Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.

Abstract INTRODUCTION: In Brazil, the plague is established in several foci located mainly in the northeastern part of the country, where it alternates between active and quiescent periods. These foci in the State of Ceará have high epidemiological importance. In addition to other plague detection activities, plague areas can be monitored through serological surveys of dogs and cats (domestic carnivores), which, following feeding on plague-infected rodents, can develop mild to severe forms of the disease and produce long-lasting antibodies. This study aimed to characterize the circulation dynamics and spatial distribution of Yersinia pestis antibodies in dogs and cats in plague foci areas of Ceará. METHODS: An ecological study was conducted to analyze the temporal series and spatial distribution of secondary data obtained from domestic carnivore serum surveillance in Ceará’s plague areas from 1990 to 2014. RESULTS: Joinpoint analysis revealed that the overall trend was a reduction in antibody-positive animals. The mean proportion of antibody-positivity during the whole study period was 1.5% (3,023/203,311) for dogs, and 0.7% (426/61,135) for cats, with more than 4% antibody-positivity in dogs in 1997 and 2002. Antibody titers ranging from 1/16 to 1/64 were frequent. Despite fluctuations and a significant reduction, in recent years, there were antibody-positive animals annually throughout the study period, and the localities containing antibody-positive animals increased in number. CONCLUSION: Yersinia pestis is actively circulating in the study areas, posing a danger to the human population.

Abstract: Background: Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. Objectives: To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. Methods: This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. Results: 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). Conclusion: This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance.

Danos neurais contribuem para a incapacidade física na hanseníase. O objetivo foi estimar a prevalência de indivíduos com incapacidade física após a alta de poliquimioterapia da hanseníase em Araguaína, Tocantins, Brasil. Estudo transversal com 282 casos novos de 2004 a 2009. O grau de incapacidade no diagnóstico e na cura foi coletado de prontuários e do Sistema de Informação de Agravos de Notificação. No pós-alta usou-se o formulário de avaliação neurológica simplificada. A prevalência de incapacidade foi de 29,4%, sendo 8,9% grau 2. Houve associação entre incapacidades físicas com multibacilares (p < 0,001) e com episódios reacionais (p < 0,001). No diagnóstico, a ocorrência de deformidades foi 1,7 vez maior nos homens (IC95%: 1,23-2,37). Entre o diagnóstico e a alta houve piora do grau de incapacidade e esta piora foi maior após a alta: 25%. A piora do grau de incapacidade foi mais expressiva após a alta, apresentando associação com multibacilares e episódios reacionais. É preciso monitoramento contínuo de casos em alta, para prevenir sequelas e limitação funcional.

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Daños neurales contribuyen a la incapacidad física en la hanseniasis. El objetivo fue estimar la prevalencia de individuos con incapacidad física, tras el alta de poliquimioterapia de la hanseniasis en Araguaína, Tocantins, Brasil. Estudio transversal con 282 casos nuevos de 2004 a 2009. El grado de incapacidad en el diagnóstico y en la cura se recogió de historiales médicos y del sistema de información de quejas por notificación. En el post alta se usó el formulario de evaluación neurológica simplificada. La prevalencia de incapacidad fue de un 29,4%, siendo un 8,9% grado 2. Hubo asociación entre incapacidades físicas con multibacilares (p < 0,001) y con episodios reaccionales (p < 0,001). En el diagnóstico, la ocurrencia de deformidades fue un 1,7 veces mayor en los hombres (IC95%: 1,23-2,37). Entre el diagnóstico y el alta hubo un empeoramiento del grado de incapacidad y ese empeoramiento fue mayor tras el alta: un 25%. El empeoramiento del grado de incapacidad fue más expresivo tras el alta, presentando asociación con multibacilares y episodios reaccionales. Es preciso el monitoreo continuo de casos en alta, para prevenir secuelas y limitación funcional.

Danos neurais contribuem para a incapacidade física na hanseníase. O objetivo foi estimar a prevalência de indivíduos com incapacidade física após a alta de poliquimioterapia da hanseníase em Araguaína, Tocantins, Brasil. Estudo transversal com 282 casos novos de 2004 a 2009. O grau de incapacidade no diagnóstico e na cura foi coletado de prontuários e do Sistema de Informação de Agravos de Notificação. No pós-alta usou-se o formulário de avaliação neurológica simplificada. A prevalência de incapacidade foi de 29,4%, sendo 8,9% grau 2. Houve associação entre incapacidades físicas com multibacilares (p < 0,001) e com episódios reacionais (p < 0,001). No diagnóstico, a ocorrência de deformidades foi 1,7 vez maior nos homens (IC95%: 1,23-2,37). Entre o diagnóstico e a alta houve piora do grau de incapacidade e esta piora foi maior após a alta: 25%. A piora do grau de incapacidade foi mais expressiva após a alta, apresentando associação com multibacilares e episódios reacionais. É preciso monitoramento contínuo de casos em alta, para prevenir sequelas e limitação funcional.

