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representam um grupo caracterizado por alta exposi&#231;&#227;o ao bacilo&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> Portanto&#44; do ponto de vista epidemiol&#243;gico&#44; uma das atividades fundamentais para evitar o aumento da transmiss&#227;o da hansen&#237;ase &#233; o exame de contatos&#44; o qual poderia aumentar o diagn&#243;stico e a cura da doen&#231;a de maneira mais precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O exame cl&#237;nico dermatoneurol&#243;gico e a baciloscopia positiva ainda s&#227;o considerados soberanos para a defini&#231;&#227;o do diagn&#243;stico da hansen&#237;ase&#46; Embora a baciloscopia auxilie no diagn&#243;stico da doen&#231;a&#44; ela apresenta baixa sensibilidade&#44; principalmente nas formas paucibacilares &#40;PB&#41;&#44; podendo apresentar tamb&#233;m negatividade em alguns pacientes MB em decorr&#234;ncia de procedimentos inadequados de coleta&#44; colora&#231;&#227;o&#44; leitura e pela possibilidade de o bacilo n&#227;o ser evidenciado nos s&#237;tios de coleta&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O sorodiagn&#243;stico amplia o rol de exames laboratoriais que colaboram no diagn&#243;stico da hansen&#237;ase&#46; O ant&#237;geno glicolip&#237;dio fen&#243;lico&#8208;1 &#40;PGL&#8208;I&#41; &#233; o principal glicolip&#237;dio antig&#234;nico do <span class="elsevierStyleItalic">Mycobacterium leprae</span>&#44; produzindo anticorpos das classes IgG &#40;imunoglobulina do tipo G&#41; e IgM &#40;imunoglobulina do tipo M&#41;&#44; relacionados com a atividade da doen&#231;a e forma cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;9</span></a> A detec&#231;&#227;o de anticorpos IgM ao glicolip&#237;dio fen&#243;lico I &#40;PGL&#8208;I&#41; no sorodiagn&#243;stico &#233; o melhor teste padronizado para hansen&#237;ase&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O ML Flow se apresenta como teste r&#225;pido e de f&#225;cil execu&#231;&#227;o para a detec&#231;&#227;o de anticorpos da imunoglobulina M para o PGL&#8208;I do <span class="elsevierStyleItalic">M&#46; leprae&#46;</span> Assim como outros testes sorol&#243;gicos&#44; o ML Flow n&#227;o &#233; considerado padr&#227;o&#8208;ouro para o diagn&#243;stico&#44; mas pode ser usado como ferramenta complementar para classifica&#231;&#227;o cl&#237;nica ap&#243;s o diagn&#243;stico inicial&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> defini&#231;&#227;o e monitoramento de terapia medicamentosa&#44; risco de recidiva e na sele&#231;&#227;o dos contatos com maior risco de adoecer&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo teve como objetivo associar os resultados do teste ML Flow no caso &#237;ndice com sua classifica&#231;&#227;o cl&#237;nica&#44; verificar a frequ&#234;ncia dos resultados positivos ML Flow no contato domiciliar e tra&#231;ar o perfil epidemiol&#243;gico dos casos e seus contatos domiciliares&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">O estudo foi realizado em seis munic&#237;pios da regi&#227;o noroeste do estado de S&#227;o Paulo&#44; que ser&#227;o designados como munic&#237;pios I&#44; II&#44; III&#44; IV&#44; V e VI&#44; que totalizam uma popula&#231;&#227;o de 574&#46;151 habitantes&#46; Dentre os munic&#237;pios selecionados&#44; cinco deles apresentam preval&#234;ncia considerada m&#233;dia a muito alta pelo MS &#40;1&#44;0 a 19&#44;99 casos&#47;10 mil habitantes&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> e s&#227;o considerados munic&#237;pios priorit&#225;rios de acordo com a rela&#231;&#227;o do Programa de Controle da Hansen&#237;ase 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo abrangeu todos os novos casos com diagn&#243;stico de hansen&#237;ase&#44; virgens de tratamento ao longo de um ano&#44; no per&#237;odo de outubro de 2018 a outubro de 2019&#44; e seus contatos domiciliares&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram selecionados apenas os casos virgens de tratamento&#44; uma vez que ap&#243;s o in&#237;cio do tratamento a tend&#234;ncia &#233; a diminui&#231;&#227;o da carga bacilar e dos anticorpos da classe IgM&#46; Considerando que o teste de escolha do estudo foi qualitativo&#44; isso poderia interferir em sua sensibilidade&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para a caracteriza&#231;&#227;o do perfil do caso &#237;ndice e seus contatos domiciliares&#44; foi realizada a an&#225;lise de prontu&#225;rios cl&#237;nicos existentes nas unidades de sa&#250;de e entrevista&#44; por meio de formul&#225;rios espec&#237;ficos&#44; com dados sociodemogr&#225;ficos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nos casos &#237;ndices&#44; a coleta da amostra de sangue para realiza&#231;&#227;o do teste ML Flow foi realizada no momento da entrevista&#44; mediante assinatura do Termo de Consentimento Livre e Esclarecido &#40;TCLE&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os contatos domiciliares foram convidados por meio telef&#244;nico&#44; com agendamento pr&#233;vio do local&#44; data e hor&#225;rio para coleta&#44; de acordo com a conveni&#234;ncia do contato domiciliar&#44; do servi&#231;o e do profissional&#46; No caso de n&#227;o comparecimento&#44; uma nova liga&#231;&#227;o e agendamento eram realizados&#44; respeitando&#44; para a coleta de todos os dados da pesquisa&#44; o prazo m&#225;ximo de 60 dias ap&#243;s o diagn&#243;stico do caso &#237;ndice&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Todos os contatos domiciliares foram submetidos a exames dermatol&#243;gicos e avalia&#231;&#227;o neurol&#243;gica simplificada &#40;ANS&#41;&#46; A coleta de sangue para realiza&#231;&#227;o do teste ML Flow foi realizada ap&#243;s autoriza&#231;&#227;o e assinatura do TCLE&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Ap&#243;s coletada&#44; a amostra de sangue&#44; em ambos os casos&#44; foi encaminhada ao Laborat&#243;rio de Refer&#234;ncia&#44; o Centro Regional do Instituto Adolfo Lutz de S&#227;o Jose do Rio Preto&#44; com a guia preenchida conforme fluxo previamente estabelecido&#46; Foi utilizado o procedimento operacional padr&#227;o do Instituto Adolfo Lutz para coleta e armazenamento de amostra biol&#243;gica&#46; O procedimento para realiza&#231;&#227;o do teste ML Flow&#44; bem como a interpreta&#231;&#227;o dos resultados&#44; foram seguidos conforme descritos na bula do teste por Buhrer&#8208;Sekula et al&#46;&#44; 2003&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Os resultados foram inseridos em planilha Excel e analisados no programa estat&#237;stico EPI INFO&#46;7&#44; <span class="elsevierStyleItalic">software</span> desenvolvido pelo Center for Diseases Control and Prevention &#40;CDC&#41;&#46; Verificou&#8208;se a frequ&#234;ncia das vari&#225;veis estudadas e&#44; para verificar associa&#231;&#227;o entre as vari&#225;veis&#44; utilizou&#8208;se o teste exato de Fisher&#59; foram considerados significantes os valores de p &#8804; 0&#44;05&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O projeto foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa do Instituto Adolfo Lutz&#44; com Parecer&#58; 2&#46;118&#46;254&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo estudado&#44; foram coletadas amostras de sangue de 26 novos casos &#237;ndices de hansen&#237;ase nos seguintes munic&#237;pios&#58; um