02362nas a2200385   4500000000100000008004100001260001200042653004500054653001100099653001200110653002200122653001400144100001400158700001400172700001400186700001500200700001400215700001600229700001300245700001100258700001900269700001400288700001200302700001700314700001400331700001600345700001700361700001300378700002200391700001500413700001500428245009000443520142900533022001401962       2021                            d  c05/202110a
          Mycobacterium leprae
        10aBrazil10aschools10asocial networking10aworkplace1 aKendall C1 aKerr LRFS1 aMiranda J1 ade Pinho S1 aAndrade R1 aRodrigues L1 aFrota CC1 aMota R1 aDe Almeida RLF1 aMoreira F1 aGomes R1 ade Almeida N1 aFrança L1 aPontes MADA1 aGonçalves H1 aPenna GO1 aBührer-Sékula S1 aKlovdahl A1 aBarreto ML00aA social network approach for the study of leprosy transmission beyond the household.3 a<p><b>BACKGROUND: </b>Mycobacterium leprae was the first microorganism directly associated with a disease, however, there are still important gaps in our understanding of transmission. Although household contacts are prioritized, there is evidence of the importance of extrahousehold contacts. The goal of this article is to contribute to our understanding of the transmission of leprosy ex-household.</p><p><b>METHODS: </b>We compare co-location data of 397 leprosy cases and 211 controls drawn from the Centro de Dermatologia Sanitária D. Libânia in Fortaleza, Brazil. We collected lifetime geolocation data related to residence, school attendance and workplace and developed novel methods to establish a critical distance (Rc) for exposure and evaluated the potential for transmission for residence, school and workplace.</p><p><b>RESULTS: </b>Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an Rc of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases.</p><p><b>CONCLUSIONS: </b>Our novel network approach offers a promising opportunity to explore leprosy transmission. Our networks confirm the importance of coresidence, provide a boundary and suggest a role for transmission in workplaces. Schools, on the other hand, do not demonstrate a clustering of cases. Our findings may have programmatic relevance.</p>  a1878-3503