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o estado do Amazonas apresentou taxa de preval&#234;ncia de hansen&#237;ase de 0&#44;93&#47;10&#46;000&#160;habitantes&#46; No mesmo ano&#44; foram diagnosticados&#160;425&#160;casos novos&#46; Apesar da redu&#231;&#227;o da taxa de detec&#231;&#227;o de&#160;21&#44;54&#160;casos&#44; em&#160;2009&#44; para&#160;10&#44;31&#47;100&#46;000&#44; em&#160;2018&#44; o estado permanece com par&#226;metro de alta endemicidade&#46; Em&#160;2018&#44; 9&#44;2&#37;&#160;dos novos pacientes apresentaram G2 no momento do diagn&#243;stico&#44; e a taxa de detec&#231;&#227;o de novos casos em menores de&#160;15&#160;anos foi&#160;de 4&#44;19&#47;100&#46;000&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O estado do Amazonas apresenta &#225;rea territorial de&#160;1&#46;571&#46;000&#160;km<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&#44; e &#233; dividido em 62 munic&#237;pios&#46; Em 2010&#44; o estado tinha 3&#46;483&#46;985 habitantes e a capital&#44; Manaus&#44; concentrava 51&#44;7&#37;&#160;da popula&#231;&#227;o &#40;1&#46;802&#46;014 habitantes&#41;&#46; Na regi&#227;o metropolitana de Manaus &#40;RMM&#41;&#44; composta pelos munic&#237;pios de Autazes&#44; Careiro&#44; Careiro da V&#225;rzea&#44; Iranduba&#44; Itacoatiara&#44; Itapiranga&#44; Manacapuru&#44; Manaus&#44; Manaquiri&#44; Novo Air&#227;o&#44; Presidente Figueiredo&#44; Rio Preto da Eva e Silves&#44; habitavam 2&#46;210&#46;665&#160;&#40;63&#44;4&#37;&#41; pessoas&#46; O estado conta cm&#160;25&#160;rodovias estaduais&#44; distribu&#237;das&#44; principalmente&#44; no entorno da RMM&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A Funda&#231;&#227;o Alfredo da Matta &#40;FUAM&#41;&#44; em Manaus&#44; &#233; centro de refer&#234;ncia para diagn&#243;stico e tratamento da hansen&#237;ase no Amazonas&#46; A FUAM promove a&#231;&#245;es regulares de supervis&#227;o da hansen&#237;ase e treinamento de profissionais da sa&#250;de na capital e demais munic&#237;pios do estado&#46; Essas atividades s&#227;o realizadas por equipes compostas por dermatologista&#44; enfermeiros&#44; t&#233;cnicos de enfermagem e&#47;ou laborat&#243;rio&#44; dependendo da demanda do munic&#237;pio e da necessidade de treinamentos espec&#237;ficos&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">No presente estudo foram avaliados os resultados das supervis&#245;es realizadas no per&#237;odo de mar&#231;o de&#160;2012 a dezembro de&#160;2017&#44; com &#234;nfase na detec&#231;&#227;o de casos novos diagnosticados pelas equipes da FUAM&#44; comparando&#8208;os com os pacientes notificados pelas unidades municipais de sa&#250;de&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Trata&#8208;se de estudo retrospectivo e descritivo de casos novos de hansen&#237;ase diagnosticados no per&#237;odo da realiza&#231;&#227;o do estudo&#46; Foram utilizados dados epidemiol&#243;gicos do Sistema de Informa&#231;&#227;o de Agravos de Notifica&#231;&#227;o &#40;SINAN&#41; e da Coordena&#231;&#227;o Estadual de Hansen&#237;ase&#46; O estudo foi submetido e aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos os munic&#237;pios do estado foram visitados pelas equipes da FUAM&#44; alguns anualmente e outros com intervalo superior a um ano&#46; Em&#160;2017&#44; foram realizadas supervis&#245;es nos&#160;62&#160;munic&#237;pios&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No per&#237;odo do estudo foram registrados&#160;3&#46;299&#160;casos novos&#58; 1&#46;637&#160;&#40;49&#44;6&#37;&#41; residiam na RMM e 1&#46;662&#160;&#40;50&#44;4&#37;&#41;&#44; nos outros munic&#237;pios&#46; Desse total&#44; 1&#46;910&#160;&#40;57&#44;9&#37;&#41; pacientes eram multibacilares&#44; 303&#160;&#40;9&#44;2&#37;&#41; apresentaram G2 no momento do diagn&#243;stico e 362&#160;&#40;11&#37;&#41; eram menores de&#160;15&#160;anos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Durante as supervis&#245;es&#44; 642&#160;novos casos foram diagnosticados pelas equipes da FUAM&#46; Esse n&#250;mero equivale a 19&#44;5&#37;&#160;do total de doentes registrados no per&#237;odo de realiza&#231;&#227;o do estudo&#59; 293 &#40;45&#44;6&#37;&#41; residiam na RMM e 349 &#40;54&#44;4&#37;&#41; nos demais munic&#237;pios&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Outro aspecto relevante da investiga&#231;&#227;o&#58; 1&#46;143&#160;&#40;34&#44;6&#37;&#41; dos novos casos moravam no munic&#237;pio de Manaus e&#44; dentre esses&#44; 808&#160;&#40;70&#44;7&#37;&#41; foram diagnosticados na sede da FUAM&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os munic&#237;pios que apresentaram as maiores taxas de detec&#231;&#227;o no per&#237;odo do estudo foram&#58; Itamarati &#40;81&#44;25&#47;100&#46;000&#41;&#44; Tapau&#225; &#40;76&#44;65&#47;100&#46;000&#41;&#44; Humait&#225; &#40;61&#44;05&#47;100&#46;000&#41;&#44; Boca do Acre &#40;45&#44;25&#47;100&#46;000&#41; e Guajar&#225; &#40;40&#44;70&#47;100&#46;000&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Em&#160;2017&#44; ano