Perspectives for leprosy control and elimination

Abstract

Recently, data and news about rising numbers of leprosy cases in some low endemic countries, as well as in certain areas of high-burden countries, have become prominent 1 . This increase leads us to reflect upon changes in transmission patterns and difficulties regarding interventions strategies for leprosy control.Leprosy is classified as a neglected tropical disease (NTD) targeted for elimination 2 . The goal of elimination as a public health problem was agreed upon by the Member States of the World Health Organization (WHO) in 1991 3 . Since the resolution, many countries have revised their leprosy strategies including a rigorous review and updating of databases, standardized declaration of cure upon multi-drug therapy (MDT) completion according to official protocols with reduced treatment time 4 etc. Additionally, countries invested considerable efforts in active case finding, including campaigns, decentralization of care, definition of priority areas for interventions and integration of activities with other NTDs 5 . More recently, integration with other chronic infectious diseases has also been explored 5 . Of note, even Mycobacterium leprae transmission prediction models suggest that case detection needs to be increased to reduce disease burden and achieve reduced transmission 6 .It is generally accepted that there are no sudden leprosy outbreaks due to the long incubation period and the slow evolution of the disease, which mean that the patients being diagnosed today were infected several years ago 7 . Consequently, changes in the trend of incidence indicators are slow, except for the effects of operational factors. In developing countries, active case finding efforts in vulnerable populations typically result in the detection of new patients, with the most vulnerable groups being the contacts of index patients, including domestic, neighbor and social contacts 8 , whose risk is dependent on proximity and contact duration, leprosy type of the index patient, and blood relationship. There is now also consensus that M. leprae circulate in the environment of endemic areas. This ecological component has recently been explored in more detail, but its epidemiological significance remains unclear 9 . Other etiological agents such as M. lepromatosis have also been described 10 .Treatment for leprosy has been made available for decades through the WHO to endemic countries, free of charge. Reported stock-outs of the medication are due to logistical issues. To complement the standard MDT, locally procured drugs are needed for special conditions, and to control so-called leprosy reactions.To sum up, by "leprosy" we are referring to a historically endemic, treatable, and curable infectious disease. Therefore, the basic surveillance recommendations are to ensure early diagnosis and

Accuracy of rapid point-of-care serological tests for leprosy diagnosis: a systematic review and meta-analysis

“…At the same time, PB mainly presents cellular immunity, which is not easily assessed through either POC immunochromatographic or immunoassays. 49 Identifying a host biomarker signature to support diagnosis has made a significant advance, with high titters of anti-PGL-1 IgM, IP-10/CXCL-10 and CRP being associated with leprosy. 50…”

Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil

“…The WHO recommends SDR-PEP, and some national programs have already included or are considering to include such interventions in the routines of their health services. It is also important to create partnerships with other institutions in order to develop new and more effective tools and initiatives for the prevention and control of leprosy [ 12 , 53 , 54 ].…”

Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil

“…Given the long incubation period and the slow clinical progression of leprosy [ 12 ], it is reasonable to consider systematic leprosy screening for all CL patients seeking assistance in health facilities [ 5 ]. In fact, most patients who presented both diseases during our study period were first diagnosed with CL; within three years, most of them were diagnosed with the second disease.…”

“…In fact, our findings also suggested that adult individuals are more likely to present a second disease. In addition to a greater exposure to CL vectors [ 46 ], this increased risk may be attributed to the higher number of interpersonal contacts and the long incubation period of leprosy [ 12 , 44 , 48 ].…”

“…For leprosy, the strategy has not managed to interrupt transmission, which has been relatively stagnant for more than a decade [ 2 ]. Many endemic countries are still struggling to achieve timely diagnosis, often due to control programs relying on passive case detection, weak health care delivery systems, and limited funding [ 1 , 10 , 11 , 12 ]. As a way to overcome these challenges, integration of vertical NTDs control programs and mainstreaming into primary health care is recommended to achieve cost-effectiveness, sustainability, and universal coverage [ 1 , 7 , 13 ].…”