array:24 [
  "pii" => "S0365059621001227"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2020.07.016"
  "estado" => "S300"
  "fechaPublicacion" => "2021-07-01"
  "aid" => "382"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2021"
  "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" => "S2666275221001235"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2020.07.024"
      "estado" => "S300"
      "fechaPublicacion" => "2021-07-01"
      "aid" => "382"
      "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 &#8208; Investiga&#231;&#227;o</span>"
        "titulo" => "Casos de hansen&#237;ase diagnosticados por exame de contatos numa capital hiperend&#234;mica do nordeste brasileiro"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "510"
            "paginaFinal" => "513"
          ]
        ]
        "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" => 894
                "Ancho" => 2341
                "Tamanyo" => 97278
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">S&#233;rie hist&#243;rica de hansen&#237;ase diagnosticada pelo modo de detec&#231;&#227;o de casos novos por exame de contato por ano de notifica&#231;&#227;o &#40;S&#227;o Lu&#237;s&#44; MA&#44; 2010&#8208;2017&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fonte&#58; SINAN&#44; 2019&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Aruse Maria Marques Soares, Rita da Gra&#231;a Carvalhal Fraz&#227;o Corr&#234;a, Kezia Cristina Batista dos Santos, Ivan Abreu Figueiredo, Maria de F&#225;tima Lires Paiva, Dorlene Maria Cardoso de Aquino"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Aruse Maria Marques"
                "apellidos" => "Soares"
              ]
              1 => array:2 [
                "nombre" => "Rita da Gra&#231;a Carvalhal Fraz&#227;o"
                "apellidos" => "Corr&#234;a"
              ]
              2 => array:2 [
                "nombre" => "Kezia Cristina Batista dos"
                "apellidos" => "Santos"
              ]
              3 => array:2 [
                "nombre" => "Ivan Abreu"
                "apellidos" => "Figueiredo"
              ]
              4 => array:2 [
                "nombre" => "Maria de F&#225;tima Lires"
                "apellidos" => "Paiva"
              ]
              5 => array:2 [
                "nombre" => "Dorlene Maria Cardoso de"
                "apellidos" => "Aquino"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059621001227"
          "doi" => "10.1016/j.abd.2020.07.016"
          "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/S0365059621001227?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221001235?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009600000004/v1_202107170646/S2666275221001235/v1_202107170646/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059621001276"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2020.07.017"
    "estado" => "S300"
    "fechaPublicacion" => "2021-07-01"
    "aid" => "387"
    "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" => "Training of primary care physicians enhances performance of mobile teledermatology"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "514"
          "paginaFinal" => "516"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 2150
              "Ancho" => 2174
              "Tamanyo" => 463894
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examples of lesions and image quality acquired with mobile phones and sent to galliera&#46;telederm&#46;it&#58; &#40;A&#41;&#44;83-year-old man&#44; back&#58; T1a melanoma&#59; &#40;B&#41;&#44; 36-year-old man&#44; back&#58; T2b melanoma&#59; &#40;C&#41;&#44; 68-year-old women&#44; left flank&#58; T3b melanoma&#59; &#40;D&#41;&#44; 72-year-old man&#44; left arm&#58; pigmented basal cell carcinoma&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cesare Massone, Sanja Javor, Ilaria Amato, Giovanni Biondo, Alexandra Maria Giovanna Brunasso, Rainer Hofmann-Wellenhof"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Cesare"
              "apellidos" => "Massone"
            ]
            1 => array:2 [
              "nombre" => "Sanja"
              "apellidos" => "Javor"
            ]
            2 => array:2 [
              "nombre" => "Ilaria"
              "apellidos" => "Amato"
            ]
            3 => array:2 [
              "nombre" => "Giovanni"
              "apellidos" => "Biondo"
            ]
            4 => array:2 [
              "nombre" => "Alexandra Maria Giovanna"
              "apellidos" => "Brunasso"
            ]
            5 => array:2 [
              "nombre" => "Rainer"
              "apellidos" => "Hofmann-Wellenhof"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221001296"
        "doi" => "10.1016/j.abdp.2020.07.025"
        "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/S2666275221001296?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621001276?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009600000004/v4_202107160617/S0365059621001276/v4_202107160617/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0365059621001070"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2021.04.002"
    "estado" => "S300"
    "fechaPublicacion" => "2021-07-01"
    "aid" => "367"
    "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:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>"
      "titulo" => "Factors associated with the etiological uncertainty of drug reactions&#58; a cross-sectional study in southern Brazil"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "508"
          "paginaFinal" => "510"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Fabiana Bazanella de Oliveira, Paula Chiamenti, Roberta de Freitas Horn, Renan Rangel Bonamigo"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Fabiana Bazanella de"
              "apellidos" => "Oliveira"
            ]
            1 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Chiamenti"
            ]
            2 => array:2 [
              "nombre" => "Roberta de Freitas"
              "apellidos" => "Horn"
            ]
            3 => array:2 [
              "nombre" => "Renan Rangel"
              "apellidos" => "Bonamigo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221001089"
        "doi" => "10.1016/j.abdp.2020.08.016"
        "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/S2666275221001089?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621001070?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009600000004/v4_202107160617/S0365059621001070/v4_202107160617/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>"
    "titulo" => "Leprosy cases diagnosed by contacts examination in a hyperendemic capital city of northeastern Brazil"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "510"
        "paginaFinal" => "513"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Aruse Maria Marques Soares, Rita da Gra&#231;a Carvalhal Fraz&#227;o Corr&#234;a, Kezia Cristina Batista dos Santos, Ivan Abreu Figueiredo, Maria de F&#225;tima Lires Paiva, Dorlene Maria Cardoso de Aquino"
        "autores" => array:6 [
          0 => array:3 [
            "nombre" => "Aruse Maria Marques"
            "apellidos" => "Soares"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Rita da Gra&#231;a Carvalhal Fraz&#227;o"
            "apellidos" => "Corr&#234;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Kezia Cristina Batista dos"
            "apellidos" => "Santos"
            "email" => array:1 [
              0 => "kezia_cristinabs@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Ivan Abreu"
            "apellidos" => "Figueiredo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Maria de F&#225;tima Lires"
            "apellidos" => "Paiva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Dorlene Maria Cardoso de"
            "apellidos" => "Aquino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Department of Nursing&#44; Federal University of Maranh&#227;o&#44; S&#227;o Lu&#237;s&#44; Maranh&#227;o&#44; MA&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Collective Health&#44; Universidade Federal do Maranh&#227;o&#44; S&#227;o Lu&#237;s&#44; Maranh&#227;o&#44; MA&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Medicine&#44; Universidade Federal do Maranh&#227;o&#44; S&#227;o Lu&#237;s&#44; Maranh&#227;o&#44; MA&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "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" => 894
            "Ancho" => 2341
            "Tamanyo" => 126250