em que todos os munic&#237;pios foram supervisionados&#44; foram diagnosticados 449 casos novos de hansen&#237;ase&#58; 126&#160;&#40;28&#44;1&#37;&#41; residiam no munic&#237;pio de Manaus e 323&#160;&#40;71&#44;9&#37;&#41;&#44; nos demais munic&#237;pios&#46; Naquele ano&#44; as equipes da FUAM diagnosticaram 152&#160;&#40;33&#44;8&#37;&#41; pacientes&#58; 53&#160;&#40;42&#37;&#41; em Manaus e 99&#160;&#40;33&#44;1&#37;&#41; nos demais munic&#237;pios&#46; Dentre os 126 casos novos residentes em Manaus&#44; 101&#160;&#40;80&#44;2&#37;&#41; foram diagnosticados na sede da FUAM&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Considerando a extens&#227;o territorial do estado e que na maior parte dos munic&#237;pios do interior n&#227;o h&#225; transporte rodovi&#225;rio&#44; seria poss&#237;vel inferir que os munic&#237;pios da RMM teriam f&#225;cil acesso a pareceres do centro de refer&#234;ncia e notificariam a maioria dos casos novos&#46; No per&#237;odo do estudo&#44; 1&#46;637&#160;&#40;49&#44;6&#37;&#41; casos de hansen&#237;ase residiam na RMM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; No entanto&#44; desse total&#44; 293&#160;&#40;17&#44;9&#37;&#41; pacientes foram diagnosticados durante as supervis&#245;es&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Os dados de Manaus tamb&#233;m s&#227;o importantes&#58; dentre os 1&#46;143&#160;&#40;34&#44;6&#37;&#41; novos casos diagnosticados no munic&#237;pio&#44; no per&#237;odo do estudo&#44; 808&#160;&#40;70&#44;7&#37;&#41; foram identificados na FUAM&#46; Isso indica que os pacientes n&#227;o procuram os centros de sa&#250;de da capital&#44; n&#227;o s&#227;o diagnosticados nesses locais ou s&#227;o sistematicamente encaminhados para a FUAM&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Quando se analisam de maneira isolada os dados mais recentes&#44; de&#160;2017&#44; verifica&#8208;se que n&#227;o houve mudan&#231;as importantes no per&#237;odo de estudo&#44; quando foram registrados 449&#160;casos novos em todo o estado&#58; 126&#160;&#40;28&#44;1&#37;&#41; residiam em Manaus e 323&#160;&#40;71&#44;9&#37;&#41;&#44; nos demais munic&#237;pios&#46; Desse total&#44; 152&#160;&#40;33&#44;8&#37;&#41; casos foram diagnosticados durante as supervis&#245;es&#46; Verificou&#8208;se&#44; ainda&#44; que mais de&#160;80&#37; dos casos novos que residiam em Manaus foram diagnosticados na FUAM&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Esses dados explicam&#44; em parte&#44; a baixa resolutividade do programa de controle da hansen&#237;ase&#44; com diagn&#243;sticos tardios e importante n&#250;mero de casos novos em crian&#231;as&#46; Diagn&#243;stico tardio implica tamb&#233;m em casos multibacilares sem diagn&#243;stico&#44; respons&#225;veis pela manuten&#231;&#227;o da endemia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Face aos dados apresentados&#44; evidenciando que 642&#160;&#40;19&#44;5&#37;&#41; casos novos de hansen&#237;ase n&#227;o teriam sido diagnosticados sem a presen&#231;a do dermatologista&#44; sugere&#8208;se avalia&#231;&#227;o das atividades do Programa de Controle da Hansen&#237;ase&#44; com &#234;nfase na capacita&#231;&#227;o dos profissionais de sa&#250;de da capital e munic&#237;pios&#44; bem como supervis&#245;es e atualiza&#231;&#245;es regulares desses profissionais&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Dejanane Silva e Silva&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Jamile Izan Lopes Palheita J&#250;nior&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Valderiza Louren&#231;o Pedrosa&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Carolina Talhari&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Munic&#237;pios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Total&nbsp;\t\t\t\t\t\t\n
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                  \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&#250;mero de casos&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">Porcentagem&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&#250;mero de casos&nbsp;\t\t\t\t\t\t\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" scope="col" style="border-bottom: 2px solid black">Porcentagem&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" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Manaus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">162&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">14&#44;20&#37;&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">981&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">85&#44;80&#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">1&#46;143&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">Presidente Figueiredo&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">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#37;&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">39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Rio Preto da