[Eradication of leprosy and public health. Vaccination and multidrug therapy].
Leprosy is a disease, which still affects large populations in the developing countries particularly in Africa, Asia and Latin America. For the last 15 years significant advances have been made towards leprosy elimination. The most effective strategy for leprosy control is an early identification of cases and an effective treatment with multidrug therapy (MDT). The vaccination against leprosy plays only an additional role. There are two possible approaches to develop vaccine against leprosy. One is to produce a vaccine based on organisms related to M. leprae, such as: BCG, ICRC bacillus, Mycobacterium w, Mycobacterium vaccae, Mycobacterium habana. However, these organisms related to M. leprae are not very promising in experimental animal studies. In 1970s a new vaccine was prepared based on killed M. leprae. This vaccine, tested alone and together with BCG revealed little impact on increasing vaccine efficacy. The success in cloning and expressing the M. leprae genome in E. coli created the possibility of moving towards a second generation vaccine using peptide antigens. Up till now only MDT has essential impact on decline of global leprosy prevalence. Out of 122 endemic countries in 1985, 107 countries have reached elimination of leprosy at country level. At the end of 2000 leprosy was a public health problem only in 15 countries (prevalence rate > 1/10.000). Currently leprosy remains a problem mainly in 6 major endemic countries. Among these, India alone accounts for 64% of prevalence and 78% of detection worldwide.