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Historical series of leprosy diagnosed by detecting new cases by contact examination per year of notification&#46; S&#227;o Lu&#237;s&#8211;MA&#44; 2010&#8211;2017&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; SINAN&#44; 2019&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leprosy&#44; an infectious disease with a prolonged incubation period&#44; has in the household contacts an important means for the maintenance of the endemy&#46; It is characterized by a clinical dermatological-neurological syndrome with a high potential to cause physical disabilities and deformities&#44; in addition to social and psychological impacts&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is still considered a relevant public health problem in most Brazilian states&#44; despite efforts by the Ministry of Health to control the infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2018&#44; 208&#44;619 new cases were reported worldwide&#44; with Brazil being the 2<span class="elsevierStyleSup">nd</span> country with the highest prevalence of the disease&#44; registering a total of 28&#44;660 new cases&#44; representing 13&#46;3&#37; of the global total of new occurrences&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Household contacts are highly vulnerable to disease development due to prolonged exposure to the bacilli in the home environment&#46; This risk is approximately five to ten times greater in families with one case of the disease and increases by up to ten times in the event of more than one case in the same household&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In regions of high endemicity&#44; contact surveillance becomes an essential measure for disease control&#44; therefore&#44; it is recommended to carry out a dermatological-neurological evaluation at least once a year&#44; for at least five years&#44; in all contacts&#46; After this period&#44; these contacts should be informed of the possibility of the appearance of signs and symptoms suggestive of leprosy in the future&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2017&#44; the municipality of S&#227;o Lu&#237;s&#44; state of Maranh&#227;o&#44; Brazil&#44; was classified as regular in relation to the proportion of examined contacts&#44; as it examined 51&#46;58&#37; of registered contacts&#44; a fact that is considered of concern&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this sense&#44; knowledge of the occurrence of leprosy cases diagnosed by contact examination among household contacts in that municipality can bring valuable contributions both to the labor practice of health professionals and to users assisted by the Family Health Strategy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This is an epidemiological&#44; descriptive&#44; retrospective and cross-sectional study with the objective of studying the occurrence of leprosy cases among household contacts of the notified cases in the municipality of S&#227;o Lu&#237;s&#44; state of Maranh&#227;o&#44; from 2010 to 2017&#44; through information collected from the Notifiable Diseases Information System &#40;SINAN&#41;&#44; notification forms and patient records &#40;n&#160;&#61;&#160;182&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data were analyzed using the EPI-INFO program&#44; version 7 &#40;CDC-Atlanta&#44; EUA&#41;&#46; The prevalence of leprosy among the examined contacts was calculated&#44; followed by the absolute and relative frequencies for the descriptive analysis&#46; This study is part of the macro-project entitled &#8220;Integrated Approach to Clinical&#44; Epidemiological &#40;Space-Temporal&#41;&#44; Operational and Psychosocial Aspects of Leprosy in a Hyperendemic Municipality of Maranh&#227;o &#40;INTEGRAHANS MARANH&#195;O&#41;&#8221;&#44; approved by the Research Ethics Committee under Register 2&#46;508&#46; 780&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows that&#44; during the study period&#44; 17&#44;309 household contacts were registered&#44; 9&#44;387 were examined and 182 were diagnosed with leprosy with a prevalence of 193&#46;9&#47;10&#44;000 contacts&#46; At the beginning of the historical series&#44; 3&#46;52&#37; leprosy cases were notified among contacts&#44; corresponding to the highest percentage&#46; In 2011&#44; there was a decline in the percentage to 2&#46;20&#37;&#46; It was observed that years 2012&#44; 2014&#44; 2015&#44; and 2016 were the periods that showed the lower rates and there were similar percentages in the years 2013 and 2017&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the sociodemographic characteristics of household contacts diagnosed with leprosy&#46; A higher frequency was observed in the age group of 15&#8211;59 years &#40;63&#46;74&#37;&#41;&#44; females &#40;56&#46;59&#37;&#41;&#44; brown ethnicity &#40;58&#46;79&#37;&#41; and those with incomplete elementary school &#40;26&#46;37&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical characteristics&#58; 48&#46;90&#37; of cases corresponded to the borderline form&#44; there was a predominance of a degree of disability equal to zero at the beginning of treatment &#40;64&#46;06&#37;&#41; and bacilloscopy mostly not performed &#40;53&#46;28&#37;&#41;&#46; As for the number of lesions and affected nerves&#44; most had up to 5 lesions &#40;87&#46;16&#37;&#41; and no affected nerves &#40;59&#46;34&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows that the borderline clinical form was predominant in all years&#44; with the exception of 2012&#44; in which 50&#46;00&#37; of the cases corresponded to the tuberculoid form&#46; Variations were also observed in the percentages of the indeterminate&#44; tuberculoid and lepromatous forms during the years 2010 to 2017&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The prevalence of contacts with leprosy was higher than the results of a similar survey also carried out in S&#227;o Lu&#237;s&#44; state of Maranh&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The high percentage of prevalence found in the municipality is directly related to the low coverage of the Family Health Strategy &#40;FHS&#41; in S&#227;o Lu&#237;s&#44; which is only 34&#46;67&#37;&#46; Municipalities with low coverage can limit the actions of the FHS teams&#44; especially regarding surveillance and contact control actions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The predominant age group &#40;15&#8211;59 years&#41; is a matter of concern&#44; as it includes young individuals of productive age&#44; with a negative impact on the labor market and the national&#44; family and individual economy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is also noteworthy that 30&#46;2&#37; of new leprosy cases diagnosed among the examined contacts were children and adolescents under the age of 15&#44; which is a major epidemiological concern in relation to disease control in the municipality&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The low level of schooling found among the individuals may be related to the lack of information about the disease and its particularities and&#44; consequently&#44; the delay in seeking adequate assistance in health services&#44; making the diagnosis and adherence to treatment difficult&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The borderline clinical form indicates late diagnosis and failure in Primary Care actions developed for this purpose&#46; Other national studies have found similar results&#44; in places where the multibacillary forms prevailed over paucibacillary ones&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There was a predominance of zero degree physical disability&#59; however&#44; there were cases with grades 1 and 2&#46; It was observed there is a contradiction between the predominance of the borderline clinical form and the zero degree physical disability&#46; This fact can be attributed to the lack of preparation and&#47;or experience to carry out the assessment of the degree of disability or some technical or operational problems when sending data to SINAN&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study has limitations regarding the use of secondary data&#44; due to possible errors or absence of information in the medical records&#44; notification forms and SINAN system&#46; The sociodemographic and clinical characteristics found in this study reflect the fact that leprosy is a neglected disease and the precariousness of actions aimed at early detection among contacts&#44; demonstrated by the high prevalence rate of leprosy among household contacts and the predominant borderline clinical form&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">This study received financial support from the <span class="elsevierStyleGrantSponsor" id="gs0005">Foundation for the Support of Research and Scientific and Technological Development of Maranh&#227;o</span>&#40;FAPEMA&#44; <span class="elsevierStyleItalic">Funda&#231;&#227;o de Amparo &#224; Pesquisa e ao Desenvolvimento Cient&#237;fico e Tecnol&#243;gico do Maranh&#227;o</span>&#44; process n&#46; 01347&#47;17&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The funding source had no involvement in the study design selection process&#59; in the collection&#44; analysis and interpretation of data&#59; writing of the report&#59; and in the decision to send the article for publication&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Aruse Maria Marques Soares&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Rita da Gra&#231;a Carvalhal Fraz&#227;o Corr&#234;a&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; critical review of the manuscript&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Kezia Cristina Batista dos Santos&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ivan Abreu Figueiredo&#58; Approval of the final version of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Maria de F&#225;tima Lires Paiva&#58; Approval of the final version of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Dorlene Maria Cardoso de Aquino&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#8217; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-07-04"
