{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:20:49Z","timestamp":1788355249228,"version":"build-2803163510"},"reference-count":46,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Viable\n                    <jats:italic>Mycobacterium leprae<\/jats:italic>\n                    has been detected in the environment and there is growing evidence that the environment may play a role in transmission. Our objective, therefore, was to further explore the association of insecure water, sanitation, and hygiene (WASH) and leprosy in a hyperendemic area of Brazil. A case\u2013control study was conducted in eastern Minas Gerais, Brazil, between June 2016 and December 2018. Individuals with newly diagnosed leprosy and controls ages 3 years or older were enrolled. A demographic and WASH questionnaire was administered, and blood and stool collected for helminth diagnoses. Descriptive, bivariate, and multivariable analyses were conducted. Seventy-nine cases and 81 noncontact controls were recruited. The mean age was 40, and 52% were male. Most (75% [\n                    <jats:italic>n<\/jats:italic>\n                    = 120]) had piped water, 112 (71%) had a household piped sewer system, and 45 (29%) used a latrine or other type of sanitation system. Leprosy was associated with larger household sizes (adjusted odds ratio [aOR] = 1.34; 95% CI: 1.07\u20131.68], and, unexpectedly, with an improved household sewer system (aOR = 4.67; 95% CI: 1.51\u201314.45). Those with leprosy were also less likely to use piped water for drinking (aOR = 0.39; 95% CI: 0.13\u20131.18) or to treat their water (aOR = 0.52; 95% CI: 0.25\u20131.06), although these did not reach statistical significance. Although the positive association with a piped sewer system was unexpected, the findings suggest that WASH factors could be related to leprosy in this context, and further investigation into potential mechanisms for exposure is warranted.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0334","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:08:43Z","timestamp":1785427723000},"page":"468-474","source":"Crossref","is-referenced-by-count":0,"title":["Leprosy, Water, Sanitation, and Hygiene: A Case\u2013Control Study in a Hyperendemic Area of Brazil"],"prefix":"10.4269","volume":"115","author":[{"given":"Tolulope R.","family":"Ojo-Akosile","sequence":"first","affiliation":[{"name":"Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA;"},{"name":"Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena B. P.","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Program Multicentrica de Bioquimica e Biologia Molecular, Universidade Federal de Juiz de Fora \u2013 Campus G. Valadares, Governador Valadares, Brazil;"},{"name":"Universidade Valle do Rio Doce, Governador Valadares, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary K.","family":"e Lima","sequence":"additional","affiliation":[{"name":"Universidade Valle do Rio Doce, Governador Valadares, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 A.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Unifenas Universidad, Belo Horizonte, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Clennon","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Emory University, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre C.","family":"Branco","sequence":"additional","affiliation":[{"name":"CREDENPES, Centro de Referencia em Doen\u00e7as End\u00eamicas e Programas Especiais, Governador Valadares, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica B. M.","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal de Juiz de Fora, Governador Valadares, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Aparecida","family":"de Faria Grossi","sequence":"additional","affiliation":[{"name":"Unifenas Universidad, Belo Horizonte, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia A. O.","family":"Fraga","sequence":"additional","affiliation":[{"name":"Program Multicentrica de Bioquimica e Biologia Molecular, Universidade Federal de Juiz de Fora \u2013 Campus G. Valadares, Governador Valadares, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica K.","family":"Fairley","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA;"},{"name":"Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"1","key":"b1","series-title":"Clin Microbiol Rev","first-page":"80","article-title":"Leprosy in the 21st century","volume":"28","author":"White","year":"2015"},{"issue":"2","key":"b2","series-title":"Lancet Infect Dis","first-page":"135","article-title":"Are leprosy case numbers reliable?","volume":"18","author":"Salgado","year":"2018"},{"issue":"12","key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e3405","article-title":"Long-term survival and virulence of Mycobacterium leprae in amoebal cysts","volume":"8","author":"Wheat","year":"2014"},{"key":"b4","article-title":"Leprosy (Hansen\u2019s Disease). 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