{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:15:30Z","timestamp":1778084130116,"version":"3.51.4"},"reference-count":98,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Gansu in northwestern China has maintained leprosy elimination at the national and county level, yet localized transmission persists in certain endemic foci. This 70-year analysis (1950\u20132020) assessed the impact of key control strategies using an interrupted time-series analysis of new case detection rate (NCDR) with break points at the 1958 \u201csurvey\u2013isolate\u2013treat\u201d strategy and the 1987 multidrug therapy (MDT) rollout. Among 4,872 registered cases, NCDR rose initially and then declined steadily to 0.027\/100,000 by 2020. Significant geographic clustering was observed in southeastern counties (Moran\u2019s\n                    <jats:italic>I<\/jats:italic>\n                    = 0.403,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.05). Most cases were male farmers (male-to-female ratio 2.37:1), and Han ethnicity accounted for 75.9% of all cases. The proportion of multibacillary cases increased significantly from 78.0% before 1987 to 84.9% after MDT implementation. Time-series analysis indicated that the 1958 strategy was associated with a sustained decline in detection rates during the high-endemic phase, whereas MDT introduction in 1987 led to an immediate level reduction during the low-endemic phase. These results underscore the complementary role of historical integrated control measures and modern chemotherapy in sustaining leprosy elimination. However, transmission persists, and the rising proportion of multibacillary cases highlights the ongoing need for targeted active surveillance, contact screening, and strengthened early detection to achieve WHO 2030 eradication targets.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0633","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:01:37Z","timestamp":1774969297000},"page":"821-831","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological Trends and Impact of Leprosy Control Strategies in Gansu, China: A 70-Year Interrupted Time-Series Analysis (1950\u20132020)"],"prefix":"10.4269","volume":"114","author":[{"given":"Shan","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Leprosy Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongmao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Leprosy Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiwen","family":"Yu","sequence":"additional","affiliation":[{"name":"National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Nanjing, China;"},{"name":"Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LiangBin","family":"Yan","sequence":"additional","affiliation":[{"name":"National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Nanjing, China;"},{"name":"Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shumei","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Leprosy Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Eur Acad Dermatol Venereol","first-page":"1205","article-title":"Position statement: LEPROSY: Diagnosis, treatment and follow-up","volume":"33","author":"Alemu Belachew","year":"2019"},{"key":"b2","series-title":"Indian J Dermatol","first-page":"55","article-title":"Leprosy scenario at a tertiary level hospital in Delhi: A 5-year retrospective study","volume":"60","author":"Chhabra","year":"2015"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"e293","article-title":"Multidrug therapy for leprosy: A game changer on the path to elimination","volume":"17","author":"Smith","year":"2017"},{"key":"b4","article-title":"Global Leprosy (Hansen Disease) Update, 2023: Elimination of Leprosy Disease is Possible\u2014Time to Act!","year":"2024"},{"key":"b5","article-title":"Towards Zero Leprosy. Global Leprosy (Hansen\u2019s Disease) Strategy 2021\u20132030.","year":"2021"},{"key":"b6","series-title":"J Epidemiol Glob Health","first-page":"13","article-title":"Policy evolution and lessons learned from China\u2019s efforts to eliminate leprosy","volume":"14","author":"Liu","year":"2024"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0011092","article-title":"Leprosy among