    "fechaAceptado" => "2020-07-23"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">How to cite this article&#58; Soares AMM&#44; Corr&#234;a RGCF&#44; Santos KCB&#44; Figueiredo IA&#44; Paiva MFL&#44; Aquino DMC&#46; Leprosy cases diagnosed by contacts examination in a hyperendemic capital city of northeastern Brazil&#46; An Bras Dermatol&#46; 2021&#59;96&#58;510&#8211;3&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 894
            "Ancho" => 2341
            "Tamanyo" => 126250
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Historical series of leprosy diagnosed by detecting new cases by contact examination per year of notification&#46; S&#227;o Lu&#237;s&#8211;MA&#44; 2010&#8211;2017&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; SINAN&#44; 2019&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1052
            "Ancho" => 2055
            "Tamanyo" => 127483
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical form in the household contacts diagnosed with leprosy per year of notification&#46; S&#227;o Lu&#237;s&#8211;MA&#44; 2010&#8211;2017&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Source&#58; SINAN&#44; 2019&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Source&#58; SINAN&#44; 2019&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "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" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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"><span class="elsevierStyleBold">Age</span>&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">&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">&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">00 to 06 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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&#46;04&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">07 to 14 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;18&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">15 to 59 years&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">116&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&#46;74&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">60 to 100 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Ethnicity&#47;skin color</span>&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">&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">&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">White&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Black&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&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&#46;49&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">Yellow&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">01&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&#46;54&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">Brown&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">107&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">58&#46;79&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">Not recorded&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">04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sex</span>&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">&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">&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">Male&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">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;41&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">Female&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">103&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">56&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Level of schooling</span>&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">&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">&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">Illiterate&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">07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;85&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">1<span class="elsevierStyleSup">st</span> Grade to incomplete 4<span class="elsevierStyleSup">th</span> Grade of Elementary School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&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&#46;50&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">Complete 4<span class="elsevierStyleSup">th</span> Grade of Elementary School&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">09&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&#46;95&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">5<span class="elsevierStyleSup">th</span> Grade to incomplete 8<span class="elsevierStyleSup">th</span> Grade of Elementary School&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">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;37&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">Complete Elementary School&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">09&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&#46;95&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">Incomplete High School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&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&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete High School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;68&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">Incomplete Higher Education&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">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;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">Complete Higher Education&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">03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Does not apply <a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#47;Not recorded&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">7&#46;68&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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2657902.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Child aged 0 to 6 years&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic characteristics of household contacts diagnosed with leprosy&#46; S&#227;o Lu&#237;s&#8211;MA&#44; 2010&#8211;2017&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Source&#58; SINAN&#44; 2019&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "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" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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"><span class="elsevierStyleBold">Clinical form</span>&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">&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">&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">Indeterminate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&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&#46;87&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">Tuberculoid&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">52&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">28&#46;57&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">Bordeline&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">89&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">48&#46;90&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">Lepromatous&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">5&#46;49&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">Not classified&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">04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Degree of disability</span>&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">&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">&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">Zero&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">117&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">64&#46;06&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">One&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">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Two&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">08&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&#46;45&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">Not recorded&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">5&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Bacilloscopy</span>&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">&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">&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">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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&#46;07&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">Negative&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">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;65&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">Not performed&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">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Number of lesions</span>&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">&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">&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">Up to 5 lesions&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">155&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">87&#46;16&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">06 to 10 lesions&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><td class="td" title="\n
