开展消除麻风运动后对当地新发现病人状况的影响

目的：分析开展消除麻风运动后对当地新发现麻风病人状况的影响。方法：通过比较麻风高流行县（市）开展消除麻风运动前、中和后一年的麻风新发现病人资料，分析新发现麻风病人各个方面情况。结果：发现所有8个县（市）在开展消除麻风运动当年发现病人数均为最高。在开展消除麻风运动后一年，防治力量强的县（市）发现病人数维持在开展消除麻风运动前一年的水平，防治力量弱的县（市）发现病人数则比开展运动前一年有减少。在开展消除运动期间发现的病人居住地离县麻风专业机构的距离最远，平均为62．8公里／人。开展消除运动期间疾病延迟期为最长，平均为42．9月，消除运动后一年发现的病人疾病平均延迟期缩短至26．5月。结论：开展消除麻风运动后在短期内不会对当地的新发现病人数产生很大的影响，但其促进了部分麻风流行病学指标好转，从而促进了当地麻风防治。     

Trends in case detection influenced by leprosy elimination campaigns in certain areas of China

LECs were carried out from 1998 to 2000 in eight counties of west China. The number of cases detected during the year of LECs was much higher than that detected by routine methods before the year of the LEC. However, the annual number of cases detected during the year after the LEC showed different patterns. One pattern is that the number of new cases detected in the year after the LEC declined to the level similar to that before the year of the LEC. The second pattern is that the number of new cases detected in the year after the LEC declined steeply to less than that detected before the year of the LEC. Following peak case-detection during the year of the LEC, a gradual decrease in the number of new cases was observed in the subsequent years. The repeat LEC brought a weakly rebounding peak case-detection during the year following the first LEC carried out 3 years earlier. The operational, epidemiological and technical factors influencing the trends of case-detection during the LECs are discussed.     

重复开展消除麻风运动对当地新发现病人情况的影响

目的:观察贵州省兴义市重复开展消除麻风运动对当地新发现麻风病人的影响.方法:收集1996～2004年新发现麻风病人的有关资料进行比较分析.结果:9年共发现麻风病人166例,平均每年发现18.4例,年均发现率为2.65/10万.1999年首次开展消除麻风运动后3年,新病人中的2级畸残率和延迟期呈明显下降趋势,低于开展前3年的水平.两次开展消除麻风运动时的畸残率和平均延迟期均达较高水平,提示该地区虽两次开展消除麻风运动但麻风流行程度仍处于较高水平.结论:重复实施消除麻风运动可促进某些流行病学指标的好转,应反复多次开展.     

Guidelines for carrying out leprosy elimination campaigns 1996. WHO, Action Programme for the Elimination of Leprosy

A Leprosy Elimination Campaign (LEC) is an initiative which aims to detect leprosy cases, particularly the more serious ones referred to as 'cases of consequence', that remain undetected in the community, and to treat them with MDT. This will subsequently reduce the delay in managing such cases in the community and ensure that the existing health services are able to treat them. It is a time-bound, one-time activity. Leprosy of consequence is defined as cases with more than five skin lesions and skin smear positive cases. Such cases are regarded as being of consequence because they act as a major source of infection in the community and are either already disabled or at high risk of becoming disabled. LEC is a focused combination of activities which includes: orientation courses for local health workers and volunteers; community awareness creation activities; case-finding and treating every detected case immediately with MDT. These campaigns are to be carried out primarily in endemic regions where the prevalence and new case detections are high and where the gap between estimated and registered cases is large. It is a national activity, implemented by the national staff with technical cooperation from WHO and other agencies.     

陕西省麻风新发病例基本情况分析

通过全国麻风防治管理信息系统（LEPMIS）收集陕西省2004-2020年麻风病例资料,对新发麻风患者的基本情况进行回顾性分析。研究纳入了305个麻风新发病例,其中男212例,女93例,MB型麻风272例(89.2%),PB型麻风33例(10.82%)。60岁以上患者49例,20～59岁247例,20以下患者9例。100例（32.8%）有家庭内接触史。42例（13.8%）出现麻风反应,247例（81%）出现神经损害,男性神经损伤率高于女性（86.3% vs 68.8%）。218例（71.5%）出现畸残,其中II级畸残122例,I级畸残96例。     

云南勐腊县391例麻风新发病人畸残影响因素分析

目的：分析勐腊县近70年麻风新发患者畸残情况及影响因素。方法：收集勐腊县历年麻风患者资料,采用二元logistic回归分析方法分析麻风畸残的影响因素。结果：共分析勐腊县麻风患者391例,麻风新发病例畸残率46.04%（180/391）,其中2 级畸残率44.50%（174/391）。延迟期2～5年、5～10年、≥10年的麻风患者发生畸残风险分别是延迟期＜2年的2.49倍（P=0.018）、4.8倍（P＜0.001）和14.56倍（P＜0.001）;家外传染的麻风畸残风险是家内传染的1.93倍（P=0.030）;有麻风反应的麻风畸残风险是没有反应的2.36倍（P=0.010）;神经损害数2～4条和＞4条的麻风畸残风险分别是神经损害1条的3.37倍（P=0.029）和5.09倍（P=0.009）。结论：勐腊县麻风畸残的危险因素主要有延迟期、家外传染、麻风反应、神经损害数。     

