Research Letter
Leprosy in the state of Amazonas: is there actually a decrease in its incidence and prevalence?
Dejanane Silva e Silvaa,b, Jamile Izan Lopes Palheta Júniora, Valderiza Lourenço Pedrosaa,b, Carolina Talharia,b,c,
Autor para correspondência
a Fundação Alfredo da Matta de Dermatologia e Venereologia, Department of Tropical Dermatology, Manaus, AM, Brazil
b Curso de Pós-Graduação em Ciências Aplicadas à Dermatologia, Universidade do Estado do Amazonas, Manaus, AM, Brazil
c Universidade do Estado do Amazonas. Department of Dermatology, Manaus, AM, Brazil
Lido
4276
Vezesque se leu este artigo
1859
Total PDF
2417
Total HTML
Compartilhar estatÃsticas
array:24 [ "pii" => "S0365059622000824" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.01.007" "estado" => "S300" "fechaPublicacion" => "2022-07-01" "aid" => "562" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:19 [ "pii" => "S266627522200100X" "issn" => "26662752" "doi" => "10.1016/j.abdp.2022.06.011" "estado" => "S300" "fechaPublicacion" => "2022-07-01" "aid" => "562" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta ‐ Caso clínico</span>" "titulo" => "Hanseníase no estado do Amazonas: há realmente queda na incidência e prevalência?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "515" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3429 "Ancho" => 2917 "Tamanyo" => 874547 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Taxas de detecção de novos casos de hanseníase por regiões do Amazonas, 2012 e 2017.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dejanane Silva e Silva, Jamile Izan Lopes Palheta Júnior, Valderiza Lourenço Pedrosa, Carolina Talhari" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Dejanane Silva e" "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Jamile Izan Lopes" "apellidos" => "Palheta Júnior" ] 2 => array:2 [ "nombre" => "Valderiza Lourenço" "apellidos" => "Pedrosa" ] 3 => array:2 [ "nombre" => "Carolina" "apellidos" => "Talhari" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059622000824" "doi" => "10.1016/j.abd.2021.01.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000824?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522200100X?idApp=UINPBA00008Z" "url" => "/26662752/0000009700000004/v1_202207280537/S266627522200100X/v1_202207280537/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059622000861" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.02.012" "estado" => "S300" "fechaPublicacion" => "2022-07-01" "aid" => "570" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Longitudinal melanonychia in childhood: a great challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "516" "paginaFinal" => "519" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2186 "Ancho" => 2508 "Tamanyo" => 418373 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical (A) and dermoscopic (B) aspect at the first consultation; (C–D) Clinical (C) and dermoscopic (D) aspect five years after the biopsy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabela Boechat Morato, João Renato Vianna Gontijo, Glaysson Tassara Tavares, Flávia Vasques Bittencourt" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Isabela Boechat" "apellidos" => "Morato" ] 1 => array:2 [ "nombre" => "João Renato Vianna" "apellidos" => "Gontijo" ] 2 => array:2 [ "nombre" => "Glaysson Tassara" "apellidos" => "Tavares" ] 3 => array:2 [ "nombre" => "Flávia Vasques" "apellidos" => "Bittencourt" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222000844" "doi" => "10.1016/j.abdp.2022.05.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222000844?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000861?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000004/v1_202206290808/S0365059622000861/v1_202206290808/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059622000800" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.01.006" "estado" => "S300" "fechaPublicacion" => "2022-07-01" "aid" => "560" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Chronic urticaria: profile from a reference center" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "511" "paginaFinal" => "512" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 651 "Ancho" => 1400 "Tamanyo" => 65528 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Profile of patients with inducible chronic urticaria.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Carolina Miranda Carvalho Ferreira Fernandes de Souza, Sérgio D. Dortas Junior, Guilherme Gomes Azizi, Alfeu Tavares França, Omar Lupi, Solange O.R. Valle" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ana Carolina Miranda Carvalho Ferreira Fernandes" "apellidos" => "de Souza" ] 1 => array:2 [ "nombre" => "Sérgio D." "apellidos" => "Dortas Junior" ] 2 => array:2 [ "nombre" => "Guilherme Gomes" "apellidos" => "Azizi" ] 3 => array:2 [ "nombre" => "Alfeu Tavares" "apellidos" => "França" ] 4 => array:2 [ "nombre" => "Omar" "apellidos" => "Lupi" ] 5 => array:2 [ "nombre" => "Solange O.R." "apellidos" => "Valle" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222000790" "doi" => "10.1016/j.abdp.2022.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222000790?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000800?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000004/v1_202206290808/S0365059622000800/v1_202206290808/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Leprosy in the state of Amazonas: is there actually a decrease in its incidence and prevalence?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "515" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Dejanane Silva e Silva, Jamile Izan Lopes Palheta Júnior, Valderiza Lourenço Pedrosa, Carolina Talhari" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Dejanane Silva e" "apellidos" => "Silva" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Jamile Izan Lopes" "apellidos" => "Palheta Júnior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Valderiza Lourenço" "apellidos" => "Pedrosa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Carolina" "apellidos" => "Talhari" "email" => array:1 [ 0 => "carolinatalhari@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Fundação Alfredo da Matta de Dermatologia e Venereologia, Department of Tropical Dermatology, Manaus, AM, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Curso de Pós-Graduação em Ciências Aplicadas à Dermatologia, Universidade do Estado do Amazonas, Manaus, AM, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidade do Estado do Amazonas. Department of Dermatology, Manaus, AM, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3429 "Ancho" => 2917 "Tamanyo" => 817018 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Detection rates of new leprosy cases per region of the state of Amazonas, 2012 and 2017.