                  \t\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&#46;26&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">&#43; than 10 lesions&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">07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;84&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">Not recorded&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">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Number of affected nerves</span>&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">&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">&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">None&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">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;34&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">01 to 04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&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">29&#46;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">more than 04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;43&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">Not recorded&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">02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09&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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2657901.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of household contacts diagnosed with leprosy&#46; S&#227;o Lu&#237;s&#8211;MA&#44; 2010&#8211;2017&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surveillance of intradomiciliary contacts of leprosy cases&#58; perspective of the client in a hyperendemic municipality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;S&#46;B&#46; Romanholo"
                            1 => "E&#46;A&#46; Souza"
                            2 => "A&#46;N&#46; Ramos J&#250;nior"
                            3 => "A&#46;C&#46;G&#46;C&#46;B&#46; Kaiser"
                            4 => "I&#46;O&#46; Silva"
                            5 => "A&#46;L&#46; Brito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/0034-7167-2016-0607"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Enferm"
                        "fecha" => "2018"
                        "volumen" => "71"
                        "paginaInicial" => "163"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29324959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiological profile of in-house contacts of leprosy cases in a Brazilian hypertendemic capital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Mendon&#231;a"
                            1 => "Y&#46;N&#46;L&#46; Andrade"
                            2 => "I&#46;L&#46;T&#46;P&#46; Rolim"
                            3 => "D&#46;M&#46;C&#46; Aquino"
                            4 => "V&#46;M&#46;S&#46; Soeiro"
                            5 => "L&#46;H&#46; Santos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Fun Care"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "873"
                        "paginaFinal" => "879"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brasil&#46; Minist&#233;rio da Sa&#250;de&#46; Boletim Epidemiol&#243;gico Hansen&#237;ase &#91;Internet&#93;&#46; 2020&#59;1&#40;esp&#41;&#58;1-52&#46; &#91;cited Fev 14 2020&#93;&#46; Avaliable from&#58; &#60;<a target="_blank" href="http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-de-hanseniase-2020">http&#58;&#47;&#47;www&#46;aids&#46;gov&#46;br&#47;pt-br&#47;pub&#47;2020&#47;boletim-epidemiologico-de-hanseniase-2020</a>&#62;&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of surveillance actions of household contacts of patients with leprosy in the City of Igarap&#233;-A&#231;u&#44; Par&#225; State&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;C&#46; Lobato"
                            1 => "M&#46;B&#46; Xavier"
                            2 => "D&#46;C&#46;O&#46; Neves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Pan-Amaz Saude"
                        "fecha" => "2016"
                        "volumen" => "7"
                        "paginaInicial" => "45"
                        "paginaFinal" => "53"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brasil&#46; 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&#44; 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&#58; manual t&#233;cnico-operacional&#46; &#91;Internet&#93;&#44; 2016&#44; Minist&#233;rio da Sa&#250;de&#59; Bras&#237;lia&#44; 2016&#46; &#91;cited Jul 19&#44; 2020&#93;&#46; Avaliable from&#58; <a target="_blank" href="http://portalarquivos2.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf">http&#58;&#47;&#47;portalarquivos2&#46;saude&#46;gov&#46;br&#47;images&#47;pdf&#47;2016&#47;fevereiro&#47;04&#47;diretrizes-eliminacao-hanseniase-4fev16-web&#46;pdf</a>"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brasil&#46; Minist&#233;rio da Sa&#250;de&#46; Percentual de contatos examinados entre registrados dos casos novos de hansen&#237;ase nos anos das coortes&#44; estados&#44; capitais&#46; Brasil&#58; 2017&#46; &#91;Internet&#93; &#91;cited Fev 14&#44; 2020&#93;&#46; Avaliable from&#58; <a target="_blank" href="http://portalarquivos2.saude.gov.br/images/pdf/2018/julho/13/Percentual-de-contatos-de-casos-novos-de-hanseniase-examinados-entre-os-registrados-nosanos-das-coortes-2000-a-2017.pdf">http&#58;&#47;&#47;portalarquivos2&#46;saude&#46;gov&#46;br&#47;images&#47;pdf&#47;2018&#47;julho&#47;13&#47;Percentual-de-contatos-de-casos-novos-de-hanseniase-examinados-entre-os-registrados-nosanos-das-coortes-2000-a-2017&#46;pdf</a>"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tend&#234;ncia temporal da hansen&#237;ase em regi&#227;o de alta endemicidade do Nordeste brasileiro"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;M&#46; Pereira"
                            1 => "L&#46;M&#46;S&#46; Silva"
                            2 => "M&#46;S&#46;A&#46; Dias"
                            3 => "L&#46;D&#46; Monteiro"
                            4 => "M&#46;R&#46;F&#46; Silva"
                            5 => "O&#46;M&#46; Alencar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/0034-7167-2018-0682"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Enferm"
                        "fecha" => "2019"
                        "volumen" => "72"
                        "paginaInicial" => "1356"
                        "paginaFinal" => "1362"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31531662"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and control of Hansen&#8217;s disease&#58; a research in an urban occupation area of S&#227;o Luis&#44; Maranh&#227;o state&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46;B&#46; Pacheco"
                            1 => "M&#46;L&#46;L&#46; Aires"
                            2 => "E&#46;S&#46; Seixas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Bras Med Fam Comunidade"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "23"
                        "paginaFinal" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with the worsening of the disability grade during leprosy treatment in Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;G&#46; Costa"
                            1 => "D&#46; Cortela"
                            2 => "R&#46;C&#46; Soares"
                            3 => "E&#46; Ignotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lepr Rev"
                        "fecha" => "2015"
                        "volumen" => "86"
                        "paginaInicial" => "265"
                        "paginaFinal" => "272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26665362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of clinical aspects of leprosy patients between 2010-2017 at a reference center in Campinas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46;S&#46; Santos"
                            1 => "J&#46;L&#46;B&#46; Aquino"
                            2 => "E&#46; Pegas"
                            3 => "E&#46;C&#46;F&#46; Abrahao Machado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2019.05.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2020"
                        "volumen" => "95"
                        "paginaInicial" => "252"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32146014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009600000004/v4_202107160617/S0365059621001227/v4_202107160617/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/03650596/0000009600000004/v4_202107160617/S0365059621001227/v4_202107160617/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621001227?idApp=UINPBA00008Z"
]
Compartilhar
Informação da revista
Vol. 96. Núm. 4.
Páginas 510-513 (1 julho 2021)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Visitas
5911
Vol. 96. Núm. 4.
Páginas 510-513 (1 julho 2021)
Research Letter
Open Access
Leprosy cases diagnosed by contacts examination in a hyperendemic capital city of northeastern Brazil
Visitas
5911
Aruse Maria Marques Soaresa, Rita da Graça Carvalhal Frazão Corrêaa, Kezia Cristina Batista dos Santosb,
Autor para correspondência
kezia_cristinabs@hotmail.com

