What is PEP?
PEP is an acronym for post-exposure prophylaxis. Post-exposure prophylaxis (PEP) is the administration of medication that prevent a certain disease in a person who has been exposed and therefore may have been infected. PEP as an approach is utilized, albeit with different medicines and treatment approaches; for multiple diseases such as human immunodeficiency viruses (HIV), and Rabies.
PEP for leprosy is the administration of drugs (e.g.: rifampicin) to prevent leprosy disease in a person who is or has been in close contact with a leprosy patient as there is a higher probability that the person may have been infected (WHO, 2020, p. x). In the past different medicines or combinations of medicines have been tried for prophylaxis of leprosy in small intervention projects and studies: dapsone; acedapsone; rifampicin, ofloxacin and minocycline (ROM); and rifampicin alone. In a big research project in Bangladesh called COLEP study, it was found that a single-dose rifampicin (SDR), given once, demonstrated a reduction of 57% of new leprosy patients among contacts when compared to a placebo (Moet et al., 2008). Studies in different countries have proven that chemoprophylaxis with SDR can be implemented as part of routine leprosy control activities, is effective and highly acceptable (WHO, 2020, p. viii; Richardus et al., 2020). Besides the feasibility in routine leprosy control services, the safety of SDR-PEP was investigated in a large-scale, international study called LPEP study, in more than 11 countries where nearly 175,000 contacts of leprosy patients were receiving SDR-PEP. The World Health Organization (WHO) advises the use of SDR-PEP in the Roadmap for Neglected Tropical Diseases 2021 – 2030, the Global Leprosy Strategy, and the WHO Guidelines for the Diagnosis, Treatment, and Prevention of Leprosy. More information on PEP implementation can be found in the WHO Technical Guidance ‘Leprosy/Hansen disease: Contact tracing and post-exposure prophylaxis’ (WHO,2020).
Leprosy control programmes that introduced the combination of contact screening and PEP have shown to be effective in bringing down the number of new cases (WHO, 2020, p. viii). The two interlinked approaches are considered by WHO as major public health interventions: screening of contacts will detect otherwise hidden leprosy patients, while PEP will reduce future clinical leprosy among healthy contacts. Together, these interventions can halt transmission. According to a modelling study, routine implementation of SDR-PEP would lead to a reduction of 50% and 90% in new cases across the majority of countries within 5 and 22 years, provided that 20.6 and 40.2 million individuals receive PEP treatment over the respective periods. The involvement of family members, persons affected by leprosy and community leaders and good quality community and health worker education is essential for maximizing coverage and impact of both interventions (WHO, 2020, p. viii).
Are you looking for support or more information on the implementation of PEP?
Please feel free to reach out to one of the organizations listed below. If you are unsure who to contact, you can contact Infolep and we are happy to get you in touch with the appropriate organization and/or person.
Moet, F. J., Pahan, D., Oskam, L., & Richardus, J. H. (2008). Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomised controlled trial. Bmj, 336(7647), 761-764.
Richardus, J. H., Tiwari, A., Barth-Jaeggi, T., Arif, M. A., Banstola, N. L., Baskota, R., ... & Steinmann, P. (2021). Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme. The Lancet Global Health, 9(1), e81-e90.
World Health Organization. (2020). Leprosy/Hansen disease: contact tracing and post-exposure prophylaxis.