Leprosy outbreak investigation in two closed villages of Chattrakarn District and Wat District, Phitsanulok Province, Thailand, 2010-2016

Abstract

Background: Background: On 26th May 2016, the district surveillance rapid respond team (SRRT) was received a notification from sub-district network about the new suspected leprosy. The case was a twenty years old female who have a family members with previous leprosy. The SRRT conducted outbreak investigation with aimed to confirm diagnosis and outbreak, to describe the disease burden in the villages and to implement prevention and control measures.
Methods: We conducted descriptive epidemiology by reviewing the medical records and interviewing the cases and relatives. Active case finding was done by standard case definition. We also conducted laboratory investigation by slit skin smear for Mycobacterium leprae. The environmental survey was carried out at surrounding case’s habitat and behavioral prone for infection among the family members.
Results: During 2010 – 2016, five cases of leprosy were detected in two villages. There were three males and two females. All cases presented with chronic cutaneous manifestation of anesthetic patches more than three months prior diagnosis. Thickening of peripheral nerves was palpable in four cases (80%) while positive skin smear of Mycobacterium leprae were positive in three cases (60%) with bacteriological index (BI) from 2.83 - 4.5. All of 3 cases were classified as multibacillary leprosy (MB) with sub-classified as lepromatous type (LL). Another two cases were classified as paucibacillary leprosy (PB) with sub-classified as borderline tuberculoid (BT). All of confirmed cases were met definition criteria of four cardinal signs of leprosy. In 2016, there was additional one case. She was twenty years old and living with the relatives who diagnosed with leprosy. She had been closed contact with her grandfather who raised her up and later became leprosy.
Conclusions: There was confirmed leprosy outbreak among the family members. Health education and surveillance was done in the village and follow-up the physical examination ampng household members, neighboring contacts who were living nearby within twenty meters around house of index case by criteria of Rajprachasamasai institute.