caso nos munic&#237;pios I e VI&#44; cinco no II e 19 casos no munic&#237;pio V&#46; Os munic&#237;pios III e IV n&#227;o coletaram amostras no per&#237;odo do estudo&#46; Esses novos casos originaram 61 contatos domiciliares&#44; dos quais foram entrevistados 44 &#40;72&#44;3&#37;&#41;&#44; al&#233;m da realiza&#231;&#227;o da coleta de sangue e do exame dermatoneurol&#243;gico&#46; Houve exclus&#227;o de 17 &#40;27&#44;7&#37;&#41; contatos&#58; sete n&#227;o foram poss&#237;veis de localizar &#40;endere&#231;o e telefone dispon&#237;veis incorretos ou mudan&#231;a de cidade&#41;&#44; quatro recusaram&#8208;se a participar da pesquisa e seis&#44; apesar de quatro contatos telef&#244;nicos e dois agendamentos&#44; n&#227;o compareceram ao local &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A m&#233;dia de idade foi de 49&#44;3 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44;3&#41; para o caso &#237;ndice e 40&#44;4 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#44;4&#41; para o contato domiciliar&#46; A m&#233;dia encontrada foi de 2&#44;35 &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;54&#41; contatos para cada caso&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o a saneamento b&#225;sico e &#225;gua encanada&#44; 100&#37; das resid&#234;ncias eram abastecidas pelos servi&#231;os das redes municipais&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Tanto nos casos &#237;ndices &#40;19&#47;26&#41; quanto nos contatos domiciliares &#40;25&#47;44&#41; houve predom&#237;nio de pessoas de pele branca&#46; Em 50&#37; &#40;13&#47;26&#41; dos casos de hansen&#237;ase entrevistados&#44; a renda familiar era de at&#233; dois sal&#225;rios&#8208;m&#237;nimos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Em 46&#44;2&#37; &#40;12&#47;26&#41; das resid&#234;ncias moravam quatro pessoas&#44; e em 59&#44;1&#37; delas havia at&#233; quatro c&#244;modos&#46; O tempo m&#233;dio de moradia dos contatos com os casos foi em m&#233;dia de 14 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;58&#41;&#44; e 88&#44;6&#37; dos contatos domiciliares n&#227;o conviveram&#44; nos &#250;ltimos 10 anos&#44; com outros casos de hansen&#237;ase fora do domic&#237;lio e nunca moraram com outra pessoa com a mesma doen&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Em 61&#44;4&#37; &#40;27&#47;44&#41; dos contatos domiciliares foram realizados exame dermatoneurol&#243;gico&#46; Observou&#8208;se que mesmo entre os contatos que tomaram a vacina BCG&#44; ainda assim 22&#44;7&#37; &#40;10&#47;44&#41; tiveram o resultado do teste ML Flow positivo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">O resultado positivo para ML Flow dos contatos foi mais frequente em mulheres &#40;15&#44;9&#37;&#59; 7&#47;44&#41; com idade superior a 35 anos &#40;13&#44;6&#37;&#59; 6&#47;44&#41; e com ensino fundamental incompleto ou analfabeto &#40;18&#44;2&#37;&#59; 8&#47;44&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A positividade no teste ML Flow&#44; quando relacionado com o grau de parentesco do contato com o caso&#44; foi mais presente em marido&#47;mulher &#40;4&#44;9&#37;&#59; 4&#47;44&#41;&#44; seguido por irm&#227;os &#40;6&#44;8&#37;&#59; 3&#47;44&#41; e filhos &#40;4&#44;5&#37;&#59; 2&#47;44&#41;&#46; Quando observado o n&#250;mero total de coletas de cada grau de parentesco com a positividade&#44; o n&#250;mero de irm&#227;os sobressai&#58; quatro coletas&#44; e destas&#44; tr&#234;s foram positivas &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Dentre casos diagnosticados com forma cl&#237;nica dimorfa e virchoviana &#40;MB&#41;&#44; quando a baciloscopia foi associada ao teste MF Flow&#44; os resultados apresentados foram compat&#237;veis em 20 &#40;76&#44;9&#37;&#41; casos&#44; dos quais 12 &#40;60&#37;&#41; foram positivos e oito &#40;40&#37;&#41; negativos para ambos os testes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quando comparado o resultado do teste ML Flow do caso &#237;ndice com sua classifica&#231;&#227;o operacional &#40;PB ou MB&#41;&#44; observamos que todos os pacientes classificados como PB &#40;cinco&#59; 19&#44;2&#37;&#41; tiveram resultado negativo&#59; entre os pacientes MB&#44; 14 &#40;53&#44;8&#37;&#41; foram positivos e sete &#40;27&#37;&#41; negativos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A m&#233;dia de aparecimento dos sintomas para os casos que tiveram sorologia positiva &#40;53&#44;8&#37;&#59; 14&#47;26&#41; foi de 31&#44;7 meses &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#44;9&#41;&#46; A mediana foi de 12 meses &#40;6&#8208;32&#41;&#46; Para os casos que tiveram sorologia negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; a m&#233;dia foi de 38&#44;75 &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44;54&#41;&#44; com mediana de 30 meses &#40;5&#8208;99&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">Anticorpos anti&#8208;PGL&#8208;I&#44; principalmente da classe IgM&#44; s&#227;o considerados espec&#237;ficos para <span class="elsevierStyleItalic">M&#46; leprae</span> e s&#227;o encontrados em pacientes com hansen&#237;ase&#44; mas tamb&#233;m podem ocorrer em baixos t&#237;tulos em pessoas expostas&#46; Os anticorpos n&#227;o conferem prote&#231;&#227;o e indicam infec&#231;&#227;o por <span class="elsevierStyleItalic">M&#46; leprae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> A positividade do teste ML Flow nos contatos &#233; indicador indireto da dissemina&#231;&#227;o da infec&#231;&#227;o por <span class="elsevierStyleItalic">M&#46; leprae</span> na popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Neste estudo&#44; o achado de 27&#44;3&#37; de soropositividade nos contatos domiciliares &#233; concordante com a literatura e demonstrou soropositividade para o ML Flow entre 15&#44;6&#37; nos PB<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">19&#44;20</span></a> a 28&#44;6&#37; nos MB&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#44;18</span></a> O monitoramento desses contatos evidenciou que os que apresentam ML Flow positivo t&#234;m mais risco de desenvolver formas MB do que os contatos soronegativos&#44; mesmo sem apresentar evid&#234;ncias cl&#237;nicas compat&#237;veis com a doen&#231;a&#44; fato que reafirma a necessidade de acompanhamento mais efetivo desse grupo familiar&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">A maioria dos contatos soropositivos foi do sexo feminino&#59; no entanto&#44; at&#233; o momento&#44; n&#227;o existe consenso sobre esse dado na literatura&#46; Alguns trabalhos apresentam maior soropositividade para o sexo masculino&#59;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">18&#44;22</span></a> j&#225; outros&#44; para o feminino&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">23&#8211;25</span></a> Cabe lembrar que as mulheres procuram mais os servi&#231;os de sa&#250;de&#44; o que deve favorecer maior acesso aos servi&#231;os de sa&#250;de e ao diagn&#243;stico da hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> Na an&#225;lise&#44; n&#227;o foi encontrada associa&#231;&#227;o dos dados sociodemogr&#225;ficos com os resultados do ML Flow nos contatos intradomiciliares&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Maior positividade ocorreu entre os contatos domiciliares de casos &#237;ndice MB &#40;dimorfo e virchoviano&#41;&#46; Esse