new child cases in China: Epidemiological and clinical analysis from 2011 to 2020","volume":"17","author":"Peng","year":"2023"},{"key":"b8","series-title":"Zhonghua Liu Xing Bing Xue Za Zhi","first-page":"1095","article-title":"A long-term evolution on the epidemiological characteristics of leprosy, towards the goal of its elimination in 1949\u20132007 in China","volume":"29","author":"Shen","year":"2008"},{"key":"b9","series-title":"Sci Rep","first-page":"11407","article-title":"Monitoring and detection of leprosy patients in Southwest China: A retrospective study, 2010\u20132014","volume":"8","author":"Le","year":"2018"},{"key":"b10","series-title":"BMC Public Health","first-page":"2707","article-title":"High-risk spatiotemporal patterns of leprosy in the southeastern region of Yunnan province from 2010 to 2022: An analysis at the township level","volume":"24","author":"Qiao","year":"2024"},{"key":"b11","series-title":"PLoS Negl Trop Dis","first-page":"e0008956","article-title":"Temporal-spatial distribution characteristics of leprosy: A new challenge for leprosy prevention and control in Zhejiang, China","volume":"15","author":"Wu","year":"2021"},{"key":"b12","series-title":"BMC Public Health","first-page":"1790","article-title":"Epidemiological situation of leprosy in a province in China: A long time to diagnosis and a high rate of deformity","volume":"20","author":"Zhang","year":"2020"},{"key":"b13","series-title":"Dis Surveill","first-page":"975","article-title":"Symptom surveillance for leprosy in Gansu 2019\u2009\u2212\u20092022","volume":"39","author":"Wu","year":"2024"},{"key":"b14","series-title":"China Compendium of Statistics 1949\u20132008","year":"2010"},{"key":"b15","series-title":"BMJ Glob Health","first-page":"e003567","article-title":"Use of interrupted time series methods in the evaluation of health system quality improvement interventions: A methodological systematic review","volume":"5","author":"Hategeka","year":"2020"},{"key":"b16","series-title":"Sci Rep","first-page":"9777","article-title":"An interrupted time series study of the leprosy case detection in Brazil after the COVID-19 pandemic","volume":"15","author":"Sousa","year":"2025"},{"key":"b17","series-title":"Vaccines (Basel)","first-page":"527","article-title":"Is Brazil reversing the decline in childhood immunization coverage in the post-COVID-19 era? An interrupted time series analysis","volume":"13","author":"Saavedra","year":"2025"},{"key":"b18","series-title":"Int J Epidemiol","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: A tutorial","volume":"46","author":"Bernal","year":"2017"},{"key":"b19","series-title":"BMC Med Res Methodol","first-page":"181","article-title":"Evaluation of statistical methods used in the analysis of interrupted time series studies: A simulation study","volume":"21","author":"Turner","year":"2021"},{"key":"b20","series-title":"Drug Alcohol Rev","first-page":"1131","article-title":"Interrupted time series analysis of Canadian legal cannabis sales during the COVID-19 pandemic","volume":"41","author":"Armstrong","year":"2022"},{"key":"b21","series-title":"Am J Trop Med Hyg","first-page":"165","article-title":"Epidemiological characteristics and factors associated with cure of leprosy in Chongqing, China, from 1949 to 2019","volume":"108","author":"Wang","year":"2023"},{"key":"b22","series-title":"Lepr Rev","first-page":"6","article-title":"Trends in new leprosy case detection over 57 years (1952\u20132008) in Yuxi, Yunnan Province of Southwest China","volume":"82","author":"Li","year":"2011"},{"key":"b23","series-title":"Chin J Lepr Skin Dis","first-page":"253","article-title":"Epidemiological characteristies of the spatial distribution of new leprosy cases in Gansu Province from 2000 to 2020","volume":"39","author":"Sun","year":"2023"},{"key":"b24","series-title":"Study on the Status of Medical and Health Resources Allocation in Longnan City","author":"Zheng","year":"2019"},{"key":"b25","series-title":"Trop Med Infect Dis","first-page":"183","article-title":"The lost peace\u2019: Evidencing the syndemic relationship between neglected tropical diseases and mental distress in