David Alexander Phillips1,+, José Antonio Ferreira2, Deidra Ansah3, Herica SA Teixeira2,4, Uriel Kitron5, Thelma de Filippis2, Marcelo H de Alcântara4, Jessica K Fairley6
1Augusta University/University of Georgia Medical Partnership, Athens, GA, United States
2Escola de Medicina, Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brasil
3Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, United States
4Secretaria Municipal de Saúde, Vespasiano, MG, Brasil
5Emory University, Department of Environmental Science, Atlanta, GA, United States
6Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
BACKGROUND Despite public health efforts to reduce the global burden of leprosy, gaps remain in the knowledge surrounding transmission of infection. Helminth co-infections have been associated with a shift towards the lepromatous end of the disease spectrum, potentially increasing transmission in co-endemic areas.
OBJECTIVES Using this biologically plausible association, we conducted a geographic information systems (GIS) study to investigate the spatial associations of schistosomiasis and leprosy in an endemic area of Minas Gerais (MG), Brazil.
METHODS Data on new cases of Mycobacterium leprae and Schistosoma mansoni infections from 2007-2014 were retrieved from the Brazilian national notifiable diseases information system for seven municipalities in and surrounding Vespasiano, MG. A total of 139 cases of leprosy and 200 cases of schistosomiasis were mapped to a municipality level. For one municipality, cases were mapped to a neighborhood level and a stratified analysis was conducted to identify spatial associations.
FINDINGS A relative risk of 6.80 [95% confidence interval (CI) 1.46 - 31.64] of leprosy was found in neighborhoods with schistosomiasis. Incidence rates of leprosy increased with corresponding incidence rates of schistosomiasis, and the temporal trends of both infections were similar.
CONCLUSIONS The associations found in this project support the hypothesis that helminth infections may influence the transmission of leprosy in co-endemic areas.
+ Corresponding author:
Received 29 August 2016
Accepted 23 December 2016