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Protecting people against leprosy: Chemoprophylaxis and immunoprophylaxis.

Abstract

Elimination of leprosy cannot be achieved by multidrug therapy alone, and new tools are needed to prevent leprosy. A randomized controlled trial with chemoprophylaxis for contacts of leprosy patients using a single dose of rifampicin (SDR) has shown an overall protective effect of approximately 60%, effective in the first 2 years after the intervention. When a contact who previously received bacillus Calmette-Guérin (BCG) vaccination also receives SDR, the protective effect is additive, approximating 80%. Vaccine trials have been conducted with BCG, often in combination with Mycobacterium leprae or related Mycobacterium vaccines as immunoprophylaxis for contacts of leprosy patients, with BCG giving the best results. Meta-analysis shows that the protective effect of BCG vaccination is larger in observational studies than in trials, 60% versus 41%, and is higher among contacts of leprosy patients than among the general population, 68% versus 53%. We believe that a future leprosy control strategy should include contact management, consisting of a contact survey, at which time preventive interventions could be added, such as chemoprophylaxis and immunoprophylaxis. Modeling studies have shown that both interventions will lower the incidence of leprosy in the population. Implementation studies of such contact-based strategy are now called for.

More information

Type
Journal Article
Author
Richardus JH
Oskam L
Year of Publication
2015
Journal
Clinics in Dermatology
Volume
33
Issue
1
Number of Pages
19 - 25
Language
eng
ISSN Number
0738081X
Call Number
RICHARDUS 2015
DOI
10.1016/j.clindermatol.2014.07.009
Alternate Journal
Clin Dermatol
Publication Language
eng