dado&#44; que corrobora os estudos existentes&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#44;18&#44;20&#44;22</span></a> &#233; um achado esperado&#44; uma vez que os contatos domiciliares de pacientes com hansen&#237;ase MB na forma virchoviana apresentaram risco 3&#44;8 vezes maior de desenvolvimento de hansen&#237;ase do que os contatos de pacientes com outras formas cl&#237;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">A m&#233;dia de aparecimento dos sintomas encontrada neste estudo aventa a possibilidade de que os casos com sorologia positiva t&#234;m menor resist&#234;ncia ao bacilo de Hansen&#59; portanto&#44; ficam doentes mais precocemente do que aqueles com sorologia negativa&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Os achados deste estudo relativos &#224; faixa et&#225;ria e escolaridade tamb&#233;m convergem com os encontrados na literatura&#44; com predom&#237;nio para a faixa et&#225;ria<span class="elsevierStyleHsp" style=""></span>&#62; 35 anos e baixa escolaridade &#40;ensino fundamental incompleto ou analfabeto&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">18&#44;21&#44;26</span></a> A pouca escolaridade pode interferir na dificuldade de compreender as informa&#231;&#245;es divulgadas acerca da hansen&#237;ase e favorecer a dissemina&#231;&#227;o e o risco de contrair a doen&#231;a&#46; Ademais&#44; estudos apresentam rela&#231;&#227;o inversa entre o n&#250;mero de anos estudados e rentabilidade das fam&#237;lias que&#44; em sua maioria&#44; apresentam baixa renda e desempregados ou trabalhadores aut&#244;nomos&#44; sugerindo ser doen&#231;a associada a fatores socioecon&#244;micos&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A ocorr&#234;ncia de casos novos entre contatos domiciliares consangu&#237;neos do caso &#237;ndice&#44; principalmente parentes de primeiro grau&#44; apresentou probabilidade 2&#44;05 vezes maior em rela&#231;&#227;o a outros tipos de parentesco&#44; evidenciando a import&#226;ncia da suscetibilidade gen&#233;tica na cadeia de transmiss&#227;o da doen&#231;a&#44; j&#225; amplamente documentado na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;27&#44;28</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de 14 anos de conv&#237;vio dos contatos com os casos de hansen&#237;ase e a maior parte desses contatos n&#227;o ter convivido&#44; nos &#250;ltimos dez anos&#44; com outros portadores da doen&#231;a fora do domicilio&#44; ratificam uma das propostas que para atingir as metas de elimina&#231;&#227;o como problema de sa&#250;de p&#250;blica &#233; necess&#225;rio monitorar os contatos domiciliares&#44; que s&#227;o as pessoas que residam na mesma casa ou que tenham conv&#237;vio cont&#237;nuo e prolongado com o doente&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> visto que essa popula&#231;&#227;o est&#225; mais suscet&#237;vel a adoecer&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Apesar de o exame dermatoneurol&#243;gico ser uma das diretrizes para investiga&#231;&#227;o epidemiol&#243;gica dos contatos domiciliares descritas no manual de preven&#231;&#227;o e controle da doen&#231;a&#44; ainda assim&#44; em apenas 61&#44;4&#37; dos contatos foram realizados o exame&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> indicando que o servi&#231;o de sa&#250;de precisa olhar com mais cuidado para essa problem&#225;tica&#46; Em contrapartida&#44; dos contatos avaliados&#44; a maioria apresentou pelo menos uma cicatriz vacinal de BCG&#44; o que constitui achado satisfat&#243;rio para esse grupo&#44; uma vez que essa vacina foi inclu&#237;da como medida de controle da hansen&#237;ase para uso em contatos das diversas formas cl&#237;nicas da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Os casos &#237;ndices classificados como MB &#40;dimorfo e virchoviano&#41; apresentaram positividade para o teste de ML Flow de 53&#44;9&#37;&#44; enquanto nos PB n&#227;o houve resultado positivo&#44; divergindo da sensibilidade relatada na literatura&#44; em que trabalhos apontam que a sensibilidade de alguns tipos de teste r&#225;pido &#40;NDO&#8208;LID&#44; NDO&#44; LID ou PGL&#8208;1&#41; em pacientes MB variam de 80&#37; a 95&#37;&#44; enquanto em pacientes PB&#44; quando detect&#225;vel&#44; &#233; menor e variam de 15&#37; a 64&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17&#44;21</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">A classifica&#231;&#227;o da hansen&#237;ase com base no n&#250;mero de les&#245;es em PB &#40;&#8804; cinco les&#245;es dermatol&#243;gicas&#41; e MB &#40;&#62; cinco les&#245;es dermatol&#243;gicas&#41; pode levar a um esquema terap&#234;utico inapropriado&#44; resultando no subtratamento de pacientes MB&#44; quando classificados erroneamente como PB&#46; Essa falha terap&#234;utica &#233; a preocupa&#231;&#227;o dos profissionais de sa&#250;de que&#44; n&#227;o tendo acesso aos exames laboratoriais&#44; tendem a tratar mais pacientes como MB&#46; Em estudo realizado na Nig&#233;ria&#44; foi observado que 95&#44;7&#37; receberam poliquimioterapia para MB&#44; quando apenas 62&#44;9&#37; apresentavam ML Flow positivo&#46; Desses&#44; 55&#44;9&#37; teriam at&#233; cinco les&#245;es de pele e&#44; portanto&#44; estariam classificados como PB&#44; conforme recomenda&#231;&#227;o da OMS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Todos os casos &#237;ndices realizaram tamb&#233;m exame de baciloscopia&#46; Quando comparados os resultados do teste ML Flow e baciloscopia&#44; a concord&#226;ncia foi de 75&#37;&#46; No entanto&#44; 15&#44;4&#37; dos casos &#237;ndices apresentaram resultado positivo apenas na baciloscopia e 7&#44;7&#37; apenas no teste ML Flow&#46; Os resultados negativos tiveram concord&#226;ncia de 100&#37; para ambos os testes&#46; Estes achados est&#227;o em dissenso com os apresentados na literatura&#44; onde o teste ML Flow apresenta maior sensibilidade do que os exames de baciloscopia&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17&#44;30</span></a> o que pode ser justificado pelas constantes capacita&#231;&#245;es de coleta para baciloscopia realizadas na regi&#227;o estudada&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A concord&#226;ncia cl&#237;nico&#8208;histopatol&#243;gica com os resultados do ML Flow encontrada neste estudo est&#225; de acordo com os dados apresentados na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">O diagn&#243;stico tardio promove aumento do risco de defici&#234;ncias f&#237;sicas causadas pela progress&#227;o silenciosa da a&#231;&#227;o do bacilo no organismo&#44; em especial nos nervos perif&#233;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> Apesar de a regi&#227;o estudada ser considerada de baixa endemicidade na hansen&#237;ase&#44; os achados deste estudo apontam &#237;ndices elevados de defici&#234;ncias f&#237;sicas no momento do diagn&#243;stico&#44; o que sugere diagn&#243;stico tardio&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Nenhum teste laboratorial&#44; isoladamente&#44; &#233; suficientemente sens&#237;vel e espec&#237;fico para a correta classifica&#231;&#227;o cl&#237;nica em todas as formas de hansen&#237;ase&#44; mas s&#227;o ferramentas auxiliares importantes para um diagn&#243;stico correto&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">O teste ML Flow &#233; r&#225;pido&#44; individual&#44; de