The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study

• Published in: PLoS neglected tropical diseases Vol. 15; no. 7; p. e0009635
• Main Authors: Cerqueira, Selma Regina Penha Silva, Deps, Patrícia Duarte, Cunha, Débora Vilela, Bezerra, Natanael Victor Furtunato, Barroso, Daniel Holanda, Pinheiro, Ana Bárbara Sapienza, Pillegi, Gecilmara Salviato, Repsold, Taynah Alves Rocha, Kurizky, Patrícia Shu, Collin, Simon M, Gomes, Ciro Martins
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-07-2021; Public Library of Science (PLoS)
• Subjects: Adrenal Cortex Hormones - therapeutic use; BCG Vaccine - administration & dosage; Biology and life sciences; Brazil - epidemiology; Clofazimine; Clofazimine - therapeutic use; Cohort analysis; Cohort Studies; Cohorts; Complications and side effects; Coronaviruses; Corticoids; Corticosteroids; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - therapy; COVID-19 Drug Treatment; COVID-19 Testing; Dapsone; Dapsone - therapeutic use; Diabetes mellitus; Diaminodiphenylsulfone; DNA; Drug dosages; Economic models; Economics; Epidemiology; Health hazards; Humans; Leprosy; Leprosy - drug therapy; Leprosy - epidemiology; Management; Medicine and Health Sciences; Multivariate analysis; Nucleotide sequence; Patients; PCR; Pentoxifylline - therapeutic use; Polymerase chain reaction; Prevalence studies (Epidemiology); Prospective Studies; Reverse transcription; Risk analysis; Risk Factors; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Statistical models; Survival; Survival Analysis; Thalidomide; Thalidomide - therapeutic use; Transcription; Tropical diseases; Vaccination; Viral diseases; Vulnerability; Brazil
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0009635

Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19.
We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19.
Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.