Identificação de risco associado aos comunicantes de pacientes de hanseníase através de dados epidemiológicos em municípios endêmicos no Estado do Pará

Abstract

Leprosy is a chronic microbacteriosis with high infectivity and low pathogenicity and it has great potential to generate physical disabilities. It is caused by Mycobacterium leprae, whose main host is human. Leprosy has a slow evolution caused by dermato-neurological manifestations (mainly lesions on the skin and peripheral nerves) that can progress to physical disabilities, sequelae and even deformities, causing social and psychological harm. Thus, the faster the diagnosis, the greater the chances of the patient progressing to a cure, in addition to preventing the disease transmission process. The objective of this research was to identify possible risks of infection associated with contacts of leprosy patients using statistical techniques in clinical and socioeconomic data in Santarém, Castanhal and Marituba in the state of Pará. This is an epidemiological, descriptive, analytical and retrospective study. In the data collection, cases notified at the base of the Notifiable Diseases Information System (SINAN) were used for Santarém city from 2005 to 2014 and for the cities of Castanhal and Marituba, from 2007 to 2016, to perform an active search. Active searches were carried out through visits to the homes of leprosy index cases for 7 days, which were randomly selected from SINAN registration, notified in the period of ten years prior to the year in which the active search week was carried out. A multidisciplinary team, with extensive experience in leprosy, composed of dermatologists, nurses, physiotherapists, community health agents (ACS), information technicians and laboratory technicians, carried out a dermato-neurological clinical examination in search of signs and symptoms of leprosy. The active search took place in year of 2014 in the municipality of Santarém and 70 index cases were selected, resulting in 280 contacts and 35 new cases. In the cities of Castanhal and Marituba, the search took place in the year of 2016, in the municipality of Castanhal, 28 index cases were selected, resulting in 113 contacts and 12 new cases, while in the city of Marituba, 34 indexes were selected, generating 175 contacts and 26 new cases. The epidemiological data from the active search showed that the female gender (Santarém 62.5%, Castanhal 58.41%, Marituba 59.43%), age group above 15 years (Santarém 77.86%, Castanhal 77%, Marituba 77 .71%), being a relative (Santarém 93.2%, Castanhal 89.38%, Marituba 82.86%), living together up to 10 years (Santarém 67.5%, Castanhal 77%, Marituba 67.43% ), living indoors (Santarém 83.9%, Castanhal78.76%, Marituba 84%), dormitory without density above 2 rooms (Santarém 53.2%, Castanhal 83.19%, Marituba 53.14%), having a scar of BCG vaccination (Santarém 87.14%, Castanhal 80.53%, Marituba 82.86%) were the most prevalent variables in all municipalities. The statistical data reveled that in the study the female gender Santarém (OR=1.17 –95%CI 0.557-2.47; p = 0.67), Castanhal (OR=1.46 – 95%CI 0.441-4.86; p = 0.53), Marituba (OR=1.35 – 95%CI 0.563-3.22; p = 0.50), age over 15 years old Santarém (OR=1.25 - 95%CI 0.554-2.84; p = 0.58), Castanhal (OR=1.56 - 95%CI 0.319-7.61; p = 0.58), Marituba (OR=1.69 - 95%CI 0.545-5.23; p = 0. 35), being a relative of Santarém (OR=1.34 - 95%CI 0.370-4.86; p = 0.65) , Castanhal (OR=3.49 - 95%CI 0.194-62.7; p = 0.20) , Marituba (OR=1.16 - 95%CI 0.369-3.66; p = 0.79), Santarém intradomiciliary living (OR=1.56 - 95%CI 0.522-4.65; p = 0.42), Castanhal (OR=1.39 - 95%CI 0.284-6.83; p = 0.68), Marituba (OR=1.06 - 95%CI 0.334-3.34; p = 0.92), living together up to 10 years (OR=1.20 - 95%CI 0.573-2.50; p = 0.63), Castanhal (OR=2.88 - 95%CI 0.855-9.73; p = 0.07), Marituba (OR= 2 .20 – 95%CI 0.912-5.29; p = 0.07), residence with less than or equal to 5 Santarém residents (OR=1.04 - 95%CI 0.498-2.15; p = 0.92), Castanhal (OR=1.13 - 95%CI 0.316-4.03; p = 0.85), Marituba (OR=1.05 – 95%CI 0.446-2.47; p = 0.91). and having a scar from the BCG vaccine Santarém (OR=1.15 - 95%CI 0.415-3.19; p = 0.78), Castanhal (OR=1.44 - 95%CI 0.355-5.83; p = 0.60), Marituba (OR=1.18 – 95%CI 0.407-3.43; p = 0.75), were the variables with the highest risk related to the emergence of new cases of leprosy. From this point, it showed us that the statistical evaluation returned the difficulty in defining which people in the same family will get sick, statistically. Although the risk among the contacts that could be extrapolated to the entire population was not found, the data are in line with the risks already pointed out by literature for the population in general, as opposed to the BCG vaccine scar, where the research pointed out higher risk of the disease in vaccinated contacts.