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the World Health Organization (WHO), leprosy is an important global public health problem. In 2019, 202,185 new cases were recorded, with a global prevalence of 0.22/10,000 inhabitants. India, Brazil, and Indonesia are among the countries with the highest prevalence of the disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Brazil, 23,612 new cases were diagnosed in 2019. In that year, a detection rate of 13.23/100,000 inhabitants was verified. In 1991, the WHO proposed the elimination of leprosy (less than one patient per 10,000 inhabitants) by 2005. Brazil did not reach this goal and has maintained a high endemicity. In 2019, among the new cases diagnosed in the country, 9.9% had grade 2 physical disability (G2D). Another important aspect, was the detection rate of new cases in patients under 15 years of age: 3.44/100,000 inhabitants. These data indicate the low quality of the leprosy control program.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Actions to control leprosy in Brazil include mainly the diagnosis of new cases during routine care at health centers, active search, and examination of contacts.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2018, the state of Amazonas had a prevalence rate of 0.93/10,000 inhabitants. In the same year, 425 new cases were diagnosed. Despite the reduction in the detection rate from 21.54/100,000, in 2009, to 10.31/100,000, in 2018, the state has maintained a high endemicity. In 2018, 9.2% of the new patients had G2D at the diagnosis, and the detection rate of new cases in children under 15 years was 4.19/100,000.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The state of Amazonas has a territorial area of 1,571,000 km<span class="elsevierStyleSup">2</span>, divided into 62 municipalities. In 2010, the state had 3,483,985 inhabitants and the capital city, Manaus, concentrated 51.7% of the population (1,802,014 inhabitants). The Metropolitan Region of Manaus (MRM), comprising the municipalities of Autazes, Careiro, Careiro da Várzea, Iranduba, Itacoatiara, Itapiranga, Manacapuru, Manaus, Manaquiri, Novo Airão, Presidente Figueiredo, Rio Preto da Eva and Silves, had 2,210,665 inhabitants (63.4%). The state has 25 state highways, distributed mainly around the MRM.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Alfredo da Matta Foundation (FUAM, <span class="elsevierStyleItalic">Fundação Alfredo da Matta</span>), located in Manaus, is a referral center for the diagnosis and treatment of leprosy in the Amazon region. FUAM promotes regular leprosy supervision actions and the training of health professionals in the capital and other municipalities in the state. These activities are carried out by teams consisting of dermatologists, nurses, nursing and/or laboratory technicians, depending on the demand of the municipality and the need for specific training.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the present study, the results of the supervision actions carried out from March 2012 to December 2017 were assessed, with an emphasis on the detection of new cases diagnosed by FUAM teams, comparing them with the patients notified by the municipal health units.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is a retrospective and descriptive study of new cases of leprosy diagnosed during the study period. Epidemiological data from the Notifiable Diseases Information System (SINAN, <span class="elsevierStyleItalic">Sistema de Informação de Agravos de Notificação</span>) and from the State Leprosy Coordination (<span class="elsevierStyleItalic">Coordenação Estadual de Hanseníase</span>) were used. The study was submitted to and approved by FUAM Research Ethics Committee.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All the municipalities in the state were visited by FUAM teams, some annually and others with an interval of more than one year. In 2017, supervision actions were carried out in the 62 municipalities.</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the study period, 3,299 new cases were recorded: 1,637 (49.6%) lived in the MRM and 1,662 (50.4%) in other municipalities. Of this total, 1,910 (57.9%) patients had lepromatous (multibacillary) leprosy, 303 (9.2%) had G2 at the time of diagnosis, and 362 (11%) were younger than 15 years.</p><p id="par0050" class="elsevierStylePara elsevierViewall">During the supervision, 642 new cases were diagnosed by FUAM teams. This number is equivalent to 19.5% of the total number of patients recorded during the study period; 293 (45.6%) lived in the MRM and 349 (54.4%) in other municipalities.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Another relevant aspect of the investigation is that 1,143 (34.6%) of the new cases lived in the municipality of Manaus and among these, 808 (70.7%) were diagnosed at FUAM headquarters.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The municipalities with the highest detection rates during the study period were: Itamarati (81.25/100,000), Tapauá (76.65/100,000), Humaitá (61.05/100,000), Boca do Acre (45.25/100,000). 100,000) and Guajará (40.70/100,000; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In 2017, the year when all municipalities were supervised, 449 new cases of leprosy were diagnosed: 126 (28.1%) lived in the municipality of Manaus and 323 (71.9%) in the other municipalities. In that year, FUAM teams diagnosed 152 (33.8%) patients: 53 (42%) in Manaus and 99 (33.1%) in the other municipalities. Of the 126 new cases living in Manaus, 101 (80.2%) were diagnosed at FUAM headquarters.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Considering the territorial extension of the state and that most of the municipalities in the countryside lack road transportation infrastructure, it would be possible to infer that the municipalities in the MRM would have easy access to evaluation at the referral center and would notify most of the new cases. During the study period, 1,637 (49.6%) leprosy cases lived in the MRM (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). However, of this total, 293 (17.9%) patients were diagnosed during the supervision actions.