Strategies for control and surveillance of leprosy contacts: integrative review

Collaborators

Santos KCB (0000-0001-6290-2796)^* * Orcid (Open Researcher and Contributor ID). contributed to the design and planning, analysis and interpretation of data, elaboration of the draft, critical review of content and approval of the final version of the manuscript. Corrêa RGCF (0000-0002-6451-5156)^* * Orcid (Open Researcher and Contributor ID). contributed to the elaboration of the manuscript, critical review of content and approval of the final version of the manuscript. Rolim ILTP (00000002-8453-2543)^* * Orcid (Open Researcher and Contributor ID). and Pascoal LM (00000003-0876-3996)^* * Orcid (Open Researcher and Contributor ID). also contributed to the elaboration of the manuscript. Ferreira AGN (0000-0003-3705-3918)^* * Orcid (Open Researcher and Contributor ID). contributed to the design and planning, analysis and interpretation of the data, elaboration of the draft, critical revision of the content and approval of the final version of the manuscript.

Conflict of interests: non-existent

Acronym	PubMed	Lilacs	Cinahl
P (problem)	"leprosy" (mesh terms) or "leprosy" (text word)	mh: "leprosy" or tw: "leprosy"	MH "leprosy" or "leprosy"
I (interest phenomenon)	"epidemiological monitoring" (mesh terms) or "surveillance" (text word)	mh: "epidemiological monitoring" or tw: "surveillance"	"epidemiological monitoring" or MH "epidemiological research" or MH" disease surveillance" or "surveillance"
Co (context)	"contact tracing" (mesh terms) or "household contact" (text word)	mh: "contact tracing" or tw "household contact"	MH "contact tracing" or "contact tracing" or "household contact"