Eva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;70&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73&#44;30&#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">15&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">Itacoatiara&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">7&#44;30&#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">127&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">92&#44;70&#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">137&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">Manacapuru&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">16&#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">63&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&#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">75&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">Itapiranga&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">100&#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">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
                  \t\t\t\t">0&#44;0&#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">14&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">Manaquiri&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">19&#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">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">81&#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">21&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">Iranduba&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">26&#44;40&#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
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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">73&#44;60&#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
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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">Autazes&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;40&#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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\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</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Careiro da V&#225;rzea&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;20&#37;&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
                  \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">34&#44;80&#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
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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">Careiro Castanho&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;50&#37;&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
                  \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
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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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">Novo Air&#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
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                  \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
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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">Silves&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  " align="left" valign="\n
                  \t\t\t\t\ttop\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">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">15&#44;8&#37;&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
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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">Total geral&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">&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</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
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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">1&#46;637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Casos novos de hansen&#237;ase detectados pelas equipes de sa&#250;de da FUAM e servi&#231;os de sa&#250;de municipais&#44; no per&#237;odo de mar&#231;o de&#160;2012 a dezembro de&#160;2017&#44; nos munic&#237;pios da regi&#227;o metropolitana de Manaus</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "who&#46;int &#91;Internet&#93;&#46; World Health Organization&#59; 2022&#46; Global leprosy &#40;Hansen disease&#41; update&#44; 2019&#58; time to step&#8208;up prevention initiatives&#46; Wkly Epidemiol Rec&#46; 2020&#59;36&#58;417&#8208;40&#46; Available from&#58; https&#58;&#47;&#47;www&#46;who&#46;int&#47;publications&#47;i&#47;item&#47;who&#8208;wer9536&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
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Carta ‐ Caso clínico
Hanseníase no estado do Amazonas: há realmente queda na incidência e prevalência?
Dejanane Silva e Silvaa,b, Jamile Izan Lopes Palheta Júniora, Valderiza Lourenço Pedrosaa,b, Carolina Talharia,b,c,
Autor para correspondência
carolinatalhari@gmail.com

Autor para correspondência.