f&#225;cil execu&#231;&#227;o&#44; com sensibilidade e especificidade semelhantes ao do ELISA&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> o que gerou melhor custo&#47;benef&#237;cio para a pesquisa&#46; Al&#233;m disso&#44; n&#227;o necessita de equipamentos laboratoriais para sua realiza&#231;&#227;o&#44; convergindo com as estrat&#233;gias do SUS&#46; Sua utiliza&#231;&#227;o no SUS foi aprovada pela portaria SCTIE&#47;MS n&#176; 84&#44; de 31 de dezembro de 2021&#44; e sua distribui&#231;&#227;o ser&#225; feita de maneira gradativa e descentralizada aos munic&#237;pios&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Entre os fatores limitantes para este estudo&#44; podemos destacar a dificuldade de localiza&#231;&#227;o e convencimento dos contatos em comparecer aos servi&#231;os de sa&#250;de para avalia&#231;&#227;o e coleta de material&#46; Outra dificuldade foi compilar os resultados dos exames laboratoriais&#44; pois&#44; apesar de haver uma rede de laborat&#243;rios de refer&#234;ncia com fluxos definidos para o atendimento desses pacientes&#44; alguns munic&#237;pios encaminham os exames de baciloscopia e bi&#243;psias para diferentes laborat&#243;rios sem qualquer controle de qualidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0225" class="elsevierStylePara elsevierViewall">O teste ML Flow &#233; ferramenta eficaz tanto para selecionar os contatos domiciliares com predisposi&#231;&#227;o para o desenvolvimento da doen&#231;a e que necessitam de monitoramento mais pr&#243;ximo quanto para auxiliar na classifica&#231;&#227;o cl&#237;nica correta dos casos de hansen&#237;ase&#46; Desse modo&#44; os resultados sugerem que o ML Flow pode dar celeridade ao diagn&#243;stico&#44; auxiliando para evitar as defici&#234;ncias f&#237;sicas ainda presentes nas pessoas acometidas pela hansen&#237;ase nessa regi&#227;o&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Segundo os resultados deste estudo&#44; os contatos dos doentes multibacilares&#44; com baciloscopia positiva e consangu&#237;neos&#44; parecem estar mais expostos ao bacilo da hansen&#237;ase&#46; Baixa renda&#44; baixa escolaridade e condi&#231;&#245;es de moradia insatisfat&#243;rias podem ser fatores de risco para o adoecimento por hansen&#237;ase para os contatos domiciliares&#59; o seguimento desses grupos se faz necess&#225;rio&#44; visando interromper a cadeia de transmiss&#227;o da doen&#231;a&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0235" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o Paulista Contra Hansen&#237;ase &#8211; Projeto n&#176; 183&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0240" class="elsevierStylePara elsevierViewall">Jana&#237;na Olher Martins Montanha&#58; Participou da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Susilene Maria Tonelli Nardi&#58; Participaram da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito e Orienta&#231;&#227;o do trabalho&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Fernanda Modesto Tolentino Binhardi&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Heloisa da Silveira Paro Pedro&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Milena Polotto de Santi&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">V&#226;nia Del Arco Paschoal&#58; Participaram da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito e Orienta&#231;&#227;o do trabalho&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Todos os autores aprovaram a vers&#227;o final do manuscrito e s&#227;o respons&#225;veis por todos seus aspectos&#44; incluindo a garantia de sua precis&#227;o e integridade&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0275" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0 a 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>16 a 35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>36 a 55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acima de 55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escolaridade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Analfabeto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino m&#233;dio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">31&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#243;s&#8208;graduado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Solteiro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&#47;divorciado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menos de cinco anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cinco anos ou mais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;52&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grau de parentesco com o caso</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consangu&#237;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o consangu&#237;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;54&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Passou por exame dermatoneurol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27 &#40;61&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;27&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o sabe informar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acima de 55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;20&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Analfabeto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;40&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino m&#233;dio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;31&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#243;s&#8208;graduado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  """
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Com GIF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o da frequ&#234;ncia dos dados cl&#237;nicos relacionados ao resultado do teste sorol&#243;gico ML Flow nos casos de hansen&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;</p>"
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                  \t\t\t\t\ttable-head\n
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                0 => array:1 [
                  "referenciaCompleta" => "who&#46;int &#91;Internet&#93;&#46; Word Health Organization&#46; Leprosy&#46; Number of new leprosy cases&#58; 2020&#46; Genebra&#58; WHO&#59; 2020&#46; &#91;cited 2022 Abr 09&#93;&#46; Available from&#58; https&#58;&#47;&#47;apps&#46;who&#46;int&#47;neglected&#95;diseases&#47;ntddata&#47;leprosy&#47;leprosy&#46;html&#46;"
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                  "referenciaCompleta" => "sa&#250;de&#46;gov &#91;Internet&#93;&#46; Minist&#233;rio da Sa&#250;de&#46; Secretaria de Aten&#231;&#227;o &#224; Sa&#250;de&#46; Portaria n&#176; 3&#46;125&#44; de 7 de outubro de 2010&#46; Bras&#237;lia&#44; DF&#58; Minist&#233;rio da Sa&#250;de&#46; Available from&#58; https&#58;&#47;&#47;bvsms&#46;saude&#46;gov&#46;br&#47;bvs&#47;saudelegis&#47;sas&#47;2010&#47;prt0594&#95;29&#95;10&#95;2010&#46;html&#46;"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estrat&#233;gias de controle e vigil&#226;ncia de contatos de hansen&#237;ase&#58; revis&#227;o integrativa"
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Artigo original
Teste sorológico ML Flow: ferramenta complementar na hanseníase
Janaína Olher Martins Montanhaa,
Corresponding author
janaina.montanha@ial.sp.gov.br

Autor para correspondência.