云南省麻风达标县新发现病例分析及面临形势

目的：分析云南省43个麻风病达标县（市）近5年新发现患者情况及目前面临的形势。方法：对43个县（市）1996－2000年新发现麻风疫情资料进行统计。结果：有36个达标县（市）新发现麻风患者235例，其中MB181、PB54例，男168例，女67例；Ⅱ级畸残77例（32．77％）；皮肤涂片阳性率为77．02％；主动发现75例（31．91％）、被动发现160例（68．09％）；病期在2年以内的144例（61．28％）；有9个县（市）患病率均起过0．01‰，其中4个月（市）近5年发病率均超过0．5／10万。结论：云南省麻风病达标县（市）疫情又出现反弹，目前面临的形势依然十分严峻，麻风防治工作任重而道远。     

盐城市麻风病监测工作方案实施前后病例发现效果比较

目的:比较盐城市实施麻风病监测工作方案前后早期发现麻风病人的效果.方法:运用急性弛缓性麻痹(AFP)的监测方法,实行麻风疑似病例报告制度,建立以早期发现病人为目的的麻风监测系统.结果:实施麻风病监测工作方案后,麻风疑似病例报告率、病人发现率分别是实施监测前的1.16倍、1.25倍,平均延迟期比前3年缩短5.18个月.结论:在麻风病低流行地区建立麻风监测系统可作为早期发现麻风病人的方法.     

浙江省流动人口新发麻风病例流行病学特征分析

正麻风是由麻风分枝杆菌感染引起的一种慢性传染病,在人类历史上已流行4000多年,曾经肆虐世界五大洲的各个国家,曾与梅毒、结核并称为世界三大慢性传染病。自1981年WHO推广联合化疗以来,麻风现症病例数迅速减少,大部分国家和地区已达到了基本消灭麻风的目标(患病率≤1/1万)[1],浙江省于1995年实现了以县(市、区)为单位基本消灭麻风病     

2009~2013年云南麻风新发病例分析

<正>麻风病联合化疗在云南开展已有30年时间,通过麻风病相关资料可以反映出麻风的传播程度,为以后的防治措施提供依据。现将云南省2009~2013年5年的麻风新发现病例进行分析。材料与方法资料来源于全国麻风病疫情监测系统(即每例个患者发病时的具体情况和每2个月随访情况适时通过网络上报。结果 2009~2013年5年间云南全省共发现麻风新发患者1 502例,年平均发病300例,男女比例为2.2∶1,平均发病年龄43.4岁,延迟期28.3个月     

Histoid leprosy: the impact of the entity on the postglobal leprosy elimination era

A fresh focus on histoid leprosy is the primary objective of this article, especially in the context of the postglobal leprosy elimination era. The emergence of the entity following dapsone monotherapy is well recognized, in addition to de novo cases. Irregular and inadequate therapies, coupled with resistance to dapsone and/or mutant organisms, are responsible. It was considered to be worthwhile to take stock of the condition through its history, nomenclature, epidemiology, clinical characteristics, diagnosis, and differential diagnosis. The bacteriologic and histopathologic features and immunologic profile are also described.     

广西482例新发现麻风病例发生2级畸残的影响因素分析

收集2010-2020年广西在全国麻风病防治管理信息系统中上报的麻风新发现病例的病历资料,采用二项Logistic回归对15个影响因素进行分析,共纳入482例资料完整的麻风新发现病例,其中2级畸残89例(18.46%),结果示发生2级畸残的主要危险因素包括男性(OR=2.507)、老年(≥60岁;OR=2.622)、延迟期(≥24个月;OR=7.117)和有周围神经粗大/触痛(1条周围神经粗大/触痛组OR=5.179;>1条周围神经粗大/触痛组OR=11.072)(均P<0.05)。     

麻风病基本消灭阶段的流行病学特征

目的：分析麻风病基本消灭阶段流行病学特征,以指导麻风防治工作。方法：根据山东省历年的麻风病人登记表,分析比较麻风基本消灭阶段与防治初期的流行学特征。结果：麻风基本消灭阶段的流行病学特征与防治初期比较有显著变化;新病例呈散在分布;发病年龄显著升高;少年儿童发病显著减少;多菌型病例所占比升高。复发病例在新发病例中占比升高。结论：麻风病中、高流行区达到基本消灭麻风病后,应根据其流行病学特征采取相应防治对     