a Fundação Alfredo da Matta de Dermatologia e Venereologia, Departamento Dermatologia Tropical, Manaus, AM, Brasil
b Curso de Pós‐Graduação em Ciências Aplicadas à Dermatologia, Universidade do Estado do Amazonas, Manaus, AM, Brasil
c Departamento de Dermatologia, Universidade do Estado do Amazonas, Manaus, AM, Brasil
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Taxas de detec&#231;&#227;o de novos casos de hansen&#237;ase por regi&#245;es do Amazonas&#44; 2012 e 2017&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Segundo a Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;OMS&#41;&#44; a hansen&#237;ase constitui importante problema mundial de sa&#250;de p&#250;blica&#46; Em&#160;2019 foram registrados&#160;202&#46;185&#160;casos novos&#44; com preval&#234;ncia global de&#160;0&#44;22&#47;10&#46;000&#160;habitantes&#46; Entre os pa&#237;ses com maior preval&#234;ncia est&#227;o &#205;ndia&#44; Brasil e Indon&#233;sia&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">No Brasil&#44; em&#160;2019&#44; foram diagnosticados&#160;23&#46;612&#160;casos novos&#46; Naquele ano&#44; verificou&#8208;se taxa de detec&#231;&#227;o de&#160;13&#44;23&#47;100&#46;000&#46; Em&#160;1991&#44; a OMS prop&#244;s a elimina&#231;&#227;o da hansen&#237;ase &#40;menos de um doente para&#160;10&#46;000&#160;habitantes&#41; at&#233;&#160;2005&#46; O Brasil n&#227;o atingiu essa meta e manteve o par&#226;metro de alta endemicidade&#46; Em 2019&#44; dentre os casos novos diagnosticados no pa&#237;s&#44; 9&#44;9&#37;&#160;apresentavam incapacidade f&#237;sica grau 2 &#40;G2&#41;&#46; Outro aspecto tamb&#233;m importante foi a taxa de detec&#231;&#227;o de casos novos em pacientes com menos de&#160;15&#160;anos de idade&#58;&#160;3&#44;44&#47;100&#46;000&#160;habitantes&#46; Esses dados indicam baixa qualidade do programa de controle da hansen&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> As a&#231;&#245;es para o controle da hansen&#237;ase no Brasil incluem&#44; principalmente&#44; o diagn&#243;stico de casos novos durante o atendimento de rotina nos centros de sa&#250;de&#44; busca ativa e exame de contatos&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Em&#160;2018&#44; o estado do Amazonas apresentou taxa de preval&#234;ncia de hansen&#237;ase de 0&#44;93&#47;10&#46;000&#160;habitantes&#46; No mesmo ano&#44; foram diagnosticados&#160;425&#160;casos novos&#46; Apesar da redu&#231;&#227;o da taxa de detec&#231;&#227;o de&#160;21&#44;54&#160;casos&#44; em&#160;2009&#44; para&#160;10&#44;31&#47;100&#46;000&#44; em&#160;2018&#44; o estado permanece com par&#226;metro de alta endemicidade&#46; Em&#160;2018&#44; 9&#44;2&#37;&#160;dos novos pacientes apresentaram G2 no momento do diagn&#243;stico&#44; e a taxa de detec&#231;&#227;o de novos casos em menores de&#160;15&#160;anos foi&#160;de 4&#44;19&#47;100&#46;000&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O estado do Amazonas apresenta &#225;rea territorial de&#160;1&#46;571&#46;000&#160;km<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&#44; e &#233; dividido em 62 munic&#237;pios&#46; Em 2010&#44; o estado tinha 3&#46;483&#46;985 habitantes e a capital&#44; Manaus&#44; concentrava 51&#44;7&#37;&#160;da popula&#231;&#227;o &#40;1&#46;802&#46;014 habitantes&#41;&#46; Na regi&#227;o metropolitana de Manaus &#40;RMM&#41;&#44; composta pelos munic&#237;pios de Autazes&#44; Careiro&#44; Careiro da V&#225;rzea&#44; Iranduba&#44; Itacoatiara&#44; Itapiranga&#44; Manacapuru&#44; Manaus&#44; Manaquiri&#44; Novo Air&#227;o&#44; Presidente Figueiredo&#44; Rio Preto da Eva e Silves&#44; habitavam 2&#46;210&#46;665&#160;&#40;63&#44;4&#37;&#41; pessoas&#46; O estado conta cm&#160;25&#160;rodovias estaduais&#44; distribu&#237;das&#44; principalmente&#44; no entorno da RMM&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A Funda&#231;&#227;o Alfredo da Matta &#40;FUAM&#41;&#44; em Manaus&#44; &#233; centro de refer&#234;ncia para diagn&#243;stico e tratamento da hansen&#237;ase no Amazonas&#46; A FUAM promove a&#231;&#245;es regulares de supervis&#227;o da hansen&#237;ase e treinamento de profissionais da sa&#250;de na capital e demais munic&#237;pios do estado&#46; Essas atividades s&#227;o realizadas por equipes compostas por dermatologista&#44; enfermeiros&#44; t&#233;cnicos de enfermagem e&#47;ou laborat&#243;rio&#44; dependendo da demanda do munic&#237;pio e da necessidade de treinamentos espec&#237;ficos&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">No presente estudo foram avaliados os resultados das supervis&#245;es realizadas no per&#237;odo de mar&#231;o de&#160;2012 a dezembro de&#160;2017&#44; com &#234;nfase na detec&#231;&#227;o de casos