Leprosy cases increased by 5% from January to November 2023

Between January and November 2023, Brazil diagnosed at least 19,219 new cases of leprosy. Even though preliminary, the result is already 5% higher than the total number of notifications registered in the same period in 2022.

According to information from the Leprosy Indicator Monitoring Panel, from the Ministry of Health, the state of Mato Grosso continues to lead the ranking of federative units with the highest detection rates of the disease.

By the end of November, the total of 3,927 new cases in the state already exceeded by 76% the 2,229 occurrences in the same period in 2022. Next comes Maranhão, with 2,028 notifications, a result almost 8% lower than the 2,196 previous records.

The Mato Grosso Health Department reported that in recent years diagnoses of the disease have been gradually increasing, the result of an “active detection policy” which, among other measures, includes “training of health professionals”.

Like Mato Grosso, other federative units continue to supply the national registry with information prior to November, which means that the 5% percentage tends to increase even further.

The folder also updated state data. Adding the diagnoses from December and others not yet reported to the Notifiable Diseases Information System (Sinan), the total number of new cases reported in 2023 already reaches 4,212.

“For us, the increase [dos diagnósticos] last year is nothing new, as there is a huge underreporting of cases in the country”, said the National Coordinator of the Movement for the Reintegration of People Affected by Leprosy (Morhan), Faustino Pinto, explaining that, paradoxically, the increase in diagnoses is, at first, something positive.

According to Faustino, until 2019, the number of new cases identified had been increasing year by year, without representing the real seriousness of the situation. “As for many years there has not been a national campaign to clarify and encourage people to seek health services if they suspect the disease, diagnoses are the result of a spontaneous search. People sought the health service on their own initiative, looking for the causes of a spot on their skin; numb area or nerve pain”, explained Pinto, adding that the situation worsened from 2020 to 2021, due to the covid-19 pandemic.

The Health Surveillance Secretariat of the Ministry of Health, in the epidemiological bulletin released in January 2023, with disease data for 2022, admits that the pandemic imposed an extra challenge, requiring strategies aimed at strengthening leprosy control actions .

“The covid-19 pandemic created difficulties for new diagnoses and treatment of leprosy patients, contributing to underreporting and the worst prognosis of cases”, said the secretariat when demonstrating that, from 2019 to 2020, the total number of diagnosed cases fell from 27,864 to 17,979. Furthermore, in 2021, 11.2% of the 18,318 new patients identified already had serious injuries to their eyes, hands and feet when they were diagnosed.

“In other words, today we have not even returned to pre-pandemic numbers, when we were already accusing underreporting. Which means that the current situation is even more serious, because if we are only identifying patients who arrive by spontaneous demand, many people are not being treated in time to avoid neurological sequelae. We are also failing in our efforts to interrupt the disease transmission cycle”, commented Pinto, highlighting that, once treatment begins, the infected person stops transmitting the bacteria that causes leprosy to other people susceptible to developing the disease.

Purple January

Considered one of the oldest diseases to afflict human beings, leprosy is an infectious and contagious disease that affects the skin, mucous membranes and the peripheral nervous system, that is, nerves and ganglia. Although it can be cured, it can cause irreversible neural injuries and damage if not diagnosed in time and treated appropriately.

Among the most frequent signs and symptoms are the appearance of spots, which can be white, reddish, brownish or brownish, and/or areas of the skin with altered sensitivity and involvement of peripheral nerves, generally with thickening of the skin, associated with changes sensory, motor and/or autonomic.

The appearance of areas with reduced hair and sweat may also be signs of the disease; tingling and/or tingling sensation, especially in the hands and feet; decrease or loss of sensitivity and/or muscle strength in the face, and/or hands and/or feet, as well as the occurrence of lumps (nodules) on the body, in some cases red and painful.

Most people exposed to the bacteria Mycobacterium leprae do not develop the disease.

According to the Ministry of Health, leprosy is identified through a general physical, dermatological and neurological examination. Carried out with the use of antimicrobial medications, the treatment is provided free of charge, within the Unified Health System (SUS), and does not require hospitalization. The duration of treatment varies depending on the clinical form of the disease

Cases where neural involvement is suspected, but without skin lesion, and those that present an area with questionable sensory and/or autonomic alterations and without evident skin lesion, should be referred to more complex health units capable of evaluating the patient’s general condition. . In children, the diagnosis requires a more careful assessment, due to the difficulty in applying and interpreting sensitivity tests. Furthermore, it is good to be aware, as childhood cases are indicators of active transmission of the disease, especially between relatives. People who live with people who have transmissible leprosy have three times the risk of developing the disease, due to close and prolonged contact.

To raise awareness among the population in general and public authorities in particular about the importance of early diagnosis and combating prejudice against leprosy, in Brazil, since 2016, the month of January has been dedicated to the Purple January campaign. Officialized by the Ministry of Health, the initiative seeks to disseminate information about the main signs, symptoms, treatment and prevention of the disease.

Although it appears on the Ministry of Health’s calendar, the initiative, in practice, is carried out by states and municipalities. The Pará Health Department (Sespa), for example, announced that, throughout the month, it will carry out a training cycle for state and municipal employees.

“We will cover 13 regional centers and 144 municipalities, already preparing for work in which the municipalities will play a leading role in the fight against leprosy throughout 2024 and not just in January. Later, we will encourage municipalities to work on their own campaign, because they are executors and deal directly with the population”, said in a statement the coordinator of the Leprosy Control Program at Sespa, Luís Augusto Costa de Oliveira.

According to him, in 2023, the state registered 1,349 new cases of the disease, 100 more than the notifications already released in the Ministry of Health system. Of the total, 92 cases involve children and adolescents under 15 years of age.

“Every January we see initiatives like this. In my opinion, they are timid and do not symbolize a national campaign that, if it occurred, would result in the reporting of many more cases than we have seen every year. There was an active search [de pessoas infectadas], instead of 20 thousand cases, we would have 30 thousand. Thirty thousand people diagnosed, treated and cured, with the necessary interruption of transmission. Only with this we could, in a few years, think about reducing and perhaps even eradicating the disease”, said Morhan coordinator, Faustino Pinto.

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