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Background: Human-to-human transmission of Mycobacterium leprae among household contacts of active leprosy cases is significant, and surveillance of household contacts is vital to interrupting the transmission chain for this disease. This study was conducted to identify similarities in M. leprae strains, based on genomic single nucleotide polymorphisms (SNPs), among cases and their household contacts and in multicase families in order to decipher possible associations, transmission links, various clinical conditions of index cases that enhance person-to-person transmission, and timelines for transmission patterns. Methods: PCR for M. leprae DNA detection (amplification of the Rlep gene) and SNP subtyping of M. leprae strains was performed for 61 index cases and one of their household contacts. Additionally, we studied six families with multiple cases of leprosy, to understand timelines of infectivity and its relation to severity of the disease in the index cases. Results: Index cases with lepromatous (LL) and borderline lepromatous (BL) leprosy, together with a positive bacteriological index (BI) for M. leprae, result in a higher percentage of their contacts subclinically infected with M. leprae, with odds ratios (OR) of 6.6 (95% confidence interval (CI) 1.6-27.6) for BL and LL, and 7.07 (CI 1.41-35.41) for BI-positive index cases. 75% of the case-contact pairs had a similar SNP subtype of M. leprae. The timeline of infection in multicase families revealed that contacts were infected during the BI-positive period of the index case. Conclusion: Using molecular methods, we determined that positivity for M. leprae DNA in contacts of index leprosy cases was attributed to clinical characteristics of leprosy in the index cases. LL and BL forms of leprosy, together with positive BI, contributed to dissemination of infection to household contacts. In conclusion, we found a relationship between SNP subtypes within index case-contact pairs. This method can help decipher the transmission patterns and identify individuals at risk of contracting leprosy.

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Since the onset of the COVID-19 pandemic, the priorities of leprosy affected patients in seeking anti-leprosy treatment have been affected. This study was initiated at a tertiary leprosy hospital in India to understand the health seeking behaviour of leprosy affected patients who delayed their treatment. A total of 164 patients who delayed their treatment during the COVID-19 lockdown were recruited. The health seeking behaviour and treatment methods adopted by the patients during the lockdown were retrospectively analysed through an exploratory study. Lockdown prevented travel in many cases, but stigma was not an important factor in those who delayed. Of the 164 subjects, 17 developed new leprosy-related impairments. Of those who delayed, patients with plantar ulcers carried out self-care that had been taught to them earlier and they could continue treatment in spite of the lockdown. Reinforcing the patients regularly through health education and self-care teaching helped them to manage and prevent worsening of leprosy related impairments.