ArticlePLoS neglected tropical diseases2020
Patients with skin smear positive leprosy in Bangladesh are the main risk factor for leprosy development: 21-year follow-up in the household contact study (COCOA).
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability.International journal of environmental research and public health · 2022Pooled it
- Detection of anti-M. leprae antibodies in children in leprosy-endemic areas: A systematic review.PLoS neglected tropical diseases · 2021Pooled it
- Risk factors and leprosy incidence among contacts in Bangladesh: A multilevel analysis.PLoS neglected tropical diseases · 2025Trial
- Surveillance data and progress assessment of the targets of the WHO Global Leprosy Strategy 2016-2020: A retrospective registry-based analysis in Ghana.PLoS neglected tropical diseases · 2026Article
- Biosensor-Based Platforms for the Detection and Screening ofACS infectious diseases · 2026Review
- qPCR detection ofFrontiers in molecular biosciences · 2024Article
- Prevalence and risk factors for disability in leprosy patients in Indonesia during the post-elimination era.Dermatology reports · 2023Article
- Field-friendly anti-PGL-I serosurvey in children to monitorFrontiers in medicine · 2023Article
- High yield of retrospective active case finding for leprosy in Comoros.PLoS neglected tropical diseases · 2022Article
- Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management.Journal of tropical medicine · 2022Review
- Blood RNA signature RISK4LEP predicts leprosy years before clinical onset.EBioMedicine · 2021Article
- Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study.Infectious diseases of poverty · 2021Observational
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5 authors.
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Abstract
backgroundLeprosy transmission is ongoing; globally and within Bangladesh. Household contacts of leprosy cases are at increased risk of leprosy development. Identification of household contacts at highest risk would optimize this process.
methodsThe temporal pattern of new case presentation amongst household contacts was documented in the COCOA (Contact Cohort Analysis) study. The COCOA study actively examined household contacts of confirmed leprosy index cases identified in 1995, and 2000-2014, to provide evidence for timings of contact examination policies. Data was available on 9527 index cases and 38303 household contacts. 666 household contacts were diagnosed with leprosy throughout the follow-up (maximum follow-up of 21 years). Risk factors for leprosy development within the data analysed, were identified using Cox proportional hazard regression.
findingsThe dominant risk factor for household contacts developing leprosy was having a highly skin smear positive index case in the household. As the grading of initial slit skin smear of the index case increased from negative to high positive (4-6), the hazard of their associated household contacts developing leprosy increases by 3.14 times (p<0.001). Being a blood relative was not a risk factor, no gender differences in susceptibility were found.
interpretationWe found a dominance of a single variable predicting risk for leprosy transmission-skin smear positive index cases. A small number of cases are maintaining transmission in the household setting. Focus should be performing contact examinations on these households and detecting new skin smear positive index cases. Conducting slit-skin smears on new cases is needed for predicting risk; such services need supporting. If skin smear positive cases are sustaining leprosy infection within the household setting, the administration of single-dose rifampicin (SDR) to household contacts as the sole intervention in Bangladesh will not be effective.
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