N	Country/Year	Design	Objective	Main results	Level of Evidence
A2¹⁸18 Goulart IMB, Souza DOB, Marques CR, et al. Risk and Protective Factors for Leprosy Development Determined by Epidemiological Surveillance of Household Contacts. Clin Vaccine Immunol. [internet]. 2008 [acesso em 2018 jun 14]; 15(1):101-105. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223848/. https://www.ncbi.nlm.nih.gov/pmc/article...	Brazil 2008	Case-control	To characterize important risk factors associated with the incidence of leprosy in household contacts	The contacts of patients with lepromatous leprosy were 3.8 times more likely to develop leprosy. All unfavorable combinations of the two and three tests generated significant risk values ranging from 5.76 to 24.47, with the highest risk given by the combination of no BCG scar, negative Mitsuda test and positive ML-Flow test. The positive ML-Flow test indicated a six times higher relative risk for the occurrence of the disease.	4
A4¹⁹19 Dessunti EM, Soubhia Z, Alves E, et al. Hanseníase: o controle dos contatos no município de Londrina-PR em um período de dez anos. Rev. bras. enferm. [internet]. 2008 [acesso em 2018 jun 15]; 61(spe):689-693. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S003471672008000700006&lng=en. http://www.scielo.br/scielo.php?script=s...	Brazil 2008	Descriptive, retrospective, quantitative	To analyze variables related to the intra-domiciliary contacts of patients with leprosy treated in the municipality of Londrina in a period of ten years	There were 3,394 contacts registered, with an average of 3.2 per case. 71.5% aged up to 40 years, children (40.6%) and spouse (17.8%). Of the 1,731 contacts examined (51.0%), 183 had any signs of leprosy: 16 confirmed cases. 51.6% were exposed to multibacillary forms and 10.1% evidenced two doses of BCG.	6
A6²⁰20 Durães SMB, Guedes LS, Cunha MD, et al. Estudo epidemiológico de 107 focos familiares de hanseníase no município de Duque de Caxias - Rio de Janeiro, Brasil. An. bras. dermatol. [internet]. 2010 [acesso em 2018 jun 15]; 85(3):339-345. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S036505962010000300007&lng=en. http://www.scielo.br/scielo.php?script=s...	Brazil 2010	Analytical, observational, cross-sectional, quantitative	To analyze the clinical-epidemiological profile of co-prevalent cases and to identify risk factors for illness among leprosy contacts	The controlled analysis of the type of contact and degree of relatedness variables revealed that home contact and first-degree relatedness are independently associated with a higher probability of becoming ill.	6
A10²¹21 Sarno EN, Duarte NC, Vendas AM, et al. Exposição à hanseníase, infecção e doença: um estudo de vigi lância de 25 anos dos contatos de pacientes com hanseníase. Mem. Inst. Oswaldo Cruz [internet]. 2012 [acesso em 2018 jun 15]; 107(8):1054-1059. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762012000800015&lng=en. http://www.scielo.br/scielo.php?script=s...	Brazil 2012	Analytical, observational, retrospective, quantitative	To review data of the cohort of contacts over the past 25 years on the major risk factors leading to the infectious phase of the disease, estimate the incidence rates of leprosy in the cohort and to characterize the risk factors for the disease among contacts under surveillance	The factors associated with the acquisition of the disease were: not receiving the BCG vaccine, a negative reaction of Mitsuda and contact with patients with multibacillary clinical form. The factors associated with the infection defined as a seropositivity for IgM anti-phenolic-glycolipid-1: young age (<20 years old), low measured Mitsuda reaction (<5 mm) and contact with an indexed patient with high bacilloscopic index.	6
A14²²22 Lima CSO, Galvão MHR, Brito FM, et al. Leprosy: surveillance of contacts. Rev. enferm. UFPE [internet]. 2014 [acesso em 2018 jun 15]; 8(5):1136-41. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/9791. https://periodicos.ufpe.br/revistas/revi...	Brazil 2014	Descriptive, retrospective, quantitative	To characterize the communicators of leprosy patients in a public hospital	It was observed influence of the consanguinity factor in the transmission, besides deficiency in the dermatoneurological evaluation of the communicants people.	6
A17²³23 Lobato DC, Neves DCO, Xavier MB. Avaliação das ações da vigilância de contatos domiciliares de pacientes com hanseníase no Município de Igarapé-Açu, Estado do Pará, Brasil. Rev. Pan-Amazônica Saúde [internet]. 2016 [acesso em 2018 jun 15]; 7(1):45-53. Disponível em:http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S2176-62232016000100006&lng=pt. http://scielo.iec.gov.br/scielo.php?scri...	Brazil 2016	Descriptive, retrospective, quantitative	To evaluate the actions of the surveillance of household contacts of patients with leprosy in the Municipality of Igarapé-Açu, State of Pará, Brazil, from 2004 to 2008	Of the 133 contacts identified, 52.63% were male; 42.10%, incomplete elementary school; 42.85%, singles; 55.63%, unemployed; 60.15%, family income less than 1 minimum wage; and 67.67%, a BCG scar. The rate of not assessed contacts was 84 (63.16%), and of these, 56 (66.70%) were contacts of multibacillary cases.	6
A18²⁴24 Romero-Montoya M, Beltran-Alzate JC, Cardona-Castro N. Evaluation and monitoring of mycobacterium leprae transmission in household contacts of patients with hansen's disease in Colombia. Plos negl. trop. dis. [internet]. 2017 [acesso em 2018 jun 15]; 11(1):e0005325. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289623/. https://www.ncbi.nlm.nih.gov/pmc/article...	Colombia 2017	Analytical, observational, prospective, quantitative	To evaluate the transmission of leprosy in family groups of leprosy patients from four Colombian departments: Antioquia, Bolivar, Cordoba and Sucre	159 Family Groups (FG) formed by 543 household contacts (HHCs) were evaluated. Twenty-two (4.1%) of the 543 HHCs had positive anti-PGL-I IgM antibody titers, indicating infection. The genotype of the two strains (HHCs and index case) was in agreement with 9 markers, showing individuals infected by the same strain, indicating family transmission.	6