Corresponding author.
, Ivan Abreu Figueiredoc, Maria de Fátima Lires Paivab, Dorlene Maria Cardoso de Aquinoa
a Department of Nursing, Federal University of Maranhão, São Luís, Maranhão, MA, Brazil
b Department of Collective Health, Universidade Federal do Maranhão, São Luís, Maranhão, MA, Brazil
c Department of Medicine, Universidade Federal do Maranhão, São Luís, Maranhão, MA, Brazil
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Figuras (2)
Tabelas (2)
Table 1. Sociodemographic characteristics of household contacts diagnosed with leprosy. São Luís–MA, 2010–2017.
Table 2. Clinical characteristics of household contacts diagnosed with leprosy. São Luís–MA, 2010–2017.
Mostrar maisMostrar menos
Texto Completo
Dear Editor,

Leprosy, an infectious disease with a prolonged incubation period, has in the household contacts an important means for the maintenance of the endemy. It is characterized by a clinical dermatological-neurological syndrome with a high potential to cause physical disabilities and deformities, in addition to social and psychological impacts.1,2

It is still considered a relevant public health problem in most Brazilian states, despite efforts by the Ministry of Health to control the infection.1 In 2018, 208,619 new cases were reported worldwide, with Brazil being the 2nd country with the highest prevalence of the disease, registering a total of 28,660 new cases, representing 13.3% of the global total of new occurrences.3