Liberia","volume":"9","author":"McCollum","year":"2024"},{"key":"b26","series-title":"N Engl J Med","first-page":"1843","article-title":"Single-dose rifapentine in household contacts of patients with leprosy","volume":"388","author":"Wang","year":"2023"},{"key":"b27","series-title":"BMC Infect Dis","first-page":"320","article-title":"Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001\u20132022","volume":"25","author":"Matos","year":"2025"},{"key":"b28","series-title":"Infect Dis Poverty","first-page":"38","article-title":"Wildlife hunting and the increased risk of leprosy transmission in the tropical Americas: A pathogeographical study","volume":"14","author":"Aliaga-Samanez","year":"2025"},{"key":"b29","series-title":"Public Health","first-page":"307","article-title":"Leprosy in Brazil: An analysis of the global burden of disease estimates between 1990 and 2019","volume":"236","author":"de Ara\u00fajo","year":"2024"},{"key":"b30","series-title":"PLoS One","first-page":"e0311676","article-title":"Burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020","volume":"19","author":"Mrema","year":"2024"},{"key":"b31","series-title":"Nat Rev Immunol","first-page":"737","article-title":"The X-files in immunity: Sex-based differences predispose immune responses","volume":"8","author":"Fish","year":"2008"},{"key":"b32","series-title":"PLoS Negl Trop Dis","first-page":"e0006622","article-title":"Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis","volume":"12","author":"Pescarini","year":"2018"},{"key":"b33","series-title":"Trans R Soc Trop Med Hyg","first-page":"1204","article-title":"Male sex is associated with a higher risk of multibacillary leprosy and leprosy-associated disability in northeast Brazil","volume":"119","author":"Barreto","year":"2025"},{"key":"b34","series-title":"Front Med (Lausanne)","first-page":"1243571","article-title":"Specialized active leprosy search strategies in an endemic area of the Brazilian Amazon identifies a hypermutated Mycobacterium leprae strain causing primary drug resistance","volume":"10","author":"Bouth","year":"2023"},{"key":"b35","series-title":"Tropical Med Int Health","first-page":"517","article-title":"Temporal trend, high-risk spatial and spatiotemporal clustering of leprosy indicators in Brazil: A 20-year ecological and population-based study","volume":"28","author":"Paz","year":"2023"},{"key":"b36","series-title":"Bull World Health Organ","first-page":"306","article-title":"Leprosy in China: Epidemiological trends between 1949 and 1998","volume":"79","author":"Chen","year":"2001"},{"key":"b37","series-title":"Indian J Dermatol Venereol Leprol","first-page":"322","article-title":"Diagnosing multibacillary leprosy: A comparative evaluation of diagnostic accuracy of slit-skin smear, bacterial index of granuloma and WHO operational classification","volume":"74","author":"Bhushan","year":"2008"},{"key":"b38","series-title":"Front Microbiol","first-page":"1497319","article-title":"Comparative analysis of the leprosy detection rate regarding its clinical spectrum through PCR using the 16S rRNA gene: A scientometrics and meta-analysis","volume":"15","author":"Silva","year":"2024"},{"key":"b39","series-title":"Lancet","first-page":"1717","article-title":"Internal migration and health in China","volume":"372","author":"Hu","year":"2008"},{"key":"b40","series-title":"Lepr Rev","first-page":"416","article-title":"Healthcare seeking behaviour and delay in diagnosis of leprosy in a low endemic area of China","volume":"80","author":"Zhang","year":"2009"},{"key":"b41","series-title":"A Brief History of Leprosy Control in Gansu","author":"Li","year":"2015"},{"key":"b42","series-title":"Acad Pediatr","first-page":"S38","article-title":"Use of interrupted time series analysis in evaluating health care quality improvements","volume":"13","author":"Penfold","year":"2013"},{"key":"b43","series-title":"J Drugs Dermatol","first-page":"578","article-title":"LGBTQ+ dermatological trends linked to US societal events: An interrupted time series analysis","volume":"23","author":"Ezzat","year":"2024"},{"key":"b44","series-title":"J Glob Antimicrob Resist","first-page":"459","article-title":"Risk factors for dapsone resistance in