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. 2021 Sep 20;15(9):e0009769. doi: 10.1371/journal.pntd.0009769

Table 2. Overview of usage of indicator, cut-offs, and levels for endemicity classification.

Source Study setting Endemicity/ Burden Scoring method Indicators Classification levels
Hyperendemic Very high High Medium Low Undefined endemic Non-endemic
Ajalla et al. 2016 [17] Brazil, State-level Endemicity Scoring single indicator Brazil method New case detection rate - 20–39 per 100,000 (data: 29.5 per 100,000) - - - - -
Alencar et al. 2012a [24] Brazil, state-level Endemicity Scoring multiple indicators separately Brazil method  New case detection rate >40.00 per 100,000 - - - - - -
New case detection rate in children under 15 years - - - <2.5 per 100,000 - - -
Alencar et al. 2012b [22] Brazil, municipality-level Endemicity Scoring multiple indicators separately Brazil method New case detection rate - - 95 per 100,000b - - - -
New case detection rate in children under 15 years - - 28.4 per 100,000b - - - -
Rate with grade 2 disability - - 4.4 per 100,000b - - - -
Anchieta et al. 2016 [29] Brazil, State-level Endemicity Scoring multiple indicators separately Brazil method New case detection rate 51 per 100,000 - - - - - -
New case detection rate under 15 years 17.5 per 100,000 - - - - - -
Barbosa et al. 2018 [30] Brazil, Muncipality Endemicity & burden Scoring multiple indicators separately Brazil method New case detection rate >40.00 per 100,000 20.00–39.99 per 100,000 10.00–19.99 per 100,000 2.00–9.99 per 100,000 <2.00 per 100,000 - -
New case detection rate in children under 15 years >10.00 per 100,000 5.00–9.99 per 100,000 2.50–4.99 per 100,000 0.50–2.49 per 100,000 <0.50 per 100,000 - -
New case with grade 2 disability at time of diagnosis - >10.00 per 100,000 5.00–9.99 per 100,000 2.00–4.99 per 100,000 0.1–1.99 per 100,000 - -
Bernardes et al. 2017 [14] Brazil, state-level
 Endemicity Scoring multiple indicators separately Prevalence rate - - - 4.4 per 10,000 0.73 per 10,000 - -
New case detection rate - - - 4.76 per 100,000 - - -
Brito et al. 2015 [20] Brazil, state-level Endemicity Scoring multiple indicators separately Brazil method New case detection rate - 20.00–39.99 per 100,000 - - - - -
Proportion of leprosy cases with G2D at the time of diagnosis - - >10%; 5%– 9.9% <5% - -
Cunha et al. 2015 [19] Brazil, State level Endemicity Scoring multiple indicators separately Brazil method New case detection rate >40.00 per 100,000 20.00–40 per 100,000 10.00–20 per 100,000 - - - -
New case detection rate in children under 15 years >10.00 per 100,000 5.00–10 per 100,000 - - - - -
Da Silva et al. 2010 [26] Brazil, town Endemicity Scoring single indicator Brazil method New case detection rate 40 per 10,000 - - - - - -
De Oliveira et al. 2012 [23] Brazil, municipality Endemicity Scoring single indicator Brazil method New case detection rate >40 per 100,000 - - - - - -
De Sousa et al. 2020 [31] Brazil, district Endemicity Scoring single indicator Brazil method New case detection rate >40.00 per 100,000 20.00–39.99 per 100,000 10.00–19.99 per 100,000 2.00–9.99 per 100,000 <2.00 per 100,000 - -
De Souza et al. 2018 [33] Brazil, State-level Endemicity Scoring multiple indicators separately Brazil method New case detection rate >40 per 100,000 20–40 per 100,000 10–20 per 100,000 2–10 per 100,000 <2 per 100,000 - -
New case detection rate in children under 15 years >10.00 per 100,000 5.00–9.99 per 100,000 2.50–4.99 per 100,000 0.50–2.49 per 100,000 <0.50 per 100,000 - -
Rate with grade 2 disability at time of diagnosis > 8 per 100,000 4–8 per 100,000 2–4 per 100,000 1–2 per 100,000 < 1 per 100,000 - -
Fontes et al. 2017 [11] Brazil, state-level Endemicity Scoring single indicatorBrazil method New case detection rate >4.0 per 10,000 - - - - - -