Household contacts are highly vulnerable to disease development due to prolonged exposure to the bacilli in the home environment. This risk is approximately five to ten times greater in families with one case of the disease and increases by up to ten times in the event of more than one case in the same household.2

In regions of high endemicity, contact surveillance becomes an essential measure for disease control, therefore, it is recommended to carry out a dermatological-neurological evaluation at least once a year, for at least five years, in all contacts. After this period, these contacts should be informed of the possibility of the appearance of signs and symptoms suggestive of leprosy in the future.4,5

In 2017, the municipality of São Luís, state of Maranhão, Brazil, was classified as regular in relation to the proportion of examined contacts, as it examined 51.58% of registered contacts, a fact that is considered of concern.6 In this sense, knowledge of the occurrence of leprosy cases diagnosed by contact examination among household contacts in that municipality can bring valuable contributions both to the labor practice of health professionals and to users assisted by the Family Health Strategy.

This is an epidemiological, descriptive, retrospective and cross-sectional study with the objective of studying the occurrence of leprosy cases among household contacts of the notified cases in the municipality of São Luís, state of Maranhão, from 2010 to 2017, through information collected from the Notifiable Diseases Information System (SINAN), notification forms and patient records (n = 182).

The data were analyzed using the EPI-INFO program, version 7 (CDC-Atlanta, EUA). The prevalence of leprosy among the examined contacts was calculated, followed by the absolute and relative frequencies for the descriptive analysis. This study is part of the macro-project entitled “Integrated Approach to Clinical, Epidemiological (Space-Temporal), Operational and Psychosocial Aspects of Leprosy in a Hyperendemic Municipality of Maranhão (INTEGRAHANS MARANHÃO)”, approved by the Research Ethics Committee under Register 2.508. 780.