leprosy patients: A systematic meta-analysis","volume":"30","author":"Wu","year":"2022"},{"key":"b45","series-title":"Indian J Med Res","first-page":"15","article-title":"Leprosy\u2014Evolution of the path to eradication","volume":"137","author":"Dogra","year":"2013"},{"key":"b46","series-title":"Public Health","first-page":"172","article-title":"Spatial\u2013temporal trends in leprosy burden and its associations with socioeconomic and physical geographic factors: Results from the Global Burden of Disease Study 2019","volume":"230","author":"Shen","year":"2024"},{"key":"b47","series-title":"Chin Med Sci J","first-page":"77","article-title":"Trends of case detection and other indicators of leprosy in China during 1985\u20132002","volume":"20","author":"Shen","year":"2005"},{"key":"b48","series-title":"Front Public Health","first-page":"666307","article-title":"Factors influencing leprosy incidence: A comprehensive analysis of observations in Wenshan of China, Nepal, and other global epidemic areas","volume":"9","author":"Li","year":"2021"},{"key":"b49","article-title":"Leprosy Programme and Transmission Assessment: Tool Accompanying the Technical Guidance on Interruption of Transmission and Elimination of Leprosy.","year":"2023"},{"key":"b1","series-title":"J Eur Acad Dermatol Venereol","first-page":"1205","article-title":"Position statement: LEPROSY: Diagnosis, treatment and follow-up","volume":"33","author":"Alemu Belachew","year":"2019"},{"key":"b2","series-title":"Indian J Dermatol","first-page":"55","article-title":"Leprosy scenario at a tertiary level hospital in Delhi: A 5-year retrospective study","volume":"60","author":"Chhabra","year":"2015"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"e293","article-title":"Multidrug therapy for leprosy: A game changer on the path to elimination","volume":"17","author":"Smith","year":"2017"},{"key":"b4","article-title":"Global Leprosy (Hansen Disease) Update, 2023: Elimination of Leprosy Disease is Possible\u2014Time to Act!","year":"2024"},{"key":"b5","article-title":"Towards Zero Leprosy. Global Leprosy (Hansen\u2019s Disease) Strategy 2021\u20132030.","year":"2021"},{"key":"b6","series-title":"J Epidemiol Glob Health","first-page":"13","article-title":"Policy evolution and lessons learned from China\u2019s efforts to eliminate leprosy","volume":"14","author":"Liu","year":"2024"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0011092","article-title":"Leprosy among new child cases in China: Epidemiological and clinical analysis from 2011 to 2020","volume":"17","author":"Peng","year":"2023"},{"key":"b8","series-title":"Zhonghua Liu Xing Bing Xue Za Zhi","first-page":"1095","article-title":"A long-term evolution on the epidemiological characteristics of leprosy, towards the goal of its elimination in 1949\u20132007 in China","volume":"29","author":"Shen","year":"2008"},{"key":"b9","series-title":"Sci Rep","first-page":"11407","article-title":"Monitoring and detection of leprosy patients in Southwest China: A retrospective study, 2010\u20132014","volume":"8","author":"Le","year":"2018"},{"key":"b10","series-title":"BMC Public Health","first-page":"2707","article-title":"High-risk spatiotemporal patterns of leprosy in the southeastern region of Yunnan province from 2010 to 2022: An analysis at the township level","volume":"24","author":"Qiao","year":"2024"},{"key":"b11","series-title":"PLoS Negl Trop Dis","first-page":"e0008956","article-title":"Temporal-spatial distribution characteristics of leprosy: A new challenge for leprosy prevention and control in Zhejiang, China","volume":"15","author":"Wu","year":"2021"},{"key":"b12","series-title":"BMC Public Health","first-page":"1790","article-title":"Epidemiological situation of leprosy in a province in China: A long time to diagnosis and a high rate of deformity","volume":"20","author":"Zhang","year":"2020"},{"key":"b13","series-title":"Dis Surveill","first-page":"975","article-title":"Symptom surveillance for leprosy in Gansu 2019\u2009\u2212\u20092022","volume":"39","author":"Wu","year":"2024"},{"key":"b14","series-title":"China Compendium of Statistics 1949\u20132008","year":"2010"},{"key":"b15","series-title":"BMJ Glob