N	Country/Year	Design	Objective	Main results	Level of Evidence
A3²⁵25 Vieira CSCA, Soares MT, Ribeiro CTSX, et al. Avaliação e controle de contatos faltosos de doentes com hanseníase. Rev. bras. enferm. [internet]. 2008 [acesso em 2018 jun 15]; 61(spe):682-688. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S003471672008000700005&lng=en. http://www.scielo.br/scielo.php?script=s...	Brazil 2008	Descriptive-exploratory, quantitative, cross-sectional	To carry out the active search of the intra-domiciliary contacts lacking in the control of leprosy in a Regional Ambulatory of Specialties of Vale do Paraíba	92 contacts were identified, 64.1% were absent, and 25% between 20-29 years and 58.5% were female. 66.6% reported nonadherence to the control due to forgetfulness and lack of time (11.1%); 4 contacts had leprosy symptoms, and 1 was confirmed (Dimorphic form).	6
A5²⁶26 Shen J, Wang Y, Zhou M, et al. Analysis on value of household contact survey in case detection of leprosy at a low endemic situation in China. Indian j. dermatol. venereol. leprol. [internet]. 2009 [acesso em 2018 jun 15]; 75:152-156. Disponível em: http://www.ijdvl.com/text.asp?2009/75/2/152/48660. http://www.ijdvl.com/text.asp?2009/75/2/...	China 2009	Descriptive, cross-sectional, quantitative	To evaluate the value of household contact research in the detection of cases of leprosy in a situation of low endemicity in China	The number of index cases was responsible for 22.0 and 14.1% of patients newly registered in Southwest and East China. The household contact survey (36.1%) and the skin diagnosis (62.0%) ranked first in the methods of cases detection in Southwest and East China, respectively.	6
A7²⁷27 Peixoto BKS, Figueiredo IA, Caldas AJM, et al. Aspectos epidemiológicos dos contatos de hanseníase no Município de São Luís-MA. Hansen. int. [internet]. 2011 [acesso em 2018 jun 16]; 36(1):23-30. Disponível em: http://www.ilsl.br/revista/detalhe_artigo.php?id=11559#. http://www.ilsl.br/revista/detalhe_artig...	Brazil 2011	Descriptive, retrospective, quantitative	To describe the situation of leprosy contacts and evaluate the implementation of leprosy contact surveillance by Sanitary district in the municipality of São Luís (MA)	1,520 contacts were identified, 50.3% female, aged > 14 years old (66.5%) and consanguineous relationships of 1st Degree (59.1%) with the index case. Of the 583 contacts examined, 6.5% had a diagnosis of leprosy (dimorph). The evaluation of the execution of contact surveillance actions was considered precarious in most districts.	6
A8²⁸28 Moura THM, Costa ACI, Rafael MEPP, et al. Controle dos contatos intradomiciliares de hanseníase em equipes de saúde da família. Rev. APS [internet]. 2012 [acesso em 2018 jun 16]; 15(2):139-147. Disponível em: https://aps.ufjf.emnuvens.com.br/aps/article/view/1468. https://aps.ufjf.emnuvens.com.br/aps/art...	Brazil 2012	Descriptive, cross-sectional, qualitative	To evaluate the perception on the control actions of leprosy contacts developed by the Family Health Teams (EqSF) of the II Sanitary District of Recife	The actions of control of the contacts have importance recognized by the professionals of the EqSF, however, these actions have been facing some obstacles, such as the non-attendance of the users to the health unit, difficulties to carry out educational and organizational activities.	6
A9²⁹29 Hacker MA, Duppre NC, Nery JAC, et al. Characteristics of leprosy diagnosed through the surveillance of contacts: a comparison with index cases in Rio de Janeiro, 1987-2010. Mem. Inst. Oswaldo Cruz [internet]. 2012 [acesso em 2018 jun 15]; 107(supl1):49-54. Disponível em: http://www.scielo.br/pdf/mioc/v107s1/09.pdf. http://www.scielo.br/pdf/mioc/v107s1/09....	Brazil 2012	Analytical, observational, cross-sectional, quantitative	To compare the epidemiological characteristics of cases diagnosed by contact surveillance with the characteristics of passively detected cases	Through contact surveillance, cases were diagnosed earlier, with less severe clinical presentations, lower initial and final levels of disability, lower bacillary load and prevalence of reaction. The strategy was shown to be effective in tertiary prevention, with active surveillance being important in areas of high endemicity, such as Brazil.	6
A19³⁰30 Romanholo HSB, Souza EA, Ramos JAN, et al. Vigilância de contatos intradomiciliares de hanseníase: perspectiva do usuário em município hiperendêmico. Rev. bras. enferm. [internet]. 2018 [acesso em 2018 jun 15]; 71(1):163-169. Disponível em: http://www.scielo.br/pdf/reben/v71n1/0034-7167-reben-71-01-0163.pdf. http://www.scielo.br/pdf/reben/v71n1/003...	Brazil 2018	Descriptive, cross-sectional, quantitative	To characterize patterns of approach of Intra-domiciliary Contacts (CId) of leprosy cases residing in the North of Brazil, from 2001-2012	There were 459 Cid included. The non-execution of the dermatological examination was reported by 191 people (41.6%), and the neurological examination by 252 (54.9%); 138 (30.1%) did not have indication for BCG, and 122 (26.6%) received no guidelines; 257 (56.0%) were not advised to return to a new evaluation/follow-up, and 186 (40.5%) were not geared towards the mobilization of other contacts.	6

