Fw: Ref.: (LML) Maranhão, Brazil

 

 

Leprosy Mailing List –  March 16,  2025

 

Ref.:  (LML)  Maranhão, Brazil

From: Joel Almeida, Mumbai, India

 

 

 

Dear Pieter & colleagues,

Our Brazilian colleagues have long been at the forefront of many aspects of HD control and research. These include elucidating molecular biology in HD (leprosy), socio-economic determinants, social mobilisation, management information systems, clinical skills, diagnostic kits and approaches, GIS, solidarity with persons who experience(d) HD, conditional cash transfers, primary health care etc. 

Newly diagnosed LL (lepromatous) patients with deformity at (delayed) diagnosis are an important source of viable bacilli. So too are reinfected but unprotected LL patients who previously completed 12 monthly doses of MDT. COVID with reduced physical interactions might have been a blessing in disguise. It led to delayed detection of LL HD but also reduced transmission owing to physical distancing. Accordingly, we might well be at a turning point in the endemic. We can shut down sources of viable bacilli now. In that way we can turn any temporary reduction in transmission into a full-blown and permanent decline of the endemic.

Maranhão is not the richest Brazilian state. However, it seems to be on the verge of achieving rapid decline in the incidence rate of LL (lepromatous) HD. The number of newly detected HD cases dropped substantially from 2023 to 2024. The graphs below show only 2014 to 2023, not 2024. Notably, during 2021 to 2023 there is no increase in LL patients with deformity at diagnosis. This is promising. It indicates reduction in an important source of viable bacilli. 

 

 

 

Prolonging MDT, or other ways of shutting down reinfection of LL patients in Maranhão, is likely to ensure a sustained rapid decline of HD in Maranhão. 15% to 20% annual decline in the incidence rate of LL HD (and all HD) was achieved in  several projects in endemic areas, leading to near-zero incidence rate of new HD. This is all the more encouraging because at the time they were still on relatively low incomes per capita (e.g., Karigiri (India), Karonga (Malawi), Weifang/Shandon (China), Thailand. 

Maranhão has every possibility of succeeding just as those other endemic areas did. Time will tell. The signs are promising, given the steady reduction in new LL cases with deformity at diagnosis.

With all sincerity,

 

Joel Almeida

 

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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