Trend of case detection and leprosy elimination in Brazil.

Only six countries did not meet the leprosy elimination target during 2005, amongst them Brazil. In 2006, the Brazilian Ministry of Health announced a reduction of the detection rate of 24% or 10 900 cases from 2004 to 2005. A negative binomial parabolic regression model was adjusted to the detection rate historical series from 1980 to 2004, in order to predict the 2005 detection rate and its 95% confidence interval. This analysis showed that the number of new leprosy cases for 2005 could not be predicted from the previous behaviour of the data what calls for an epidemiological or operational explanation hypothesis. The hypothesis that this drop in detected case number is due to operational change, as a reduction in diagnosis or a modification in the reporting routine, is more likely. Recent change in prevalence case definition turned the prevalence ratio a function of only one variable, the detection rate, as the duration of the diagnosed disease became fixed. In the early nineties, based on epidemiological data evaluation, the BMoH recognized the impossibility of reaching the elimination goal, but it committed to seek leprosy control. This position changed after some years. Leprosy Elimination is a strategy supported by the national and international public opinion. As a one for all recipe, it may cause unwanted effects for it is not flexible enough to deal with different epidemiological behaviours and public health traditions.