social network approach for the study of leprosy transmission beyond the household.

Background 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. Methods 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 (R_c) for exposure and evaluated the potential for transmission for residence, school and workplace. Results Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an R_c of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases. Conclusions 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. [ABSTRACT FROM AUTHOR]