, Susilene Maria Tonelli Nardia, Fernanda Modesto Tolentino Binhardia, Heloisa da Silveira Paro Pedroa, Milena Polotto de Santia, Vânia Del Arco Paschoalb
a Instituto Adolfo Lutz, Centro de Laboratório Regional de São José do Rio Preto, São José do Rio Preto, SP, Brasil
b Departamento de Enfermagem em Saúde Coletiva, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">O Brasil &#233; um dos poucos pa&#237;ses do mundo a n&#227;o atingir o patamar de elimina&#231;&#227;o da hansen&#237;ase&#44; ou seja&#44; preval&#234;ncia inferior a 1 caso&#47;10 mil habitantes&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> Para o alcance da meta de controle da hansen&#237;ase da Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41; e do Minist&#233;rio da Sa&#250;de &#40;MS&#41;&#44; uma das a&#231;&#245;es efetivas &#233; a vigil&#226;ncia de contatos&#44; que tem por finalidade a descoberta de casos novos entre aqueles que convivem ou conviveram&#44; de maneira prolongada&#44; com o caso novo de hansen&#237;ase diagnosticado&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As pessoas que t&#234;m conv&#237;vio e contato com os doentes est&#227;o expostas a um risco 3&#44;8 vezes maior de adoecer quando comparadas com a popula&#231;&#227;o geral&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;4</span></a> e os contatos domiciliares de casos multibacilares &#40;MB&#41; representam um grupo caracterizado por alta exposi&#231;&#227;o ao bacilo&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> Portanto&#44; do ponto de vista epidemiol&#243;gico&#44; uma das atividades fundamentais para evitar o aumento da transmiss&#227;o da hansen&#237;ase &#233; o exame de contatos&#44; o qual poderia aumentar o diagn&#243;stico e a cura da doen&#231;a de maneira mais precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O exame cl&#237;nico dermatoneurol&#243;gico e a baciloscopia positiva ainda s&#227;o considerados soberanos para a defini&#231;&#227;o do diagn&#243;stico da hansen&#237;ase&#46; Embora a baciloscopia auxilie no diagn&#243;stico da doen&#231;a&#44; ela apresenta baixa sensibilidade&#44; principalmente nas formas paucibacilares &#40;PB&#41;&#44; podendo apresentar tamb&#233;m negatividade em alguns pacientes MB em decorr&#234;ncia de procedimentos inadequados de coleta&#44; 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o melhor teste padronizado para hansen&#237;ase&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O ML Flow se apresenta como teste r&#225;pido e de f&#225;cil execu&#231;&#227;o para a detec&#231;&#227;o de anticorpos da imunoglobulina M para o PGL&#8208;I do <span class="elsevierStyleItalic">M&#46; leprae&#46;</span> Assim como outros testes sorol&#243;gicos&#44; o ML Flow n&#227;o &#233; considerado padr&#227;o&#8208;ouro para o diagn&#243;stico&#44; mas pode ser usado como ferramenta complementar para classifica&#231;&#227;o cl&#237;nica ap&#243;s o diagn&#243;stico inicial&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> defini&#231;&#227;o e monitoramento de terapia medicamentosa&#44; risco de recidiva e na sele&#231;&#227;o dos contatos com maior risco de adoecer&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo teve como objetivo associar os resultados do teste ML Flow no caso &#237;ndice com sua classifica&#231;&#227;o cl&#237;nica&#44; verificar a frequ&#234;ncia dos resultados positivos ML Flow no contato domiciliar e tra&#231;ar o perfil epidemiol&#243;gico dos casos e seus contatos domiciliares&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">O estudo foi realizado em seis munic&#237;pios da regi&#227;o noroeste do estado de S&#227;o Paulo&#44; que ser&#227;o designados como munic&#237;pios I&#44; II&#44; III&#44; IV&#44; V e VI&#44; que totalizam uma popula&#231;&#227;o de 574&#46;151 habitantes&#46; Dentre os munic&#237;pios selecionados&#44; cinco deles apresentam preval&#234;ncia considerada m&#233;dia a muito alta pelo MS &#40;1&#44;0 a 19&#44;99 casos&#47;10 mil habitantes&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> e s&#227;o considerados munic&#237;pios priorit&#225;rios de acordo com a rela&#231;&#227;o do Programa de Controle da Hansen&#237;ase 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo abrangeu todos os novos casos com diagn&#243;stico de hansen&#237;ase&#44; virgens de tratamento ao longo de um ano&#44; no per&#237;odo de outubro de 2018 a outubro de 2019&#44; e seus contatos domiciliares&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram selecionados apenas os casos virgens de tratamento&#44; uma vez que ap&#243;s o in&#237;cio do tratamento a tend&#234;ncia &#233; a diminui&#231;&#227;o da carga bacilar e dos anticorpos da classe IgM&#46; Considerando que o teste de escolha do estudo foi qualitativo&#44; isso poderia interferir em sua sensibilidade&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para a caracteriza&#231;&#227;o do perfil do caso &#237;ndice e seus contatos domiciliares&#44; foi realizada a an&#225;lise de prontu&#225;rios cl&#237;nicos existentes nas unidades de sa&#250;de e entrevista&#44; por meio de formul&#225;rios espec&#237;ficos&#44; com dados sociodemogr&#225;ficos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nos casos &#237;ndices&#44; a coleta da amostra de sangue para realiza&#231;&#227;o do teste ML Flow foi realizada no momento da entrevista&#44; 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a amostra de sangue&#44; em ambos os casos&#44; foi encaminhada ao Laborat&#243;rio de Refer&#234;ncia&#44; o Centro Regional do Instituto Adolfo Lutz de S&#227;o Jose do Rio Preto&#44; com a guia preenchida conforme fluxo previamente estabelecido&#46; Foi utilizado o procedimento operacional padr&#227;o do Instituto Adolfo Lutz para coleta e armazenamento de amostra biol&#243;gica&#46; O procedimento para realiza&#231;&#227;o do teste ML Flow&#44; bem como a interpreta&#231;&#227;o dos resultados&#44; foram seguidos conforme descritos na bula do teste por Buhrer&#8208;Sekula et al&#46;&#44; 2003&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Os resultados foram inseridos em planilha Excel e analisados no programa estat&#237;stico EPI INFO&#46;7&#44; <span class="elsevierStyleItalic">software</span> desenvolvido pelo Center for Diseases Control and Prevention &#40;CDC&#41;&#46; 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dos quais foram entrevistados 44 &#40;72&#44;3&#37;&#41;&#44; al&#233;m da realiza&#231;&#227;o da coleta de sangue e do exame dermatoneurol&#243;gico&#46; Houve exclus&#227;o de 17 &#40;27&#44;7&#37;&#41; contatos&#58; sete n&#227;o foram poss&#237;veis de localizar &#40;endere&#231;o e telefone dispon&#237;veis incorretos ou mudan&#231;a de cidade&#41;&#44; quatro recusaram&#8208;se a participar da pesquisa e seis&#44; apesar de quatro contatos telef&#244;nicos e dois agendamentos&#44; n&#227;o compareceram ao local &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A m&#233;dia de idade foi de 49&#44;3 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44;3&#41; para o caso &#237;ndice e 40&#44;4 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#44;4&#41; para o contato domiciliar&#46; A m&#233;dia encontrada foi de 2&#44;35 &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;54&#41; contatos para cada caso&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o a saneamento b&#225;sico e &#225;gua encanada&#44; 100&#37; das resid&#234;ncias eram abastecidas pelos servi&#231;os das redes municipais&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Tanto nos casos &#237;ndices &#40;19&#47;26&#41; quanto nos contatos domiciliares &#40;25&#47;44&#41; houve predom&#237;nio de pessoas de pele branca&#46; Em 50&#37; &#40;13&#47;26&#41; dos casos de hansen&#237;ase entrevistados&#44; a renda familiar era de at&#233; dois sal&#225;rios&#8208;m&#237;nimos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Em 46&#44;2&#37; &#40;12&#47;26&#41; das resid&#234;ncias moravam quatro pessoas&#44; e em 59&#44;1&#37; delas havia at&#233; quatro c&#244;modos&#46; O tempo m&#233;dio de moradia dos contatos com os casos foi em m&#233;dia de 14 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;58&#41;&#44; e 88&#44;6&#37; dos contatos domiciliares n&#227;o conviveram&#44; nos &#250;ltimos 10 anos&#44; com outros casos de hansen&#237;ase fora do domic&#237;lio e nunca moraram com outra pessoa com a mesma doen&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Em 61&#44;4&#37; &#40;27&#47;44&#41; dos contatos domiciliares foram realizados exame dermatoneurol&#243;gico&#46; Observou&#8208;se que mesmo entre os contatos que tomaram a vacina BCG&#44; ainda assim 22&#44;7&#37; &#40;10&#47;44&#41; tiveram o resultado do teste ML Flow positivo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">O resultado positivo para ML Flow dos contatos foi mais frequente em mulheres &#40;15&#44;9&#37;&#59; 7&#47;44&#41; com idade superior a 35 anos &#40;13&#44;6&#37;&#59; 6&#47;44&#41; e com ensino fundamental incompleto ou analfabeto &#40;18&#44;2&#37;&#59; 8&#47;44&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A positividade no teste ML Flow&#44; quando relacionado com o grau de parentesco do contato com o caso&#44; foi mais presente em marido&#47;mulher &#40;4&#44;9&#37;&#59; 4&#47;44&#41;&#44; seguido por irm&#227;os &#40;6&#44;8&#37;&#59; 3&#47;44&#41; e filhos &#40;4&#44;5&#37;&#59; 2&#47;44&#41;&#46; Quando observado o n&#250;mero total de coletas de cada grau de parentesco com a positividade&#44; o n&#250;mero de irm&#227;os sobressai&#58; quatro coletas&#44; e destas&#44; tr&#234;s foram positivas &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Dentre casos diagnosticados com forma cl&#237;nica dimorfa e virchoviana &#40;MB&#41;&#44; quando a baciloscopia foi associada ao teste MF Flow&#44; os resultados apresentados foram compat&#237;veis em 20 &#40;76&#44;9&#37;&#41; casos&#44; dos quais 12 &#40;60&#37;&#41; foram positivos e oito &#40;40&#37;&#41; negativos para ambos os testes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quando comparado o resultado do teste ML Flow do caso &#237;ndice com sua classifica&#231;&#227;o operacional &#40;PB ou MB&#41;&#44; observamos que todos os pacientes classificados como PB &#40;cinco&#59; 19&#44;2&#37;&#41; tiveram resultado negativo&#59; entre os pacientes MB&#44; 14 &#40;53&#44;8&#37;&#41; foram positivos e sete &#40;27&#37;&#41; negativos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A m&#233;dia de aparecimento dos sintomas para os casos que tiveram sorologia positiva &#40;53&#44;8&#37;&#59; 14&#47;26&#41; foi de 31&#44;7 meses &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#44;9&#41;&#46; A mediana foi de 12 meses &#40;6&#8208;32&#41;&#46; Para os casos que tiveram sorologia negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; a m&#233;dia foi de 38&#44;75 &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44;54&#41;&#44; com mediana de 30 meses &#40;5&#8208;99&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">Anticorpos anti&#8208;PGL&#8208;I&#44; principalmente da classe IgM&#44; s&#227;o considerados espec&#237;ficos para <span class="elsevierStyleItalic">M&#46; leprae</span> e s&#227;o encontrados em pacientes com hansen&#237;ase&#44; mas tamb&#233;m podem ocorrer em baixos t&#237;tulos em pessoas expostas&#46; Os anticorpos n&#227;o conferem prote&#231;&#227;o e indicam infec&#231;&#227;o por <span class="elsevierStyleItalic">M&#46; leprae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> A positividade do teste ML Flow nos contatos &#233; indicador indireto da dissemina&#231;&#227;o da infec&#231;&#227;o por <span class="elsevierStyleItalic">M&#46; leprae</span> na popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Neste estudo&#44; o achado de 27&#44;3&#37; de soropositividade nos contatos domiciliares &#233; concordante com a literatura e demonstrou soropositividade para o ML Flow entre 15&#44;6&#37; nos PB<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">19&#44;20</span></a> a 28&#44;6&#37; nos MB&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#44;18</span></a> O monitoramento desses contatos evidenciou que os que apresentam ML Flow positivo t&#234;m mais risco de desenvolver formas MB do que os contatos soronegativos&#44; mesmo sem apresentar evid&#234;ncias cl&#237;nicas compat&#237;veis com a doen&#231;a&#44; fato que reafirma a necessidade de acompanhamento mais efetivo desse grupo familiar&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">A maioria dos contatos soropositivos foi do sexo feminino&#59; no entanto&#44; at&#233; o momento&#44; n&#227;o existe consenso sobre esse dado na literatura&#46; Alguns trabalhos apresentam maior soropositividade para o sexo masculino&#59;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">18&#44;22</span></a> j&#225; outros&#44; para o feminino&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">23&#8211;25</span></a> Cabe lembrar que as mulheres procuram mais os servi&#231;os de sa&#250;de&#44; o que deve favorecer maior acesso aos servi&#231;os de sa&#250;de e ao diagn&#243;stico da hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> Na an&#225;lise&#44; n&#227;o foi encontrada associa&#231;&#227;o dos dados sociodemogr&#225;ficos com os resultados do ML Flow nos contatos intradomiciliares&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Maior positividade ocorreu entre os contatos domiciliares de casos &#237;ndice MB &#40;dimorfo e virchoviano&#41;&#46; Esse dado&#44; que corrobora os estudos existentes&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#44;18&#44;20&#44;22</span></a> &#233; um achado esperado&#44; uma vez que os contatos domiciliares de pacientes com hansen&#237;ase MB na forma virchoviana apresentaram risco 3&#44;8 vezes maior de desenvolvimento de hansen&#237;ase do que os contatos de pacientes com outras formas cl&#237;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">A m&#233;dia de aparecimento dos sintomas encontrada neste estudo aventa a possibilidade de que os casos com sorologia positiva t&#234;m menor resist&#234;ncia ao bacilo de Hansen&#59; portanto&#44; ficam doentes mais precocemente do que aqueles com sorologia negativa&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Os achados deste estudo relativos &#224; faixa et&#225;ria e escolaridade tamb&#233;m convergem com os encontrados na literatura&#44; com predom&#237;nio para a faixa et&#225;ria<span class="elsevierStyleHsp" style=""></span>&#62; 35 anos e baixa escolaridade &#40;ensino fundamental incompleto ou analfabeto&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">18&#44;21&#44;26</span></a> A pouca escolaridade pode interferir na dificuldade de compreender as informa&#231;&#245;es divulgadas acerca da hansen&#237;ase e favorecer a dissemina&#231;&#227;o e o risco de contrair a doen&#231;a&#46; Ademais&#44; estudos apresentam rela&#231;&#227;o inversa entre o n&#250;mero de anos estudados e rentabilidade das fam&#237;lias que&#44; em sua maioria&#44; apresentam baixa renda e desempregados ou trabalhadores aut&#244;nomos&#44; sugerindo ser doen&#231;a associada a fatores socioecon&#244;micos&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A ocorr&#234;ncia de casos novos entre contatos domiciliares consangu&#237;neos do caso &#237;ndice&#44; principalmente parentes de primeiro grau&#44; apresentou probabilidade 2&#44;05 vezes maior em rela&#231;&#227;o a outros tipos de parentesco&#44; evidenciando a import&#226;ncia da suscetibilidade gen&#233;tica na cadeia de transmiss&#227;o da doen&#231;a&#44; j&#225; amplamente documentado na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;27&#44;28</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de 14 anos de conv&#237;vio dos contatos com os casos de hansen&#237;ase e a maior parte desses contatos n&#227;o ter convivido&#44; nos &#250;ltimos dez anos&#44; com outros portadores da doen&#231;a fora do domicilio&#44; ratificam uma das propostas que para atingir as metas de elimina&#231;&#227;o como problema de sa&#250;de p&#250;blica &#233; necess&#225;rio monitorar os contatos domiciliares&#44; que s&#227;o as pessoas que residam na mesma casa ou que tenham conv&#237;vio cont&#237;nuo e prolongado com o doente&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> visto que essa popula&#231;&#227;o est&#225; mais suscet&#237;vel a adoecer&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Apesar de o exame dermatoneurol&#243;gico ser uma das diretrizes para investiga&#231;&#227;o epidemiol&#243;gica