Vaccinia Virus Zoonotic Infection, São Paulo State, Brazil

According to the microbiological classifi cation, 14 patients had a multibacillary form (positive smear) and 1 patient had a paucibacillary form (negative smear). Clinical signs suggested multibacillary leprosy (>5 patches or lesions on the patient’s skin) for 15 patients and paucibacillary leprosy (1–5 patches or lesions on the skin) for 2 patients. The median time between diagnosis and treatment was 6 days (range 0–20 days). Four patients had a severe disability with a grade 2. Overall, 15 patients had lepromatous leprosy and 2 had tuberculoid leprosy. Although elimination of leprosy was achieved in La Réunion, the implementation of a leprosy surveillance system enabled us to highlight an autochthonous circulation of Mycobacterium leprae, leading to a cluster of cases recently diagnosed in the southwestern part of the island. During the investigation of this cluster, it was noticed that most of the doctors were unaware of the existence of leprosy in La Réunion or of the disease’s clinical signs. Incidence of leprosy could therefore be largely underestimated because of this lack of knowledge, and actions to raise awareness among health care professionals will be established to improve the detection and rapid treatment of patients.