novos diagnosticados pelas equipes da FUAM&#44; comparando&#8208;os com os pacientes notificados pelas unidades municipais de sa&#250;de&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Trata&#8208;se de estudo retrospectivo e descritivo de casos novos de hansen&#237;ase diagnosticados no per&#237;odo da realiza&#231;&#227;o do estudo&#46; Foram utilizados dados epidemiol&#243;gicos do Sistema de Informa&#231;&#227;o de Agravos de Notifica&#231;&#227;o &#40;SINAN&#41; e da Coordena&#231;&#227;o Estadual de Hansen&#237;ase&#46; O estudo foi submetido e aprovado pelo Comit&#234; de &#201;tica em Pesquisa da FUAM&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos os munic&#237;pios do estado foram visitados pelas equipes da FUAM&#44; alguns anualmente e outros com intervalo superior a um ano&#46; Em&#160;2017&#44; foram realizadas supervis&#245;es nos&#160;62&#160;munic&#237;pios&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No per&#237;odo do estudo foram registrados&#160;3&#46;299&#160;casos novos&#58; 1&#46;637&#160;&#40;49&#44;6&#37;&#41; residiam na RMM e 1&#46;662&#160;&#40;50&#44;4&#37;&#41;&#44; nos outros munic&#237;pios&#46; Desse total&#44; 1&#46;910&#160;&#40;57&#44;9&#37;&#41; pacientes eram multibacilares&#44; 303&#160;&#40;9&#44;2&#37;&#41; apresentaram G2 no momento do diagn&#243;stico e 362&#160;&#40;11&#37;&#41; eram menores de&#160;15&#160;anos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Durante as supervis&#245;es&#44; 642&#160;novos casos foram diagnosticados pelas equipes da FUAM&#46; Esse n&#250;mero equivale a 19&#44;5&#37;&#160;do total de doentes registrados no per&#237;odo de realiza&#231;&#227;o do estudo&#59; 293 &#40;45&#44;6&#37;&#41; residiam na RMM e 349 &#40;54&#44;4&#37;&#41; nos demais munic&#237;pios&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Outro aspecto relevante da investiga&#231;&#227;o&#58; 1&#46;143&#160;&#40;34&#44;6&#37;&#41; dos novos casos moravam no munic&#237;pio de Manaus e&#44; dentre esses&#44; 808&#160;&#40;70&#44;7&#37;&#41; foram diagnosticados na sede da FUAM&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os munic&#237;pios que apresentaram as maiores taxas de detec&#231;&#227;o no per&#237;odo do estudo foram&#58; Itamarati &#40;81&#44;25&#47;100&#46;000&#41;&#44; Tapau&#225; &#40;76&#44;65&#47;100&#46;000&#41;&#44; Humait&#225; &#40;61&#44;05&#47;100&#46;000&#41;&#44; Boca do Acre &#40;45&#44;25&#47;100&#46;000&#41; e Guajar&#225; &#40;40&#44;70&#47;100&#46;000&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Em&#160;2017&#44; ano em que todos os munic&#237;pios foram supervisionados&#44; foram diagnosticados 449 casos novos de hansen&#237;ase&#58; 126&#160;&#40;28&#44;1&#37;&#41; residiam no munic&#237;pio de Manaus e 323&#160;&#40;71&#44;9&#37;&#41;&#44; nos demais munic&#237;pios&#46; Naquele ano&#44; as equipes da FUAM diagnosticaram 152&#160;&#40;33&#44;8&#37;&#41; pacientes&#58; 53&#160;&#40;42&#37;&#41; em Manaus e 99&#160;&#40;33&#44;1&#37;&#41; nos demais munic&#237;pios&#46; Dentre os 126 casos novos residentes em Manaus&#44; 101&#160;&#40;80&#44;2&#37;&#41; foram diagnosticados na sede da FUAM&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Considerando a extens&#227;o territorial do estado e que na maior parte dos munic&#237;pios do interior n&#227;o h&#225; transporte rodovi&#225;rio&#44; seria poss&#237;vel inferir que os munic&#237;pios da RMM teriam f&#225;cil acesso a pareceres do centro de refer&#234;ncia e notificariam a maioria dos casos novos&#46; No per&#237;odo do estudo&#44; 1&#46;637&#160;&#40;49&#44;6&#37;&#41; casos de hansen&#237;ase residiam na RMM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; No entanto&#44; desse total&#44; 293&#160;&#40;17&#44;9&#37;&#41; pacientes foram diagnosticados durante as supervis&#245;es&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Os dados de Manaus tamb&#233;m s&#227;o importantes&#58; dentre os 1&#46;143&#160;&#40;34&#44;6&#37;&#41; novos casos diagnosticados no munic&#237;pio&#44; no per&#237;odo do estudo&#44; 808&#160;&#40;70&#44;7&#37;&#41; foram identificados na FUAM&#46; Isso indica que os pacientes n&#227;o procuram os centros de sa&#250;de da capital&#44; n&#227;o s&#227;o diagnosticados nesses locais ou s&#227;o sistematicamente encaminhados para a FUAM&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Quando se analisam de maneira isolada os dados mais recentes&#44; de&#160;2017&#44; verifica&#8208;se que n&#227;o houve mudan&#231;as importantes no per&#237;odo de estudo&#44; quando foram registrados 449&#160;casos novos em todo o estado&#58; 126&#160;&#40;28&#44;1&#37;&#41; residiam em Manaus e 323&#160;&#40;71&#44;9&#37;&#41;&#44; nos