Rafaela Resende Gomes1, Douglas Eulálio Antunes2, Diogo Fernandes Dos Santos3, Elaine Fávaro Pípi Sabino3, Dulcinéia Bernardes Oliveira1, Isabela Maria Bernardes Goulart3. 1. National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, MG 38.413-018, Brazil. 2. National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, MG 38.413-018, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, MG 38400-902, Brazil. Electronic address: credsh@hc.ufu.br. 3. National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlandia, Uberlandia, MG 38.413-018, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlandia, Uberlandia, MG 38400-902, Brazil.
Abstract
BACKGROUND: Immunoprophylaxis with Bacillus Calmette-Guérin (BCG) vaccine is still the most effective intervention in the prevention of leprosy among household contacts (HHCs) of leprosy patients. METHODS: A retrospective cohort study using data of 5.061 HHCs for a period of 16 years (follow-up of 7 years per leprosy HHCs), evaluating the occurrence of disease as the main outcome and the presence or absence of BCG scars verified at the first evaluation. Statistical analyzes were performed using the relative risk, hazard ratio and survival curves by Kaplan-Meier test. RESULTS: A total of 92 contacts sickened, of which 41.3% (38/92) in the first year and 58.7% (54/92) in the course of the other years of follow-up. Of those who became sick, 62% (57/92) developed borderline tuberculoid (BT). The additional protective effect occurred for those who had 2 BCG scars at the first follow-up assessment (Relative Risk: 0.41; p = 0.007) when compared to those not previously exposed to the vaccine. The number of BCG scars examined at the first assessment (t0 = time zero) affected the occurrence of the outcome evidenced by the difference in survival curves throughout the follow-up (Log Rank, p = 0.041; Breslow, p = 0.012; Tarone-Ware, p = 0.020). Leprosy HHCs with 0 BCG scar at time zero (t0) have a shorter survival time (average time of 22 months between t0 and outcome) when compared to those with 2 BCG scars (average time of 36 months between t0 and outcome). CONCLUSIONS: Vaccination of healthy individuals without signs and symptoms of leprosy is extremely important because BCG vaccine has an additional protective effect in those cases with 2 BCG scars throughout follow-up. Reducing the risk of leprosy HHCs becoming sick depends on preventive actions such as immunoprophylaxis and index cases treatment.
BACKGROUND: Immunoprophylaxis with Bacillus Calmette-Guérin (BCG) vaccine is still the most effective intervention in the prevention of leprosy among household contacts (HHCs) of leprosypatients. METHODS: A retrospective cohort study using data of 5.061 HHCs for a period of 16 years (follow-up of 7 years per leprosy HHCs), evaluating the occurrence of disease as the main outcome and the presence or absence of BCG scars verified at the first evaluation. Statistical analyzes were performed using the relative risk, hazard ratio and survival curves by Kaplan-Meier test. RESULTS: A total of 92 contacts sickened, of which 41.3% (38/92) in the first year and 58.7% (54/92) in the course of the other years of follow-up. Of those who became sick, 62% (57/92) developed borderline tuberculoid (BT). The additional protective effect occurred for those who had 2 BCG scars at the first follow-up assessment (Relative Risk: 0.41; p = 0.007) when compared to those not previously exposed to the vaccine. The number of BCG scars examined at the first assessment (t0 = time zero) affected the occurrence of the outcome evidenced by the difference in survival curves throughout the follow-up (Log Rank, p = 0.041; Breslow, p = 0.012; Tarone-Ware, p = 0.020). Leprosy HHCs with 0 BCG scar at time zero (t0) have a shorter survival time (average time of 22 months between t0 and outcome) when compared to those with 2 BCG scars (average time of 36 months between t0 and outcome). CONCLUSIONS: Vaccination of healthy individuals without signs and symptoms of leprosy is extremely important because BCG vaccine has an additional protective effect in those cases with 2 BCG scars throughout follow-up. Reducing the risk of leprosy HHCs becoming sick depends on preventive actions such as immunoprophylaxis and index cases treatment.
Authors: Edilamar Silva de Alecrin; Ana Laura Grossi de Oliveira; Nathália Sernizon Guimarães; Sandra Lyon; Maria Auxiliadora Parreiras Martins; Manoel Otávio da Costa Rocha Journal: Rev Inst Med Trop Sao Paulo Date: 2022-09-30 Impact factor: 2.169
Authors: Celivane Cavalcanti Barbosa; Gilberto Silva Nunes Bezerra; Amanda Tavares Xavier; Maria de Fátima Pessoa Militão de Albuquerque; Cristine Vieira do Bonfim; Zulma Maria de Medeiros; Wayner Vieira de Souza Journal: Int J Environ Res Public Health Date: 2022-09-26 Impact factor: 4.614