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Daños neurales contribuyen a la incapacidad física en la hanseniasis. El objetivo fue estimar la prevalencia de individuos con incapacidad física, tras el alta de poliquimioterapia de la hanseniasis en Araguaína, Tocantins, Brasil. Estudio transversal con 282 casos nuevos de 2004 a 2009. El grado de incapacidad en el diagnóstico y en la cura se recogió de historiales médicos y del sistema de información de quejas por notificación. En el post alta se usó el formulario de evaluación neurológica simplificada. La prevalencia de incapacidad fue de un 29,4%, siendo un 8,9% grado 2. Hubo asociación entre incapacidades físicas con multibacilares (p < 0,001) y con episodios reaccionales (p < 0,001). En el diagnóstico, la ocurrencia de deformidades fue un 1,7 veces mayor en los hombres (IC95%: 1,23-2,37). Entre el diagnóstico y el alta hubo un empeoramiento del grado de incapacidad y ese empeoramiento fue mayor tras el alta: un 25%. El empeoramiento del grado de incapacidad fue más expresivo tras el alta, presentando asociación con multibacilares y episodios reaccionales. Es preciso el monitoreo continuo de casos en alta, para prevenir secuelas y limitación funcional.

Caracterizar o fluxo de pessoas afetadas pela hanseníase, do município de residência para o de diagnóstico, em área de alta endemicidade no Brasil. Estudo baseado em dados do Sistema de Informação de Agravos e Notificação de 2001-2009, nos estados do Maranhão, Pará, Tocantins e Piauí. Dos 373 municípios, 349 (93,6%) tiveram pelo menos um residente afetado pela hanseníase notificado em outro município (4.325 casos, 5,2% dos notificados). Os municípios com maior número de casos notificados fora de sua residência foram Timon (248) e São José de Ribamar (201), no Maranhão. Os municípios que mais receberam casos para diagnóstico foram São Luís (719) e Teresina (516). Destacam-se Goiânia (146) e o Distrito Federal (42) como polos de notificações de casos residentes no agregado, mesmo a mais de 1.000km de distância da área. O fluxo observado indica lacunas na descentralização do processo de atenção integral à pessoa afetada pela hanseníase e chama atenção para as dificuldades e desafios associados com o acompanhamento durante e após a poliquimioterapia.

The study analyzed the flow of persons with leprosy from their municipality (county) of residence to that of their diagnosis in a highly endemic area in Brazil. The study was based on data from the National Information System for Notifiable Diseases from 2001 to 2009 in the States of Maranhão, Pará, Tocantins, and Piauí. Of the 373 municipalities, 349 (93.6%) had at least one resident with leprosy that had been diagnosed in a different municipality (4,325 cases, or 5.2% of the total). The municipalities with the most cases reported elsewhere were Timon (248) and São José de Ribamar (201), Maranhão State. The municipalities that received the most exogenous cases for diagnosis were São Luís (719), capital of Maranhão, and Teresina (516), capital of Piauí. Goiânia (146), capital of Goiás, and the Federal District (42) also reported numerous cases, even though they are located more than 1,000km from the endemic area. The flow indicates gaps in the decentralization of comprehensive care for persons with leprosy and calls attention to the difficulties associated with patient monitoring during and after multidrug therapy.

Caracterizar o fluxo de pessoas afetadas pela hanseníase, do município de residência para o de diagnóstico, em área de alta endemicidade no Brasil. Estudo baseado em dados do Sistema de Informação de Agravos e Notificação de 2001-2009, nos estados do Maranhão, Pará, Tocantins e Piauí. Dos 373 municípios, 349 (93,6%) tiveram pelo menos um residente afetado pela hanseníase notificado em outro município (4.325 casos, 5,2% dos notificados). Os municípios com maior número de casos notificados fora de sua residência foram Timon (248) e São José de Ribamar (201), no Maranhão. Os municípios que mais receberam casos para diagnóstico foram São Luís (719) e Teresina (516). Destacam-se Goiânia (146) e o Distrito Federal (42) como polos de notificações de casos residentes no agregado, mesmo a mais de 1.000km de distância da área. O fluxo observado indica lacunas na descentralização do processo de atenção integral à pessoa afetada pela hanseníase e chama atenção para as dificuldades e desafios associados com o acompanhamento durante e após a poliquimioterapia.

