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Abstract：
Leprosy is an infectious disease caused by Mycobacterium leprae. As incidence begins to decline, the characteristics of new cases shifts away from those observed in highly endemic areas, revealing potentially important insights into possible ongoing sources of transmission. We aimed to investigate whether transmission is driven mainly by undiagnosed and untreated new leprosy cases in the community, or by incompletely treated or relapsing cases.
A literature search of major electronic databases was conducted in January, 2020 with 134 articles retained out of a total 4318 records identified (PROSPERO ID: CRD42020178923). We presented quantitative data from leprosy case records with supporting evidence describing the decline in incidence across several contexts. BCG vaccination, active case finding, adherence to multidrug therapy and continued surveillance following treatment were the main strategies shared by countries who achieved a substantial reduction in incidence. From 3950 leprosy case records collected across 22 low endemic countries, 48.3% were suspected to be imported, originating from transmission outside of the country. Most cases were multibacillary (64.4%) and regularly confirmed through skin biopsy, with 122 cases of suspected relapse from previous leprosy treatment. Family history was reported in 18.7% of cases, while other suspected sources included travel to high endemic areas and direct contact with armadillos. None of the countries included in the analysis reported a distinct increase in leprosy incidence in recent years.
Together with socioeconomic improvement over time, several successful leprosy control programmes have been implemented in recent decades that led to a substantial decline in incidence. Most cases described in these contexts were multibacillary and numerous cases of suspected relapse were reported. Despite these observations, there was no indication that these cases led to a rise in new secondary cases, suggesting that they do not represent a large ongoing source of human-to-human transmission.
A literature search of major electronic databases was conducted in January, 2020 with 134 articles retained out of a total 4318 records identified (PROSPERO ID: CRD42020178923). We presented quantitative data from leprosy case records with supporting evidence describing the decline in incidence across several contexts. BCG vaccination, active case finding, adherence to multidrug therapy and continued surveillance following treatment were the main strategies shared by countries who achieved a substantial reduction in incidence. From 3950 leprosy case records collected across 22 low endemic countries, 48.3% were suspected to be imported, originating from transmission outside of the country. Most cases were multibacillary (64.4%) and regularly confirmed through skin biopsy, with 122 cases of suspected relapse from previous leprosy treatment. Family history was reported in 18.7% of cases, while other suspected sources included travel to high endemic areas and direct contact with armadillos. None of the countries included in the analysis reported a distinct increase in leprosy incidence in recent years.
Together with socioeconomic improvement over time, several successful leprosy control programmes have been implemented in recent decades that led to a substantial decline in incidence. Most cases described in these contexts were multibacillary and numerous cases of suspected relapse were reported. Despite these observations, there was no indication that these cases led to a rise in new secondary cases, suggesting that they do not represent a large ongoing source of human-to-human transmission.
摘要：
麻风病是由麻风分枝杆菌引起的一种传染病。随着发病率开始下降，新病例的特征与高流行地区的病例不同，揭示对可能持续传播来源的潜在重要见解。我们的目的是调查传播是否主要由社区中未诊断和未治疗的新麻风病病例驱动，或未完全治疗或复发病例。
1月份对主要电子数据库进行了文献检索,2020年，在总共4318条记录中保留了134篇文章（PROSPEROID：CRD42020178923）。我们提供了来自麻风病病例记录的定量数据，并提供了描述多种情况下发病率下降的支持证据。卡介苗接种，积极的案例查找，坚持多药治疗和治疗后持续监测是实现发病率大幅降低的国家共同采取的主要策略.从22个低流行国家收集的3950个麻风病病例记录中，48.3%怀疑是进口的,源自国外的传播。大多数病例为多杆菌(64.4%)，定期通过皮肤活检确诊，与122例怀疑复发从以前的麻风病治疗。18.7%的病例报告有家族史，而其他可疑来源包括前往高流行地区和直接与Armadillos接触。分析中包括的国家中没有一个报告近年来麻风病发病率明显增加。
随着时间的推移，随着社会经济的改善，近几十年来，已经实施了几项成功的麻风病控制计划，导致发病率大幅下降。在这些情况下描述的大多数病例是多杆菌的，并且报告了许多可疑复发的病例。尽管有这些观察,没有迹象表明这些病例导致新的次要病例增加，这表明它们并不代表人与人之间传播的大量持续来源。
1月份对主要电子数据库进行了文献检索,2020年，在总共4318条记录中保留了134篇文章（PROSPEROID：CRD42020178923）。我们提供了来自麻风病病例记录的定量数据，并提供了描述多种情况下发病率下降的支持证据。卡介苗接种，积极的案例查找，坚持多药治疗和治疗后持续监测是实现发病率大幅降低的国家共同采取的主要策略.从22个低流行国家收集的3950个麻风病病例记录中，48.3%怀疑是进口的,源自国外的传播。大多数病例为多杆菌(64.4%)，定期通过皮肤活检确诊，与122例怀疑复发从以前的麻风病治疗。18.7%的病例报告有家族史，而其他可疑来源包括前往高流行地区和直接与Armadillos接触。分析中包括的国家中没有一个报告近年来麻风病发病率明显增加。
随着时间的推移，随着社会经济的改善，近几十年来，已经实施了几项成功的麻风病控制计划，导致发病率大幅下降。在这些情况下描述的大多数病例是多杆菌的，并且报告了许多可疑复发的病例。尽管有这些观察,没有迹象表明这些病例导致新的次要病例增加，这表明它们并不代表人与人之间传播的大量持续来源。