dos contatos domiciliares descritas no manual de preven&#231;&#227;o e controle da doen&#231;a&#44; ainda assim&#44; em apenas 61&#44;4&#37; dos contatos foram realizados o exame&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> indicando que o servi&#231;o de sa&#250;de precisa olhar com mais cuidado para essa problem&#225;tica&#46; Em contrapartida&#44; dos contatos avaliados&#44; a maioria apresentou pelo menos uma cicatriz vacinal de BCG&#44; o que constitui achado satisfat&#243;rio para esse grupo&#44; uma vez que essa vacina foi inclu&#237;da como medida de controle da hansen&#237;ase para uso em contatos das diversas formas cl&#237;nicas da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Os casos &#237;ndices classificados como MB &#40;dimorfo e virchoviano&#41; apresentaram positividade para o teste de ML Flow de 53&#44;9&#37;&#44; enquanto nos PB n&#227;o houve resultado positivo&#44; divergindo da sensibilidade relatada na literatura&#44; em que trabalhos apontam que a sensibilidade de alguns tipos de teste r&#225;pido &#40;NDO&#8208;LID&#44; NDO&#44; LID ou PGL&#8208;1&#41; em pacientes MB variam de 80&#37; a 95&#37;&#44; enquanto em pacientes PB&#44; quando detect&#225;vel&#44; &#233; menor e variam de 15&#37; a 64&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17&#44;21</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">A classifica&#231;&#227;o da hansen&#237;ase com base no n&#250;mero de les&#245;es em PB &#40;&#8804; cinco les&#245;es dermatol&#243;gicas&#41; e MB &#40;&#62; cinco les&#245;es dermatol&#243;gicas&#41; pode levar a um esquema terap&#234;utico inapropriado&#44; resultando no subtratamento de pacientes MB&#44; quando classificados erroneamente como PB&#46; Essa falha terap&#234;utica &#233; a preocupa&#231;&#227;o dos profissionais de sa&#250;de que&#44; n&#227;o tendo acesso aos exames laboratoriais&#44; tendem a tratar mais pacientes como MB&#46; Em estudo realizado na Nig&#233;ria&#44; foi observado que 95&#44;7&#37; receberam poliquimioterapia para MB&#44; quando apenas 62&#44;9&#37; apresentavam ML Flow positivo&#46; Desses&#44; 55&#44;9&#37; teriam at&#233; cinco les&#245;es de pele e&#44; portanto&#44; estariam classificados como PB&#44; conforme recomenda&#231;&#227;o da OMS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Todos os casos &#237;ndices realizaram tamb&#233;m exame de baciloscopia&#46; Quando comparados os resultados do teste ML Flow e baciloscopia&#44; a concord&#226;ncia foi de 75&#37;&#46; No entanto&#44; 15&#44;4&#37; dos casos &#237;ndices apresentaram resultado positivo apenas na baciloscopia e 7&#44;7&#37; apenas no teste ML Flow&#46; Os resultados negativos tiveram concord&#226;ncia de 100&#37; para ambos os testes&#46; Estes achados est&#227;o em dissenso com os apresentados na literatura&#44; onde o teste ML Flow apresenta maior sensibilidade do que os exames de baciloscopia&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17&#44;30</span></a> o que pode ser justificado pelas constantes capacita&#231;&#245;es de coleta para baciloscopia realizadas na regi&#227;o estudada&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A concord&#226;ncia cl&#237;nico&#8208;histopatol&#243;gica com os resultados do ML Flow encontrada neste estudo est&#225; de acordo com os dados apresentados na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">O diagn&#243;stico tardio promove aumento do risco de defici&#234;ncias f&#237;sicas causadas pela progress&#227;o silenciosa da a&#231;&#227;o do bacilo no organismo&#44; em especial nos nervos perif&#233;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> Apesar de a regi&#227;o estudada ser considerada de baixa endemicidade na hansen&#237;ase&#44; os achados deste estudo apontam &#237;ndices elevados de defici&#234;ncias f&#237;sicas no momento do diagn&#243;stico&#44; o que sugere diagn&#243;stico tardio&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Nenhum teste laboratorial&#44; isoladamente&#44; &#233; suficientemente sens&#237;vel e espec&#237;fico para a correta classifica&#231;&#227;o cl&#237;nica em todas as formas de hansen&#237;ase&#44; mas s&#227;o ferramentas auxiliares importantes para um diagn&#243;stico correto&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">O teste ML Flow &#233; r&#225;pido&#44; individual&#44; de f&#225;cil execu&#231;&#227;o&#44; com sensibilidade e especificidade semelhantes ao do ELISA&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> o que gerou melhor custo&#47;benef&#237;cio para a pesquisa&#46; Al&#233;m disso&#44; n&#227;o necessita de equipamentos laboratoriais para sua realiza&#231;&#227;o&#44; convergindo com as estrat&#233;gias do SUS&#46; Sua utiliza&#231;&#227;o no SUS foi aprovada pela portaria SCTIE&#47;MS n&#176; 84&#44; de 31 de dezembro de 2021&#44; e sua distribui&#231;&#227;o ser&#225; feita de maneira gradativa e descentralizada aos munic&#237;pios&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Entre os fatores limitantes para este estudo&#44; podemos destacar a dificuldade de localiza&#231;&#227;o e convencimento dos contatos em comparecer aos servi&#231;os de sa&#250;de para avalia&#231;&#227;o e coleta de material&#46; Outra dificuldade foi compilar os resultados dos exames laboratoriais&#44; pois&#44; apesar de haver uma rede de laborat&#243;rios de refer&#234;ncia com fluxos definidos para o atendimento desses pacientes&#44; alguns munic&#237;pios encaminham os exames de baciloscopia e bi&#243;psias para diferentes laborat&#243;rios sem qualquer controle de qualidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0225" class="elsevierStylePara elsevierViewall">O teste ML Flow &#233; ferramenta eficaz tanto para selecionar os contatos domiciliares com predisposi&#231;&#227;o para o desenvolvimento da doen&#231;a e que necessitam de monitoramento mais pr&#243;ximo quanto para auxiliar na classifica&#231;&#227;o cl&#237;nica correta dos casos de hansen&#237;ase&#46; Desse modo&#44; os resultados sugerem que o ML Flow pode dar celeridade ao diagn&#243;stico&#44; auxiliando para evitar as defici&#234;ncias f&#237;sicas ainda presentes nas pessoas acometidas pela hansen&#237;ase nessa regi&#227;o&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Segundo os resultados deste estudo&#44; os contatos dos doentes multibacilares&#44; com baciloscopia positiva e consangu&#237;neos&#44; parecem estar mais expostos ao bacilo da hansen&#237;ase&#46; Baixa renda&#44; baixa escolaridade e condi&#231;&#245;es de moradia insatisfat&#243;rias podem ser fatores de risco para o adoecimento por hansen&#237;ase para os contatos domiciliares&#59; o seguimento desses grupos se faz necess&#225;rio&#44; visando interromper a cadeia de transmiss&#227;o da doen&#231;a&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0235" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o Paulista Contra Hansen&#237;ase &#8211; Projeto n&#176; 183&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0240" class="elsevierStylePara elsevierViewall">Jana&#237;na Olher Martins Montanha&#58; Participou da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Susilene Maria Tonelli Nardi&#58; Participaram da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito e Orienta&#231;&#227;o do trabalho&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Fernanda Modesto Tolentino Binhardi&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Heloisa da Silveira Paro Pedro&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Milena Polotto de Santi&#58; Contribu&#237;ram na concep&#231;&#227;o e delineamento do estudo&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">V&#226;nia Del Arco Paschoal&#58; Participaram da concep&#231;&#227;o e delineamento do estudo&#59; Coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos resultados&#59; Reda&#231;&#227;o e revis&#227;o cr&#237;tica do conte&#250;do do manuscrito e Orienta&#231;&#227;o do trabalho&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Todos os autores aprovaram a vers&#227;o final do manuscrito e s&#227;o respons&#225;veis por todos seus aspectos&#44; incluindo a garantia de sua precis&#227;o e integridade&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0275" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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          "titulo" => "Contribui&#231;&#227;o dos autores"