The study analyzed the flow of persons with leprosy from their municipality (county) of residence to that of their diagnosis in a highly endemic area in Brazil. The study was based on data from the National Information System for Notifiable Diseases from 2001 to 2009 in the States of Maranhão, Pará, Tocantins, and Piauí. Of the 373 municipalities, 349 (93.6%) had at least one resident with leprosy that had been diagnosed in a different municipality (4,325 cases, or 5.2% of the total). The municipalities with the most cases reported elsewhere were Timon (248) and São José de Ribamar (201), Maranhão State. The municipalities that received the most exogenous cases for diagnosis were São Luís (719), capital of Maranhão, and Teresina (516), capital of Piauí. Goiânia (146), capital of Goiás, and the Federal District (42) also reported numerous cases, even though they are located more than 1,000km from the endemic area. The flow indicates gaps in the decentralization of comprehensive care for persons with leprosy and calls attention to the difficulties associated with patient monitoring during and after multidrug therapy.

OBJETIVO: Investigar os fatores de risco ou de proteção para a fluorose dentária na dentição permanente de crianças de 6 a 8 anos em um bairro no Município de Fortaleza, Brasil. MÉTODOS: Este estudo de caso-controle incluiu 67 crianças com fluorose nos incisivos superiores e inferiores permanentes erupcionados, conforme o índice de Dean, e 57 controles. A presença de fluorose foi determinada como variável dependente. Os dados acerca das variáveis independentes foram obtidos através de entrevistas com os pais das crianças. O teste exato de Fisher foi utilizado para verificar a existência de associação entre fluorose e as variáveis independentes. Foi calculada a razão de chances (odds ratio, OR) para verificar a associação e a probabilidade de fluorose no grupo-caso, ambos com significância de 95%. RESULTADOS: Houve associação significativa da fluorose com tipo de moradia (própria, alugada ou ocupada), mas não com fonte de água para consumo ou uso de dentifrícios fluoretados e suplementos de flúor. Na análise univariada, o risco de fluorose foi maior em crianças que iniciaram o consumo de leite em pó reconstituído com água antes dos 2 anos de idade (OR = 4,53; IC95%: 1,07 a 26,74) e nas que não mamaram (OR = 6,66; IC95%: 1,61 a 38,62). Na análise multivariada, somente a amamentação apresentou associação com a fluorose (4,54; IC95%: 1,21 a 16,66). CONCLUSÕES: A amamentação se configurou como fator de proteção contra a fluorose. É preciso estabelecer critérios de classificação mais específicos para permitir a investigação de relações entre fluorose e classe socioeconômica

OBJECTIVE: To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. METHODS: This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95% significance level. RESULTS: Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95%: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95%: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95%: 1.21-16.66). CONCLUSIONS: Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class

This study was carried out to evaluate the residual effect of three larvicides under laboratory conditions for 100 days in Aedes aegypti. The larval mortality rate was measured without water renewal or with daily water renewal (80%). With temephos, there was 100% mortality in both groups until the 70th day. In the Bacillus thuringiensis israelensis (Bti)-WDG test, there was no difference during the first 20 days. With Bti-G, without water renewal, mortality was sustained above 90% for up to 35 days. The second experiment (with water renewal) reduced the mortality to below 90% after the first 20 days. When renewed water was provided, the residual effect was significantly lower for all larvicides.

INTRODUÇÃO: desde seu registro, em 2005, no município de Fortaleza, o Aedes albopictus tem exibido uma rápida dispersão. Um estudo visando à identificação das áreas de sua ocorrência, os seus criadouros e a associação com Aedes aegypti e outros culicídeos foi realizado durante o ano de 2008. MÉTODOS: foram coletadas, de janeiro a julho de 2008, amostras de formas imaturas de culicídeos provenientes de imóveis situados nos bairros de Fortaleza, ressaltando-se algumas características dos criadouros, tais como localização (intradomicílio ou peridomicílio), presença de cobertura (proteção contra a incidência de raios solares e chuva), turbidez da água (água límpida e não límpida), material constituinte, volume, altura em relação ao nível do solo e presença simultânea de diferentes espécies de culicídeos no mesmo criadouro. RESULTADOS: a localização no intradomicílio foi um fator importante para os criadouros do Aedes albopictus [RP=0,52 IC95% (0,33-0,81)], por outro lado, a turbidez da água e a cobertura do depósito não se mostraram como diferenciadores para a infestação [p>0,05]. Para o Aedes aegypti a ausência de turbidez da água foi significativa para a infestação nos criadouros [RP=1,14 IC95% (1,06-1,22)]. CONCLUSÕES: a ausência de uma das espécies nos criadouros favorecia sua infestação por outra; criadouros não infestados por Aedes albopictus tinham uma prevalência de infestação de 2,05 [IC95%1,72-2,44] vezes maior pelo Aedes aegypti. Não houve associação significativa entre volume e altura do criadouro e infestação por ambas as espécies. As duas espécies encontram-se dispersas por todo o município, ocupando os mais diversos tipos de criadouros. No entanto, pode-se identificar uma ligeira separação física, com uma infestação maior do Aedes albopictus no peridomicílio.