Health","first-page":"e003567","article-title":"Use of interrupted time series methods in the evaluation of health system quality improvement interventions: A methodological systematic review","volume":"5","author":"Hategeka","year":"2020"},{"key":"b16","series-title":"Sci Rep","first-page":"9777","article-title":"An interrupted time series study of the leprosy case detection in Brazil after the COVID-19 pandemic","volume":"15","author":"Sousa","year":"2025"},{"key":"b17","series-title":"Vaccines (Basel)","first-page":"527","article-title":"Is Brazil reversing the decline in childhood immunization coverage in the post-COVID-19 era? An interrupted time series analysis","volume":"13","author":"Saavedra","year":"2025"},{"key":"b18","series-title":"Int J Epidemiol","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: A tutorial","volume":"46","author":"Bernal","year":"2017"},{"key":"b19","series-title":"BMC Med Res Methodol","first-page":"181","article-title":"Evaluation of statistical methods used in the analysis of interrupted time series studies: A simulation study","volume":"21","author":"Turner","year":"2021"},{"key":"b20","series-title":"Drug Alcohol Rev","first-page":"1131","article-title":"Interrupted time series analysis of Canadian legal cannabis sales during the COVID-19 pandemic","volume":"41","author":"Armstrong","year":"2022"},{"key":"b21","series-title":"Am J Trop Med Hyg","first-page":"165","article-title":"Epidemiological characteristics and factors associated with cure of leprosy in Chongqing, China, from 1949 to 2019","volume":"108","author":"Wang","year":"2023"},{"key":"b22","series-title":"Lepr Rev","first-page":"6","article-title":"Trends in new leprosy case detection over 57 years (1952\u20132008) in Yuxi, Yunnan Province of Southwest China","volume":"82","author":"Li","year":"2011"},{"key":"b23","series-title":"Chin J Lepr Skin Dis","first-page":"253","article-title":"Epidemiological characteristies of the spatial distribution of new leprosy cases in Gansu Province from 2000 to 2020","volume":"39","author":"Sun","year":"2023"},{"key":"b24","series-title":"Study on the Status of Medical and Health Resources Allocation in Longnan City","author":"Zheng","year":"2019"},{"key":"b25","series-title":"Trop Med Infect Dis","first-page":"183","article-title":"The lost peace\u2019: Evidencing the syndemic relationship between neglected tropical diseases and mental distress in Liberia","volume":"9","author":"McCollum","year":"2024"},{"key":"b26","series-title":"N Engl J Med","first-page":"1843","article-title":"Single-dose rifapentine in household contacts of patients with leprosy","volume":"388","author":"Wang","year":"2023"},{"key":"b27","series-title":"BMC Infect Dis","first-page":"320","article-title":"Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001\u20132022","volume":"25","author":"Matos","year":"2025"},{"key":"b28","series-title":"Infect Dis Poverty","first-page":"38","article-title":"Wildlife hunting and the increased risk of leprosy transmission in the tropical Americas: A pathogeographical study","volume":"14","author":"Aliaga-Samanez","year":"2025"},{"key":"b29","series-title":"Public Health","first-page":"307","article-title":"Leprosy in Brazil: An analysis of the global burden of disease estimates between 1990 and 2019","volume":"236","author":"de Ara\u00fajo","year":"2024"},{"key":"b30","series-title":"PLoS One","first-page":"e0311676","article-title":"Burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020","volume":"19","author":"Mrema","year":"2024"},{"key":"b31","series-title":"Nat Rev Immunol","first-page":"737","article-title":"The X-files in immunity: Sex-based differences predispose immune responses","volume":"8","author":"Fish","year":"2008"},{"key":"b32","series-title":"PLoS Negl Trop Dis","first-page":"e0006622","article-title":"Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis","volume":"12","author":"Pescarini","year":"2018"},{"key":"b33","series-title":"Trans R Soc Trop Med Hyg","first-page":"1204","article-title":"Male sex is associated with a higher risk of multibacillary leprosy and leprosy-associated disability in northeast