IJE Advance Access originally published online on July 15, 2004
International Journal of Epidemiology 2004 33(6):1329-1336; doi:10.1093/ije/dyh266
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IJE vol.33 no.6 © International Epidemiological Association 2004; all rights reserved.
Infectious Diseases |
Population survey to determine risk factors for Mycobacterium leprae transmission and infection
1 KIT (Koninklijk Instituut voor de Tropen/Royal Tropical Institute), KIT Biomedical Research, Amsterdam, The Netherlands
2 Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
3 Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
Correspondence: Dr L Oskam, Koninklijk Instituut voor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ Amsterdam, The Netherlands. E-mail: l.oskam{at}kit.nl
Background Not every leprosy patient is equally effective in transmitting Mycobacterium leprae. We studied the spatial distribution of infection (using seropositivity as a marker) in the population to identify which disease characteristics of leprosy patients are important in transmission.
Methods Clinical data and blood samples for anti-M. leprae ELISA were collected during a cross-sectional survey on five Indonesian islands highly endemic for leprosy. A geographic information system (GIS) was used to define contacts of patients. We investigated spatial clustering of patients and seropositive people and used logistic regression to determine risk factors for seropositivity.
Results Of the 3986 people examined for leprosy, 3271 gave blood. Seroprevalence varied between islands (1.7–8.7%) and correlated significantly with leprosy prevalence. Five clusters of patients and two clusters of seropositives were detected. In multivariate analysis, seropositivity significantly differed by leprosy status, age, sex, and island. Serological status of patients appeared to be the best discriminator of contact groups with higher seroprevalence: contacts of seropositive patients had an adjusted odds ratio (aOR) of 1.75 (95% CI 0.922–3.31). This increased seroprevalence was strongest for contact groups living 
75 m of two seropositive patients (aOR = 3.07; 95% CI 1.74–5.42).
Conclusions In this highly endemic area for leprosy, not only household contacts of seropositive patients, but also people living in the vicinity of a seropositive patient were more likely to harbour antibodies against M. leprae. Through measuring the serological status of patients and using a broader definition of contacts, higher risk groups can be more specifically identified.
Keywords Mycobacterium leprae, leprosy, serology, epidemiology, geographic information system
Accepted 1 June 2004
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