Genetic diversity of Mycobacterium leprae in the state of S?o Paulo, an area of low-leprosy incidence in Brazil

Background: Brazil has the second largest number of leprosy cases worldwide, and the state of Sao Paulo has been considered non -endemic since 2006.Methods: We analyzed 16 variable number tandem repeats loci and three single nucleotide polymorphisms loci of Mycobacterium leprae (M. leprae) in 125 clinical isolates from patients in different municipalities in the state.Results: The clustering pattern of M. leprae indicated that the transmission of leprosy persisted in the state and included scenarios of intra-extra-familial transmission in areas with low endemicity.Conclusions: A significantly active circulation of M. leprae was observed. Therefore, surveillance and control measures must be implemented.