Fig. 1 shows that, during the study period, 17,309 household contacts were registered, 9,387 were examined and 182 were diagnosed with leprosy with a prevalence of 193.9/10,000 contacts. At the beginning of the historical series, 3.52% leprosy cases were notified among contacts, corresponding to the highest percentage. In 2011, there was a decline in the percentage to 2.20%. It was observed that years 2012, 2014, 2015, and 2016 were the periods that showed the lower rates and there were similar percentages in the years 2013 and 2017.

Figure 1.

Historical series of leprosy diagnosed by detecting new cases by contact examination per year of notification. São Luís–MA, 2010–2017.

Source: SINAN, 2019.

(0.12MB).

Table 1 shows the sociodemographic characteristics of household contacts diagnosed with leprosy. A higher frequency was observed in the age group of 15–59 years (63.74%), females (56.59%), brown ethnicity (58.79%) and those with incomplete elementary school (26.37%).

Table 1.

Sociodemographic characteristics of household contacts diagnosed with leprosy. São Luís–MA, 2010–2017.

Variables 
Age     
00 to 06 years  11  6.04 
07 to 14 years  44  24.18 
15 to 59 years  116  63.74 
60 to 100 years  11  6.04 
Ethnicity/skin color     
White  40  22.00 
Black  30  16.49 
Yellow  01  0.54 
Brown  107  58.79 
Not recorded  04  2.18 
Sex     
Male  79  43.41 
Female  103  56.59 
Level of schooling     
Illiterate  07  3.85 
1st Grade to incomplete 4th Grade of Elementary School  30  16.50 
Complete 4th Grade of Elementary School  09  4.95 
5th Grade to incomplete 8th Grade of Elementary School  48  26.37 
Complete Elementary School  09  4.95 
Incomplete High School  23  12.63 
Complete High School  34  18.68 
Incomplete Higher Education  05  2.75 
Complete Higher Education  03  1.64 
Does not apply a/Not recorded  14  7.68 
Total  182  100 

Source: SINAN, 2019.

a

Child aged 0 to 6 years.

Table 2 shows the clinical characteristics: 48.90% of cases corresponded to the borderline form, there was a predominance of a degree of disability equal to zero at the beginning of treatment (64.06%) and bacilloscopy mostly not performed (53.28%). As for the number of lesions and affected nerves, most had up to 5 lesions (87.16%) and no affected nerves (59.34%).

Table 2.

Clinical characteristics of household contacts diagnosed with leprosy. São Luís–MA, 2010–2017.

Variables 
Clinical form     
Indeterminate  27  14.87 
Tuberculoid  52  28.57 
Bordeline  89  48.90 
Lepromatous  10  5.49 
Not classified  04  2.20 
Degree of disability     
Zero  117  64.06 
One  47  26.00 
Two  08  4.45 
Not recorded  10  5.49 
Bacilloscopy     
Positive  11  6.07 
Negative  74  40.65 
Not performed  97  53.28 
Number of lesions     
Up to 5 lesions  155  87.16 
06 to 10 lesions  15  8.26 
+ than 10 lesions  07  3.84 
Not recorded  05  2.74 
Number of affected nerves     
None  108  59.34 
01 to 04  53  29.14 
more than 04  19  10.43 
Not recorded  02  1.09 
Total  182  100 

Source: SINAN, 2019.

Fig. 2 shows that the borderline clinical form was predominant in all years, with the exception of 2012, in which 50.00% of the cases corresponded to the tuberculoid form. Variations were also observed in the percentages of the indeterminate, tuberculoid and lepromatous forms during the years 2010 to 2017.

Figure 2.

Clinical form in the household contacts diagnosed with leprosy per year of notification. São Luís–MA, 2010–2017.

Source: SINAN, 2019.

(0.12MB).

The prevalence of contacts with leprosy was higher than the results of a similar survey also carried out in São Luís, state of Maranhão.2 The high percentage of prevalence found in the municipality is directly related to the low coverage of the Family Health Strategy (FHS) in São Luís, which is only 34.67%. Municipalities with low coverage can limit the actions of the FHS teams, especially regarding surveillance and contact control actions.7

The predominant age group (15–59 years) is a matter of concern, as it includes young individuals of productive age, with a negative impact on the labor market and the national, family and individual economy.8 It is also noteworthy that 30.2% of new leprosy cases diagnosed among the examined contacts were children and adolescents under the age of 15, which is a major epidemiological concern in relation to disease control in the municipality.

The low level of schooling found among the individuals may be related to the lack of information about the disease and its particularities and, consequently, the delay in seeking adequate assistance in health services, making the diagnosis and adherence to treatment difficult.9

The borderline clinical form indicates late diagnosis and failure in Primary Care actions developed for this purpose. Other national studies have found similar results, in places where the multibacillary forms prevailed over paucibacillary ones.1,2,4,10

There was a predominance of zero degree physical disability; however, there were cases with grades 1 and 2. It was observed there is a contradiction between the predominance of the borderline clinical form and the zero degree physical disability. This fact can be attributed to the lack of preparation and/or experience to carry out the assessment of the degree of disability or some technical or operational problems when sending data to SINAN.

