02282nas a2200301   4500000000100000008004100001260001200042653002900054653002400083653002000107653002100127100001500148700001300163700002500176700001200201700001300213700001200226700001400238700001400252700001700266700001500283700001300298245011400311856007500425300001000500520145600510022001401966       2026                            d  c09/202610aAntimicrobial resistance10aSurveillance system10aLeprosy control10aChemoprophylaxis1 aFastenau A1 aAvanzi C1 aOrtuño-Gutiérrez N1 aBraet S1 aWillis M1 aAubry A1 ade Jong B1 aVedithi S1 aSaunderson P1 aCauchoix B1 aCambau E00aAntimicrobial resistance surveillance: a crucial pillar for sustainable leprosy control and chemoprophylaxis.  uhttps://www.thelancet.com/action/showPdf?pii=S2666-5247%2826%2900169-2  a1 - 83 a<p>Leprosy, also known as Hansen´s disease, remains a public health concern, with around 200 000 new cases reported worldwide each year. Recent strategies to reduce transmission include post-exposure prophylaxis (PEP) with single-dose rifampicin, which has shown moderate protective efficacy and is being increasingly implemented on scale. However, widespread rifampicin use outside combination therapy raises concerns regarding the potential emergence of antimicrobial resistance (AMR) in Mycobacterium leprae and Mycobacterium tuberculosis. Although AMR in leprosy is less common than that in tuberculosis, resistance to rifampicin, dapsone, and fluoroquinolones highlights the need for systematic surveillance. However, AMR surveillance remains inconsistently implemented, with inadequate laboratory capacity, insufficient political prioritisation, and fragmented global coordination posing major barriers. In this Personal View, we argue that AMR surveillance should be an integral component of leprosy control and PEP programmes. We outline key challenges and propose pragmatic policy recommendations, including strengthening laboratory capacity, integrating surveillance into national programmes, and leveraging existing tuberculosis diagnostic networks. Embedding AMR surveillance within PEP strategies supports the long-term effectiveness of treatment and prevention efforts while minimising unintended consequences for global health.</p>
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