New case detection rate in children under 15 years - 0.5–1.0 per 10,000 - - - - -
Freitas et al. 2016 [18]
 Brazil, state-level
 Endemicity Scoring multiple indicators separately Brazil method New case detection rate >40.00 per 100,000 20.00–39.99 per 100,000 10.00–19.99 per 100,000 2.00–9.99 per 100,000 <2.00 per 100,000 - -
New case detection rate in children under 15 years >10.00 per 100,000 5.00–9.99 per 100,000 2.50–4.99 per 100,000 0.50–2.49 per 100,000 <0.50 per 100,000 - -
Rate of new cases with G2D at time of diagnosis - ≥4 cases >0–4 cases - 0 cases - -
Freitas et al. 2017a [15] Brazil, state-level Endemicity Scoring single indicator Brazil method New case detection rate in children under 15 years >10.00 per 100,000 (data: 22.7 per 100,000) 5.00–9.99 per 100,000 2.50–4.99 per 100,000 0.50–2.49 per 100,000 <0.50 per 100,000 - -
Freitas et al. 2017b [13] Brazil, municipality level Endemicity Scoring single indicator Brazil method New case detection rate > 40 per 100,000 - - - - - -
Ignotti et al. 2007 [28] Brazil, State-level Endemicity Scoring single indicator Trend in proportion of new cases with a single lesion at time of diagnosis 20.3–49.1% (time series) - - - - - -
Imbiriba et al. 2008 [27] Brazil, state-level Endemicity
 Scoring multiple indicators separately Brazil method Prevalence rate >20.0 per 10.000 10.0–20.0 per 10.000 5.0–10.0 per 10.000 1.0–5.0 per 10.000 <1.0 per 10,000 - -
  New case detection rate >4.0 per 10,000 2.0–4.0 per 10,000 1.0–2.0 per 10,000 0.2–1.0 per 10,000 <0.2 per 10,000 - -
    New case detection rate in children under 15 years 1.0 per 10,000 0.5–1.0 per 10,000 0.25–0.5 per 10,000 0.05–0.25 per 10,000 <0.05 per 10,000 - -
Moreira et al. 2014 [21] Brazil, State level Endemicity Scoring multiple indicators separately Brazil method New case detection rate >40.00 per 100,000 20.00–39.99 per 100,000 10.00–19.99 per 100,000 2.00–9.99 per 100,000 <2.00 per 100,000 - -
New case detection rate in children under 15 years >10.00 per 100,000 5.00–9.99 per 100,000 2.50–4.99 per 100,000 0.50–2.49 per 100,000 <0.50 per 100,000 - -
Proportion of leprosy cases with grade 2 disability at diagnosis - - >10% 5–9.9% <5% - -
Prevalence rate - - - 2.5 per 10,000 - - -
Pereira et al. 2011 [25] Brazil, municipality Endemicity Scoring multiple indicators separatelyBrazil method New case detection rate >40.00 per 100,000 20.00–39.99 per 100,000 10.00–19.99 per 100,000 2.00–9.99 per 100,000 <2.00 per 100,000 - -
New case detection rate in children under 15 years >10.00 per 100,000 - - - - - -
Pereira et al. 2019 [32] Brazil, municipality Endemicity Scoring multiple indicators separately Brazil method New case detection rate >40.00 per 100,000 - - - - - -
Proportion of children under 15 years 7.2% - - - - - -
Proportion of leprosy cases with grade 2 disability - - 7.0% - - - -
Santos et al. 2016 [16] Brazil, municipality-level Endemicity Scoring single indicator Brazil method New case detection rate in children under 15 years - 5.00–9.99 per 100,000
 - - - - -
Aggarwal et al. 2010 [36] India, district- & community-level Burden Scoring single indicator New case detection rate (district-level) - - 24 per 10,000 - - - -
New case detection rate (community-level) - - 5 per 10,000 - 2 per 10,000 - -
Govindharaj et al. 2019 [39] India, district-level Endemicity Scoring multiple indicators separately Prevalence rate - - 3.52 per 10,000 - - - -
New case detection rate - - 47.20 per 100,000 - - - -
Kumar et al. 2007 [37]  India, district-level
 Endemicity Scoring multiple indicators separately Prevalence rate - - - - - 16.4 per 10,000
-
Incidence rate - - - - - 6.2 per 10,000 person years
-
Kumar et al. 2018 [38] India, state-level Endemicity Scoring single indicator New case detection rate - - 1.28 per 10,000 - 0.21 per 10,000. - -