N	Country/Year	Design	Objective	Main results	Level of Evidence
A1³¹31 Moet FJ, Pahan D, Oskam L, et al. Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomised controlled trial. BMJ [internet]. 2008 [acesso em 2018 jun 2]; 336(7647):761-764. Disponível em: https://www.bmj.com/content/336/7647/761.long. https://www.bmj.com/content/336/7647/761...	Bangladesh 2008	Randomized clinical trial	To determine the efficacy of chemoprophylaxis using a single dose of rifampicin to prevent leprosy in close contacts	91 of the 9,452 contacts in the placebo group and 59 of 9,417 in the rifampicin group developed leprosy. There was a 57% reduction in overall incidence among leprosy contacts using a single dose of rifampicin in the first two years.	2
A11³²32 Richardus RA, Alam K, Pahan D, et al. The combined effect of chemoprophylaxis with single dose rifampicin and immunoprophylaxis with BCG to prevent leprosy in contacts of newly diagnosed leprosy cases: a cluster randomized controlled trial (MALTALEP study). BMC infect. dis. [internet]. 2013 [acesso em 2018 jun 4]; 13(1):1-8. Disponível em: https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/1471-2334-13-456. https://bmcinfectdis.biomedcentral.com/t...	Bangladesh 2013	Randomized clinical trial	To examine the combined effect of chemoprophylaxis with Single Dose Rifampicin (SDR) and immunoprophylaxis with Bacillus Calmette-Guérin (BCG), in contacts of new cases of leprosy	Primary outcome: number of new patients with leprosy emerging from the contact groups	2
A12³³33 Cabral PB, Júnior JEC, Macedo AC, et al. Anti-PGL1 salivary IgA/IgM, serum IgG/IgM, and nasal Mycobacterium leprae DNA in individuals with household contact with leprosy. Int. j. infect. dis. [internet]. 2013 [acesso em 2018 jun 22]; 17:e1005-e1010. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23871279. https://www.ncbi.nlm.nih.gov/pubmed/2387...	Brazil 2013	Analytical, observational, cross-sectional, quantitative	To evaluate levels of serum anti-PGL1 IgG/IgM and salivary anti-PGL1 IgA/IgM in addition to the detection of nasal carriage by M. leprae in household contacts of leprosy and its cases index	Salivary anti-PGL1 IgA/IgM and serum anti-PGL1 IgG showed good correlation comparing contacts and index cases. A high frequency of anti-PGL1 IgM positivity was found in IgG-negative samples. Serum anti-PGL1 IgG/IgM and salivary anti-PGL1 IgA/IgM measurements are strongly suggested for monitoring household contacts of leprosy.	6
A13³⁴34 Moura MLN, Dupnik KM, Sampaio GAA, et al. Active Surveillance of Hansen's Disease (Leprosy): Importance for Case Finding among Extra-domiciliary Contacts. Plos negl. trop. dis. [internet]. 2013 [acesso em 2018 jun 1]; 7(3):e2093. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597486/pdf/pntd.0002093.pdf. https://www.ncbi.nlm.nih.gov/pmc/article...	Brazil 2013	Analytical, ecological, cross-sectional, quantitative	To evaluate the mapping as a tool to identify high risk areas of leprosy and the usefulness of the dermatoneurological exam during home visits in high prevalence neighborhoods to identify new cases of leprosy	719 subjects were examined, of them, 82 had previous history of leprosy, 209 were household contacts and 428 lived in neighboring residences. Fifteen new cases were confirmed, detection rate of 2.0% of the persons examined. Spatial analysis showed the grouping of newly diagnosed cases and the association with residential coordinates of previously diagnosed multibacillary cases.	6
A15³⁵35 Campos DCC, Dutra APB, Suares VL, et al. New strategies for active finding of leprosy cases in the Amazonian region. Rev. Soc. Bras. Med. Trop. [internet]. 2015 [acesso em 2018 jun 15]; 48(4):488-490. Disponível em: http://www.scielo.br/pdf/rsbmt/v48n4/1678-9849-rsbmt-48-04-00488.pdf. http://www.scielo.br/pdf/rsbmt/v48n4/167...	Brazil 2015	Analytical, observational, prospective, quantitative	To determine if the surveillance of extra domiciliary contacts (neighbors) and the use of SIF increase the notification of cases of leprosy	The search for cases among the neighbors of leprosy patients using the Self-Image Form (SIF) increases the notification of new leprosy cases, in this case, in 17.5% (7/40).	6
A16³⁶36 Barth-Jaeggi T, Steinmann P, Mieras L, et al. Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin. BMJ [internet] 2016 [acesso em 2018 jun 3]; 6:e013633. Disponível em: https://bmjopen.bmj.com/content/bmjopen/6/11/e013633.full.pdf. https://bmjopen.bmj.com/content/bmjopen/...	India, Indonesia, Myanmar, Nepal, Sri Lanka, Tanzania, Brazil, Cambodia 2016	Descriptive	To evaluate contact tracking and feasibility, efficacy and impact of PEP with SDR in pilot areas located in several countries endemic for leprosy	Feasibility will be assessed in terms of coverage (proportion of contacts tracked, selected and receiving PEP, if eligible), required resources and coordination efforts. Efficacy will be measured as the impact of the LPEP program on the National Cardiovascular Data Registry (NCDR) of pilot areas	6

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Strategies for control and surveillance of leprosy contacts: integrative review

ABSTRACT