demais munic&#237;pios&#46; Desse total&#44; 152&#160;&#40;33&#44;8&#37;&#41; casos foram diagnosticados durante as supervis&#245;es&#46; Verificou&#8208;se&#44; ainda&#44; que mais de&#160;80&#37; dos casos novos que residiam em Manaus foram diagnosticados na FUAM&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Esses dados explicam&#44; em parte&#44; a baixa resolutividade do programa de controle da hansen&#237;ase&#44; com diagn&#243;sticos tardios e importante n&#250;mero de casos novos em crian&#231;as&#46; Diagn&#243;stico tardio implica tamb&#233;m em casos multibacilares sem diagn&#243;stico&#44; respons&#225;veis pela manuten&#231;&#227;o da endemia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Face aos dados apresentados&#44; evidenciando que 642&#160;&#40;19&#44;5&#37;&#41; casos novos de hansen&#237;ase n&#227;o teriam sido diagnosticados sem a presen&#231;a do dermatologista&#44; sugere&#8208;se avalia&#231;&#227;o das atividades do Programa de Controle da Hansen&#237;ase&#44; com &#234;nfase na capacita&#231;&#227;o dos profissionais de sa&#250;de da capital e munic&#237;pios&#44; bem como supervis&#245;es e atualiza&#231;&#245;es regulares desses profissionais&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Dejanane Silva e Silva&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Jamile Izan Lopes Palheita J&#250;nior&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Valderiza Louren&#231;o Pedrosa&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Carolina Talhari&#58; Concep&#231;&#227;o e o desenho do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do artigo&#59; revis&#227;o cr&#237;tica do conte&#250;do intelectual&#59; aprova&#231;&#227;o final da vers&#227;o a ser enviada&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \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-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&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  " align="left" valign="\n
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                  \t\t\t\t">73&#44;30&#37;&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></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&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;30&#37;&nbsp;\t\t\t\t\t\t\n
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                  \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">92&#44;70&#37;&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
                  \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&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</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&#37;&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</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#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">75&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">Itapiranga&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">100&#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">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
                  \t\t\t\t">0&#44;0&#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">14&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">Manaquiri&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">19&#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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#37;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&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">Iranduba&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
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;40&#37;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;60&#37;&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
                  \t\t\t\t\ttop\n
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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">Autazes&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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;40&#37;&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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#37;&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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Careiro da V&#225;rzea&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\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;20&#37;&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</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;80&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&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