The study has limitations regarding the use of secondary data, due to possible errors or absence of information in the medical records, notification forms and SINAN system. The sociodemographic and clinical characteristics found in this study reflect the fact that leprosy is a neglected disease and the precariousness of actions aimed at early detection among contacts, demonstrated by the high prevalence rate of leprosy among household contacts and the predominant borderline clinical form.

Financial support

This study received financial support from the Foundation for the Support of Research and Scientific and Technological Development of Maranhão(FAPEMA, Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão, process n. 01347/17).

The funding source had no involvement in the study design selection process; in the collection, analysis and interpretation of data; writing of the report; and in the decision to send the article for publication.

Authors’ contributions

Aruse Maria Marques Soares: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.

Rita da Graça Carvalhal Frazão Corrêa: Approval of the final version of the manuscript; design and planning of the study; critical review of the manuscript.

Kezia Cristina Batista dos Santos: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the manuscript.

Ivan Abreu Figueiredo: Approval of the final version of the manuscript; critical review of the manuscript.

Maria de Fátima Lires Paiva: Approval of the final version of the manuscript; critical review of the manuscript.

Dorlene Maria Cardoso de Aquino: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
H.S.B. Romanholo, E.A. Souza, A.N. Ramos Júnior, A.C.G.C.B. Kaiser, I.O. Silva, A.L. Brito, et al.
Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality.
Rev Bras Enferm, 71 (2018), pp. 163-169
[2]
M.A. Mendonça, Y.N.L. Andrade, I.L.T.P. Rolim, D.M.C. Aquino, V.M.S. Soeiro, L.H. Santos.
Epidemiological profile of in-house contacts of leprosy cases in a Brazilian hypertendemic capital.
Rev Fun Care, 11 (2019), pp. 873-879
[3]
Brasil. Ministério da Saúde. Boletim Epidemiológico Hanseníase [Internet]. 2020;1(esp):1-52. [cited Fev 14 2020]. Avaliable from: <http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-de-hanseniase-2020>.
[4]
D.C. Lobato, M.B. Xavier, D.C.O. Neves.
Evaluation of surveillance actions of household contacts of patients with leprosy in the City of Igarapé-Açu, Pará State, Brazil.
Rev Pan-Amaz Saude, 7 (2016), pp. 45-53
[5]
Brasil. 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: manual técnico-operacional. [Internet], 2016, Ministério da Saúde; Brasília, 2016. [cited Jul 19, 2020]. Avaliable from: http://portalarquivos2.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf
[6]
Brasil. Ministério da Saúde. Percentual de contatos examinados entre registrados dos casos novos de hanseníase nos anos das coortes, estados, capitais. Brasil: 2017. [Internet] [cited Fev 14, 2020]. Avaliable from: http://portalarquivos2.saude.gov.br/images/pdf/2018/julho/13/Percentual-de-contatos-de-casos-novos-de-hanseniase-examinados-entre-os-registrados-nosanos-das-coortes-2000-a-2017.pdf
[7]
T.M. Pereira, L.M.S. Silva, M.S.A. Dias, L.D. Monteiro, M.R.F. Silva, O.M. Alencar.
Tendência temporal da hanseníase em região de alta endemicidade do Nordeste brasileiro.
Rev Bras Enferm, 72 (2019), pp. 1356-1362
[8]
M.A.B. Pacheco, M.L.L. Aires, E.S. Seixas.
Prevalence and control of Hansen’s disease: a research in an urban occupation area of São Luis, Maranhão state, Brazil.
Rev Bras Med Fam Comunidade, 9 (2014), pp. 23-30
[9]
L.G. Costa, D. Cortela, R.C. Soares, E. Ignotti.
Factors associated with the worsening of the disability grade during leprosy treatment in Brazil.
Lepr Rev, 86 (2015), pp. 265-272
[10]
M.A.S. Santos, J.L.B. Aquino, E. Pegas, E.C.F. Abrahao Machado.
Analysis of clinical aspects of leprosy patients between 2010-2017 at a reference center in Campinas.
An Bras Dermatol, 95 (2020), pp. 252-254

How to cite this article: Soares AMM, Corrêa RGCF, Santos KCB, Figueiredo IA, Paiva MFL, Aquino DMC. Leprosy cases diagnosed by contacts examination in a hyperendemic capital city of northeastern Brazil. An Bras Dermatol. 2021;96:510–3.

Copyright © 2021. Sociedade Brasileira de Dermatologia
Baixar PDF
Idiomas
Anais Brasileiros de Dermatologia (Portuguese)
Opções de artigo
Ferramentas
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.