2011-2020年山东省麻风病例早期发现综合措施效果评价

目的:通过比较历年新发麻风病例2级畸残比,评价我省综合防治措施在麻风病例早期发现中的作用。方法:近10年来,我省相继开展了麻风可疑者筛查、密切接触者检查、大众宣传、人员培训、疑似病例转诊、省级诊断确认、报病奖励、强化转诊中心、麻风症状监测等病例发现措施。结果:我省2011-2020年共发现113例新发病例,其中男71例,女42例,平均年龄52.2岁,2例儿童病例。输入病例31例,主要来自云、贵、川等高发省份,以外来媳妇和务工人员为主。本土病例主要来自原高、中流行市县,以农民(工)为主。2011-2015年平均就诊延迟期为31.7个月,2016-2020年为13.0个月,差异有统计学意义(t=2.101,P=0.04)。2011年新发病例中G2D占比40%,2020年下降至20%。多因素分析发现,诊断延迟期超过24个月与2级畸残的发生相关。结论:我省采取的麻风病例综合早期发现措施有效降低了新发患者G2D占比。     

Trends in detection of new leprosy cases at two centres in Himachal Pradesh, India: a ten-year study

An impressive decline in leprosy prevalence rate (PR) in all endemic districts of India is seen in the post-MDT era. However, the new case-detection rate, an important statistical indicator in leprosy control programmes, has not shown significant decline in spite of all efforts. In Himachal Pradesh, a decline in PR from 7.8 to 0.56/10000 between 1991 to 2000 is seen, and recently the State has won national acclaim for having achieved the goal of elimination of leprosy in all the districts. The vertical leprosy programme has been integrated into general health services of the state. An analysis of data from 1991 to 2000 of two leprosy control units of Himachal Pradesh, the Urban Leprosy Clinic in Shimla (ULC-S) and the District Leprosy Control Unit in Mandi (DLCU-M), showed no significant decline in the new cases detected. 277 and 271 new cases were detected at these centres respectively; these included 2.2% and 1.5% children of less than 14 years of age. Almost 75% of these cases were males and of MB type. A steadily increasing trend in the annual detection of new cases was seen at both the centres during the decade. The cases registered at DLCU-M were mainly indigenous to the district. At ULC-S, 45 migrant cases from other endemic areas-mainly from Nepal, Bihar, and Uttar Pradesh-had also contributed to the increased number of new cases. Other possible causes discussed for this higher new case detection, e.g. overdiagnosis, detection of backlog "hidden cases" and voluntary reporting of patients, do not differ from those seen in other parts of the country or the world.     

Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign

India (population 943 million) has seen a highly significant decrease in the prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 1981, the figure has declined to 5.2/10,000 in March 1999. This was possible due to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton vertical staff in the remaining districts, coupled with the recruitment of additional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemic districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden (and undiagnosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than 1 case per 10,000 of the population) in the whole country, it was decided to implement a massive leprosy elimination campaign (LEC) in all the States/Union Territories (UTs). The reports of 22 States/UTs indicate that 415 out of the total of 490 districts in the country were covered by modified LEC (MLEC), with 85% coverage of the population. The campaign used in India was modified from the pattern previously described by the World Health Organization. The detection of hidden or suspected cases took place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy detection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detection of 454,290 hidden cases of leprosy, whilst providing training to a large number of General Health Care staff and volunteers and creating widespread awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful health care interventions undertaken in India in recent years, particularly in the states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, the results of the MLEC strongly support the possibility that elimination levels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.     

Characteristics and treatment outcomes of leprosy patients detected during a leprosy elimination campaign in Mozambique compared with routinely detected patients

The objective of this study is to assess whether the case-finding method is a determinant for diagnostic characteristics and treatment outcome of newly diagnosed leprosy patients in Northern Mozambique. This is a retrospective cohort study of 3202 patients on the differences between entrance characteristics and treatment outcome in self-reporting patients and patients detected during a leprosy elimination campaign (LEC) in 1999 in Northern Mozambique. As a consequence of LEC activities, 3 times more patients were found compared with the same period 1 year earlier. After the LEC, case detection remained higher in the years 2000-2002 compared with the years preceding the LEC. More young (<15 years) paucibacillary (PB) cases were diagnosed during LEC activities with, surprisingly, equal percentage of disability grades. No gender imbalance was found in diagnosed LEC patients contrary to self-reporting patient groups. Comparing patients detected during a LEC in 1999 with the passive group of 1998 and 1999 showed a slight but statistically significant better treatment result for the passive group. The classification of leprosy (in favour of PB) and age (in favour of older age groups) were also determinants for favourable treatment outcomes. Volunteers had a significantly better result of treatment compared with trained nurses and regardless of detection method. LEC proved to be a useful addition to the National Leprosy and Tuberculosis Programme in Northern Mozambique. As a result, many new cases were diagnosed and put on treatment and their treatment results were very satisfactory. LEC had a lasting impact on case finding. Volunteers make a valuable contribution to leprosy control in Mozambique because they have consistently better treatment results compared with nurses.