Brazil","volume":"119","author":"Barreto","year":"2025"},{"key":"b34","series-title":"Front Med (Lausanne)","first-page":"1243571","article-title":"Specialized active leprosy search strategies in an endemic area of the Brazilian Amazon identifies a hypermutated Mycobacterium leprae strain causing primary drug resistance","volume":"10","author":"Bouth","year":"2023"},{"key":"b35","series-title":"Tropical Med Int Health","first-page":"517","article-title":"Temporal trend, high-risk spatial and spatiotemporal clustering of leprosy indicators in Brazil: A 20-year ecological and population-based study","volume":"28","author":"Paz","year":"2023"},{"key":"b36","series-title":"Bull World Health Organ","first-page":"306","article-title":"Leprosy in China: Epidemiological trends between 1949 and 1998","volume":"79","author":"Chen","year":"2001"},{"key":"b37","series-title":"Indian J Dermatol Venereol Leprol","first-page":"322","article-title":"Diagnosing multibacillary leprosy: A comparative evaluation of diagnostic accuracy of slit-skin smear, bacterial index of granuloma and WHO operational classification","volume":"74","author":"Bhushan","year":"2008"},{"key":"b38","series-title":"Front Microbiol","first-page":"1497319","article-title":"Comparative analysis of the leprosy detection rate regarding its clinical spectrum through PCR using the 16S rRNA gene: A scientometrics and meta-analysis","volume":"15","author":"Silva","year":"2024"},{"key":"b39","series-title":"Lancet","first-page":"1717","article-title":"Internal migration and health in China","volume":"372","author":"Hu","year":"2008"},{"key":"b40","series-title":"Lepr Rev","first-page":"416","article-title":"Healthcare seeking behaviour and delay in diagnosis of leprosy in a low endemic area of China","volume":"80","author":"Zhang","year":"2009"},{"key":"b41","series-title":"A Brief History of Leprosy Control in Gansu","author":"Li","year":"2015"},{"key":"b42","series-title":"Acad Pediatr","first-page":"S38","article-title":"Use of interrupted time series analysis in evaluating health care quality improvements","volume":"13","author":"Penfold","year":"2013"},{"key":"b43","series-title":"J Drugs Dermatol","first-page":"578","article-title":"LGBTQ+ dermatological trends linked to US societal events: An interrupted time series analysis","volume":"23","author":"Ezzat","year":"2024"},{"key":"b44","series-title":"J Glob Antimicrob Resist","first-page":"459","article-title":"Risk factors for dapsone resistance in leprosy patients: A systematic meta-analysis","volume":"30","author":"Wu","year":"2022"},{"key":"b45","series-title":"Indian J Med Res","first-page":"15","article-title":"Leprosy\u2014Evolution of the path to eradication","volume":"137","author":"Dogra","year":"2013"},{"key":"b46","series-title":"Public Health","first-page":"172","article-title":"Spatial\u2013temporal trends in leprosy burden and its associations with socioeconomic and physical geographic factors: Results from the Global Burden of Disease Study 2019","volume":"230","author":"Shen","year":"2024"},{"key":"b47","series-title":"Chin Med Sci J","first-page":"77","article-title":"Trends of case detection and other indicators of leprosy in China during 1985\u20132002","volume":"20","author":"Shen","year":"2005"},{"key":"b48","series-title":"Front Public Health","first-page":"666307","article-title":"Factors influencing leprosy incidence: A comprehensive analysis of observations in Wenshan of China, Nepal, and other global epidemic areas","volume":"9","author":"Li","year":"2021"},{"key":"b49","article-title":"Leprosy Programme and Transmission Assessment: Tool Accompanying the Technical Guidance on Interruption of Transmission and Elimination of Leprosy.","year":"2023"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p821.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p821.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p821.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T15:37:44Z","timestamp":1778081864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p821.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":98,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0633","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]}}}