Mohite et al. 2013 [35] India, district-level Endemicity Scoring single indicator Prevalence rate - - - - - >1 per 10,000 -
Murugaiyan et al. 2017 [34] India, district level Burden Scoring single indicator New case detection rate - - >10 per 100,000 - - - -
Dharmshaktu 2020 [56] Global, country-level Endemicity Scoring multiple indicators separately Prevalence rate - - >1 per 10,000 - - - -
New case detection rate - - >9 per 100,000 - - - -
Penna et al. 2012 [54]
 Global, country-level
 Endemicity Scoring multiple indicators separately Prevalence rate - - >1 per 10,000 - - - -
New case detection rate - - >9 per 100,000 - - - -
WER, WHO 1998 [55] Global, country-level Endemicity Scoring single indicator Prevalence rate 5–15 per 10,000 - - - - 3–5 per 10,000
1–3 per 10,000		 -
Basel et al. 2014 [2] Bangladesh, district-level Burden Scoring single indicator Incidence rate - - 3.7 per 10,000 person years at risk - - - -
Blok et al. 2018 [43] Bangladesh, regional-level Endemicity Scoring single indicator New case detection rate - - 25 per 100,000 5 per 100,000 1 per 100,000 - -
Richardus et al. 2005 [50] Bangladesh and Thailand, district- & province-level Endemicity Scoring single indicator New case detection rate (average over 10 years) - - 50 per 100,000 - 1.5 per 100,000 - -
Chen et al. 2007 [41] China, province-level Endemicity Scoring single indicator Prevalence rate per 100,000 - - - - - - <1/100,000 (referred as: dying-out)
Chen et al. 2018 [42] China, province-level Endemicity Scoring single indicator New case detection rate - - 1.13 per 100,000 - - - -
Shen et al. 2010 [40] China, province-level Endemicity Scoring single indicator Case detection rate - - - - - >0.2 per 100,000 <0.2 per 100,000
Hasker et al. 2017 [44] Comoros, island Endemicity Scoring single indicator Incidence rate - - 7.4 per 10,000 - - - -
Ortuno-Gutierrez et al. 2019 [45] Comoros, island Endemicity Scoring single indicator Incidence rate - - 5–10 per 10,000 - - - -
Odriozola et al. 2017 [52] Argentina, province-level Burden Scoring single indicator New case detection - - >100 cases - - - -
Furst et al. 2018 [46] Cambodia, country-level Endemicity Scoring single indicator New case detection rate - - - - 0.1 per 100,000 - -
Tabah et al. 2016 [48] Cameroon, regional-level Endemicity & burden Composite score with multiple indicators WHO-AFRO LBS method Prevalence rate - - >2 per 10,000 1–2 per 10,000 <1 per 10,000 - -
New case detection rate - - >20 per 100,000 10–20 per 100,000 <10 per 100,000 - -
% MB among new cases - - <50% 50–75% 76–100% - -
% children among new cases - - >20% 10–20% <10% - -
% G2D among new cases - - >20% 10–20% <10% - -
% females among new cases - - <40% >60% 40–60% - -
Prevalence/detection ratio - - >2 1–2 <1 - -
Rate with grade 2 disability - - >1 per 100,000 0.5–1 per 100,000 <0.5 per 100,000 - -
Bakker et al. 2002 [51]
 Indonesia, islands Endemicity Scoring multiple indicators separately Prevalence rate - - 195 per 10,000 - - - -
Dabrera et al. 2016 [47]
 Sri Lanka, district-level
 Endemicity Scoring multiple indicators separately New case detection rate - - 205 per 10,000 - - - -
Prevalence rate - - 511 per 10,000 - - - -
Child prevalence rate - - 1832.4 per 100,000 - - - -
Aranzazu et al. 2012 [49] Venezuela, community-level Endemicity Scoring multiple indicators separately Prevalence rate 3.4 per 10,000 - - - - - -
Case detection rate > 4 per 100

a Table provides an overview of scoring method and indicators used to describe endemicity and/or burden. Only indicators with cut-off values are presented. Note: 2 out of 47 articles did not provide classification cut-off: Araujo et al. 2017 [12] and Aceng et al 2019 [53]

b classified as high transmission areas.