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The data from the municipality of Manaus are also important: of the 1,143 (34.6%) new cases diagnosed in this municipality during the study period, 808 (70.7%) were identified in FUAM. This fact indicates that patients do not seek health centers in the capital city, are not diagnosed in these places, or are systematically referred to FUAM.</p><p id="par0080" class="elsevierStylePara elsevierViewall">When the most recent data from 2017 are analyzed, it is verified that there were no important changes during the study period. In that year, 449 new cases were recorded throughout the state: 126 (28.1%) lived in Manaus and 323 (71.9%) in other municipalities. Of this total, 152 (33.8%) cases were diagnosed during supervision actions. It was also found that more than 80% of the new cases residing in Manaus were diagnosed at FUAM.</p><p id="par0085" class="elsevierStylePara elsevierViewall">These data explain in part the low effectiveness of the leprosy control program, with late diagnoses and a significant number of new cases in children. A late diagnosis also implies undiagnosed multibacillary cases responsible for maintenance of the endemicity.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Considering the data presented herein, showing that 642 (19.5%) new cases of leprosy would not have been diagnosed without the presence of a dermatologist, it is suggested to evaluate the activities of the Leprosy Control Program, with an emphasis on training health professionals in the capital city and municipalities, as well as enacting regular supervision actions and updates of the professionals.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors' contributions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Dejanane Silva e Silva: Design and planning of the study; data collection, or analysis and interpretation of data; drafting and editing of the manuscript; critical review of intellectual content; approval of the final version of the manuscript.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Jamile Izan Lopes Palheita Júnior: Design and planning of the study; analysis and interpretation of data; critical review of the intellectual content; approval of the final version of the manuscript.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Valderiza Lourenço Pedrosa: Data analysis and interpretation; critical review of the intellectual content; approval of the final version of the manuscript.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Carolina Talhari: Design and planning of the study; analysis and interpretation of data; drafting and editing of the manuscript; critical review of the intellectual content; approval of the final version of the manuscript.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-10" "fechaAceptado" => "2021-01-03" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Fundação Alfredo da Matta de Dermatologia e Venereologia, Manaus, AM, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3429 "Ancho" => 2917 "Tamanyo" => 817018 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Detection rates of new leprosy cases per region of the state of Amazonas, 2012 and 2017.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Municipalities \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">New cases diagnosed by the FUAM health team</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">New cases diagnosed by the municipality</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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 \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of cases \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 \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage \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 \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of cases \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 \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage \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 \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Manaus \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">162 \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">14.20% \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">981 \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">85.80% \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">1143 \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">Presidente Figueiredo \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">8 \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% \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">39 \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">83% \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">47 \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">Rio Preto da Eva \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 \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">26.70% \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 \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">73.30% \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 \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">Itacoatiara \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 \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">7.30% \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">127 \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">92.70% \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">137 \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">Manacapuru \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 \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">16% \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">63 \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% \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">75 \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">Itapiranga \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 \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">100% \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 \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">0.0% \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 \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">Manaquiri \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 \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% \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 \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">81% \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">21 \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">Iranduba \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 \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">26.40% \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">39 \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">73.60% \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 \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">Autazes \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 \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">35.40% \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 \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">67% \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">48 \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">Careiro da Várzea \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 \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">65.20% \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">8 \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">34.80% \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 \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">Careiro Castanho \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 \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">35.50% \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 \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">64.50% \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 \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">Novo Airão \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 \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">54.50% \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 \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">45.50% \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 \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">Silves \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">16 \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">84.2% \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 \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">15.8% \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 \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">General total \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">293 \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"> \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">1,344 \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"> \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">1,637 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">New cases of leprosy detected by FUAM health teams and municipal health services, from March 2012 to December 2017, in the municipalities of the metropolitan region of Manaus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "who.int [Internet]. World Health Organization; c2022. Global leprosy (Hansen disease) update, 2019: time to step-up prevention initiatives. Wkly Epidemiol Rec. 2020;36:417–440. Available from: <a target="_blank" href="https://www.who.int/publications/i/item/who-wer9536">https://www.who.int/publications/i/item/who-wer9536</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da hanseníase como problema de saúde pública. Ministério da Saúde [Internet]. 2016. [cited 2020 Jul 01]. Available from: <a target="_blank" href="https://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf">https://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Boletim Epidemiológico. Hanseníase. Ministério da Saúde [Internet]. 2020. [cited 2020 Jul 01]. Available from: <a target="_blank" href="http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-de-hanseniase-2020">http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-de-hanseniase-2020</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "cidades.ibge [Internet]. Instituto Brasileiro de Geografia e Estatística - IBGE | Cidades. [cited 2020 Jul 01]. Available from: <a target="_blank" href="https://cidades.ibge.gov.br/brasil/am/itamarati/panorama">https://cidades.ibge.gov.br/brasil/am/itamarati/panorama</a>." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "sedecti.am [Internet]. Departamento de Estudos Pesquisa e Informação da SEAP. Amazonas em Mapas. 2018. [cited 2020 Jul 01]. Available from: <a target="_blank" href="http://www.sedecti.am.gov.br/wp-content/uploads/2019/07/2a_Amazonas_em_Mapas_2016_em_novembro_de_2018.pdf">http://www.sedecti.am.gov.br/wp-content/uploads/2019/07/2a_Amazonas_em_Mapas_2016_em_novembro_de_2018.pdf</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "fuam.am [Internet]. Fundação Alfredo da Matta de Dermatologia e Venereologia. Situação epidemiológica da hanseníase na Fundação Alfredo da Matta de Dermatologia – 2018. [cited 2020 Jul 01]. Available from: <a target="_blank" href="http://www.fuam.am.gov.br/wp-content/uploads/2014/05/Boletim_Epidemiologico_FUAM_2018.pdf">http://www.fuam.am.gov.br/wp-content/uploads/2014/05/Boletim_Epidemiologico_FUAM_2018.pdf</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009700000004/v1_202206290808/S0365059622000824/v1_202206290808/en/main.assets" "Apartado" => array:4 [ "identificador" => "82768" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009700000004/v1_202206290808/S0365059622000824/v1_202206290808/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000824?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 17 | 9 | 26 |
| 2024 Outubro | 113 | 71 | 184 |
| 2024 Setembro | 149 | 83 | 232 |
| 2024 Agosto | 157 | 111 | 268 |
| 2024 Julho | 134 | 100 | 234 |
| 2024 Junho | 135 | 68 | 203 |
| 2024 Maio | 89 | 65 | 154 |
| 2024 Abril | 109 | 89 | 198 |
| 2024 Março | 84 | 84 | 168 |
| 2024 Fevereiro | 85 | 76 | 161 |
| 2024 Janeiro | 80 | 58 | 138 |
| 2023 Dezembro | 44 | 55 | 99 |
| 2023 Novembro | 75 | 92 | 167 |
| 2023 Outubro | 68 | 83 | 151 |
| 2023 Setembro | 80 | 78 | 158 |
| 2023 Agosto | 69 | 25 | 94 |
| 2023 Julho | 68 | 44 | 112 |
| 2023 Junho | 93 | 42 | 135 |
| 2023 Maio | 82 | 39 | 121 |
| 2023 Abril | 44 | 21 | 65 |
| 2023 Março | 76 | 56 | 132 |
| 2023 Fevereiro | 44 | 36 | 80 |
| 2023 Janeiro | 53 | 53 | 106 |
| 2022 Dezembro | 55 | 31 | 86 |
| 2022 Novembro | 72 | 59 | 131 |
| 2022 Outubro | 80 | 66 | 146 |
| 2022 Setembro | 60 | 70 | 130 |
| 2022 Agosto | 60 | 63 | 123 |
| 2022 Julho | 96 | 88 | 184 |
| 2022 Junho | 46 | 44 | 90 |
Mostrar tudo