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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">Careiro Castanho&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&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">35&#44;50&#37;&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</td><td class="td" title="\n
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                  \t\t\t\t">64&#44;50&#37;&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">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">Novo Air&#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">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">54&#44;50&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">45&#44;50&#37;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Silves&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</td><td class="td" title="\n
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                  \t\t\t\t">84&#44;2&#37;&nbsp;\t\t\t\t\t\t\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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&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
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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">Total geral&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">293&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Casos novos de hansen&#237;ase detectados pelas equipes de sa&#250;de da FUAM e servi&#231;os de sa&#250;de municipais&#44; no per&#237;odo de mar&#231;o de&#160;2012 a dezembro de&#160;2017&#44; nos munic&#237;pios da regi&#227;o metropolitana de Manaus</p>"
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            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "who&#46;int &#91;Internet&#93;&#46; World Health Organization&#59; 2022&#46; Global leprosy &#40;Hansen disease&#41; update&#44; 2019&#58; time to step&#8208;up prevention initiatives&#46; Wkly Epidemiol Rec&#46; 2020&#59;36&#58;417&#8208;40&#46; Available from&#58; https&#58;&#47;&#47;www&#46;who&#46;int&#47;publications&#47;i&#47;item&#47;who&#8208;wer9536&#46;"
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            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
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                0 => array:1 [
                  "referenciaCompleta" => "Minist&#233;rio da Sa&#250;de&#46; Secretaria de Vigil&#226;ncia em Sa&#250;de&#46; Departamento de Vigil&#226;ncia das Doen&#231;as Transmiss&#237;veis&#46; Diretrizes para vigil&#226;ncia&#44; aten&#231;&#227;o e elimina&#231;&#227;o da hansen&#237;ase como problema de sa&#250;de p&#250;blica&#46; Minist&#233;rio da Sa&#250;de &#91;Internet&#93;&#46; 2016&#46; &#91;cited 2020 Jul 01&#93;&#46; Available from&#58; https&#58;&#47;&#47;www&#46;saude&#46;gov&#46;br&#47;images&#47;pdf&#47;2016&#47;fevereiro&#47;04&#47;diretrizes&#8208;eliminacao&#8208;hanseniase&#8208;4fev16&#8208;web&#46;pdf&#59;&#46;"
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              "identificador" => "bib0045"
              "etiqueta" => "3"
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                0 => array:1 [
                  "referenciaCompleta" => "Minist&#233;rio da Sa&#250;de&#46; Secretaria de Vigil&#226;ncia em Sa&#250;de&#46; Departamento de Vigil&#226;ncia das Doen&#231;as Transmiss&#237;veis&#46; Boletim Epidemiol&#243;gico&#46; Hansen&#237;ase&#46; Minist&#233;rio da Sa&#250;de &#91;Internet&#93;&#46; 2020&#46; &#91;cited 2020 Jul 01&#93;&#46; Available from&#58; http&#58;&#47;&#47;www&#46;aids&#46;gov&#46;br&#47;pt&#8208;br&#47;pub&#47;2020&#47;boletim&#8208;epidemiologico&#8208;de&#8208;hanseniase&#8208;2020&#46;"
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                  "referenciaCompleta" => "cidades&#46;ibge &#91;Internet&#93;&#46; Instituto Brasileiro de Geografia e Estat&#237;stica &#8208; IBGE &#124; Cidades&#46; &#91;cited 2020 Jul 01&#93;&#46; Available from&#58; https&#58;&#47;&#47;cidades&#46;ibge&#46;gov&#46;br&#47;brasil&#47;am&#47;itamarati&#47;panorama&#46;"
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              "etiqueta" => "5"
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                0 => array:1 [
                  "referenciaCompleta" => "sedecti&#46;am &#91;Internet&#93;&#46; Departamento de Estudos Pesquisa e Informa&#231;&#227;o da SEAP&#46; Amazonas em Mapas&#46; 2018&#46; &#91;cited 2020 Jul 01&#93;&#46; Available from&#58; http&#58;&#47;&#47;www&#46;sedecti&#46;am&#46;gov&#46;br&#47;wp&#8208;content&#47;uploads&#47;2019&#47;07&#47;2a&#95;Amazonas&#95;em&#95;Mapas&#95;2016&#95;em&#95;novembro&#95;de&#95;2018&#46;pdf&#46;"
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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