares/MG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Between 2017 and 2021, dermal scraping samples were collected from the earlobes, elbows, and lesions of 200 individuals with SLD examined in CREDEN-PES. A geospatial analysis estimated the coverage of health units.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: It was found that 108 (54.0%) of the participants were female, with an average age of 55 years, and the majority lived in the urban area of the municipality. The qPCR test was positive in 94 (47.0%) samples evaluated, of which 49 (52.1%) were from female individuals and 45 (47.9%) were males. A heterogeneous distribution of individuals who presented a positive qPCR test in the municipality was observed. However, in the sectors with the highest number of individuals with SLD and positive in the qPCR test, there was a predominance of female, literate, black, or mixed-race residents. Furthermore, 58.8% of individuals with SLD and positive in the qPCR test did not have coverage at a health facility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The lack of health unit coverage in places with more SLD and qPCR-positive individuals indicates the need to expand this coverage and implement active search, diagnostic suspicion, and treating leprosy in Primary Care. This would facilitate user access to the nearest.\u003c/p\u003e\n\u003cp\u003eHealth service, thus making Secondary Care (CREDEN-PES) available to perform its role as a Specialized unit\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Geospatial analysis of individuals with suspected diagnosis of leprosy and positive qPCR in an endemic region of Minas Gerais","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-25 14:26:35","doi":"10.21203/rs.3.rs-5318795/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12b1e9bf-97e6-4600-be2f-19ccac9d91da","owner":[],"postedDate":"October 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-24T13:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-25 14:26:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5318795","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5318795","identity":"rs-5318795","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}