INTRODUCTION: Since the registration of Aedes albopictus in the municipality of Fortaleza in 2005, it has shown rapid dispersion. A study aiming to identify its occurrence areas, breeding sites and associations with Aedes aegypti and other culicids was carried out during 2008. METHODS: Between January and July 2008, samples of immature forms of culicids were gathered from properties located in districts of Fortaleza. Certain features of the breeding sites were highlighted, such as location (indoors or outdoors), presence of covering (protection against impact of sunlight and rain), water turbidity (water clear or not clear), constituent material, volume, height above ground level and simultaneous presence of different species of culicids in the same breeding site. RESULTS: Indoor location was an important factor for the breeding sites for Aedes albopictus [PR = 0.52; 95% CI: 0.33-0.81]. On the other hand, water turbidity and reservoir covering were not shown to be differentiators regarding infestation [p > 0.05]. Absence of water turbidity was significant for Aedes aegypti infestation in breeding sites [PR = 1.14; 95% CI: 1.06-1.22]. CONCLUSIONS: Absence of one of the species from the breeding sites enhanced the infestation by another species. Breeding sites that had not been infested by Aedes albopictus had a prevalence of infestation by Aedes aegypti that was 2.05 times greater [95% CI: 1.72-2.44]. There was no significant association between volume and height of the breeding sites and infestation by both species. Both species were found to be dispersed throughout the municipality, occupying a wide diversity of breeding sites. However, a slight physical separation could be identified, with higher infestation with Aedes albopictus outdoors.

Estudo transversal que objetiva analisar a ocorrência de casos de hanseníase em menores de 15 anos de idade residentes no Município de Fortaleza e notificados no SINAN. Os indicadores epidemiológicos nesta população mostram hiperendemicidade. Operacionalmente observa-se a manutenção da concentração de atendimento em algumas unidades de referência, apesar de alguns avanços. Diagnóstico tardio, elevado grau de incapacidade no diagnóstico e baixo grau de avaliação de contatos registrados revelam a fragilidade das ações de controle. Ressalta-se a possibilidade de erro diagnóstico frente às características da infecção nesta população. A ocorrência de casos de hanseníase nesta população representa um indicador epidemiológico de grande relevância e sua análise amplia a discussão sobre problemas operacionais na rede de serviços de saúde.

This is a sectional study that aims to analyze the occurrence of Hansen's disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.

Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 años de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidémicos en ésta población se presentaron hiperendémicos. En la operacinalización, se observa el mantenimiento de la concentración de atención en algunas unidades recomendables, a pesar de algunos avances. Diagnósticos muy tardes, gran grado de incapacidad en el diagnóstico y bajo grado de evaluación de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta así la posibilidad de error de diagnóstico delante de las características de la infección en ésta población. La ocurrencia de casos de lepra en ésta población representa un indicador epidémico de gran importancia y su análisis amplia la discusión sobre los problemas operacionales en la red de servicios públicos.

This is a sectional study that aims to analyze the occurrence of Hansen's disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.

Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 años de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidémicos en ésta población se presentaron hiperendémicos. En la operacinalización, se observa el mantenimiento de la concentración de atención en algunas unidades recomendables, a pesar de algunos avances. Diagnósticos muy tardes, gran grado de incapacidad en el diagnóstico y bajo grado de evaluación de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta así la posibilidad de error de diagnóstico delante de las características de la infección en ésta población. La ocurrencia de casos de lepra en ésta población representa un indicador epidémico de gran importancia y su análisis amplia la discusión sobre los problemas operacionales en la red de servicios públicos.

Estudo transversal que objetiva analisar a ocorrência de casos de hanseníase em menores de 15 anos de idade residentes no Município de Fortaleza e notificados no SINAN. Os indicadores epidemiológicos nesta população mostram hiperendemicidade. Operacionalmente observa-se a manutenção da concentração de atendimento em algumas unidades de referência, apesar de alguns avanços. Diagnóstico tardio, elevado grau de incapacidade no diagnóstico e baixo grau de avaliação de contatos registrados revelam a fragilidade das ações de controle. Ressalta-se a possibilidade de erro diagnóstico frente às características da infecção nesta população. A ocorrência de casos de hanseníase nesta população representa um indicador epidemiológico de grande relevância e sua análise amplia a discussão sobre problemas operacionais na rede de serviços de saúde.