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          "titulo" => "Conflito de interesses"
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          "titulo" => "Agradecimentos"
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    "fechaRecibido" => "2022-04-18"
    "fechaAceptado" => "2022-05-30"
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          "titulo" => "Palavras chave"
          "identificador" => "xpalclavsec1641673"
          "palabras" => array:5 [
            0 => "Busca de comunicante"
            1 => "Hansen&#237;ase"
            2 => "Sa&#250;de p&#250;blica"
            3 => "Sorologia"
            4 => "Vigil&#226;ncia"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A avalia&#231;&#227;o dos contatos domiciliares de casos de hansen&#237;ase possibilita o diagn&#243;stico precoce de novos casos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Associar os resultados do teste ML Flow com caracter&#237;sticas cl&#237;nicas dos casos e verificar sua positividade nos contatos domiciliares&#44; al&#233;m de descrever o perfil epidemiol&#243;gico de ambos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo com todos os pacientes diagnosticados durante um ano&#44; virgens de tratamento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; e seus contatos domiciliares &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41; em seis munic&#237;pios do noroeste paulista &#40;Brasil&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Houve predom&#237;nio de homens 61&#44;5&#37; &#40;16&#47;26&#41;&#59; 77&#37; &#40;20&#47;26&#41; acima de 35 anos&#59; 86&#44;4&#37; &#40;22&#47;26&#41; multibacilares&#59; 61&#44;5&#37; &#40;16&#47;26&#41; com baciloscopia positiva e 65&#44;4&#37; sem defici&#234;ncia f&#237;sica &#40;17&#47;26&#41;&#46; O ML Flow foi positivo em 53&#44;8&#37; &#40;14&#47;26&#41; dos casos e se associou aos que tiveram baciloscopia positiva e foram diagnosticados como multibacilares &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entre os contatos domiciliares&#44; mulheres e com idade<span class="elsevierStyleHsp" style=""></span>&#62; 35 anos foram 52&#44;3&#37; &#40;23&#47;44&#41;&#59; a maioria havia sido vacinada com BCG &#8208; bacilo de Calmette&#8208;Gu&#233;rin 81&#44;8&#37; &#40;36&#47;44&#41;&#46; Houve positividade do ML Flow em 27&#44;3&#37; &#40;12&#47;44&#41; dos contatos domiciliares &#8211; todos conviveram com casos multibacilares&#59; sete com casos de baciloscopia positiva e seis com indiv&#237;duos consangu&#237;neos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Dificuldade no convencimento dos contatos para realizar a avalia&#231;&#227;o e coleta de material&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O teste ML Flow&#44; quando positivo nos contatos domiciliares&#44; pode auxiliar na identifica&#231;&#227;o dos casos que necessitam de acompanhamento mais atento da equipe de sa&#250;de&#44; pois indica predisposi&#231;&#227;o para a doen&#231;a&#44; em especial quando s&#227;o contatos domiciliares de casos multibacilares&#44; com baciloscopia positiva e consangu&#237;neos&#46; O ML Flow auxilia ainda na correta classifica&#231;&#227;o cl&#237;nica dos casos de hansen&#237;ase&#46;</p></span>"
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          4 => array:2 [
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Montanha JOM&#44; Nardi SMT&#44; Binhardi FMT&#44; Pedro HSP&#44; Santi MP&#44; Paschoal VDA&#46; ML Flow serological test&#58; complementary tool in leprosy&#46; An Bras Dermatol&#46; 2023&#59;98&#58;331&#8211;8&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Trabalho realizado no Centro de Laborat&#243;rio Regional de S&#227;o Jos&#233; do Rio Preto&#44; Instituto Adolfo Lutz&#44; S&#227;o Jos&#233; do Rio Preto&#44; SP&#44; Brasil&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental incompleto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental completo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino m&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#243;s&#8208;graduado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado civil</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Solteiro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&#47;divorciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vi&#250;vo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uni&#227;o consensual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Situa&#231;&#227;o trabalhista</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aposentado&#47;licen&#231;a sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Situa&#231;&#227;o moradia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casa pr&#243;pria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alugada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Situa&#231;&#227;o contato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tempo de conviv&#234;ncia com doente na mesma casa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menos de cinco anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cinco anos ou mais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;52&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grau de parentesco com o caso</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consangu&#237;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o consangu&#237;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;54&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Passou por exame dermatoneurol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;61&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;27&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o sabe informar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tomou BCG</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;81&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sem informa&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3171288.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental incompleto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino m&#233;dio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;31&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#243;s&#8208;graduado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grau de parentesco</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Filho&#40;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;27&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esposo&#40;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irm&#227;o&#40;&#227;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pai&#47;m&#227;e&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cunhado&#40;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Virchoviana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;65&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Baciloscopia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;38&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bi&#243;psia</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sugestivo hansen&#237;ase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">41&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">41&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;83&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;16&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grau de incapacidade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Com GIF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;34&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sem GIF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;65&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classifica&#231;&#227;o operacional</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Paucibacilar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multibacilar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                      "titulo" => "Estrat&#233;gias de controle e vigil&#226;ncia de contatos de hansen&#237;ase&#58; revis&#227;o integrativa"
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Article information
ISSN: 26662752
Original language: Portuguese
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