Leprosy Mailing List – November 10, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Jaison Barreto, Bauru, Brazil
Dear Pieter,
Regarding the objectives of WHO for the next 5 years, some points must be considered:
- It is easier to reach zero children with grade two than reduce the rate of grade two among new cases. Because leprosy is not suspected anymore, the diagnosis is often being made too late. We can see these clearly in states of Brazil were the disease was eliminated many years ago.
- As I wrote to LML several months ago, we still have a big problem regarding the management of leprosy: the so called PB with reactions. These patients, most of them Borderline patients, wrongly treated as PB due to bacilloscopy or skin biopsies not done or done under poor conditions. They are released as cured, suffer reactions for seven to ten years, become deformed and also sick from chronic corticosteroids use, and then they receive the information that the disease relapsed. This is extremely cruel. For these cases I think MDT-U could be useful.
- I have seen many patients who were treated twice, three times, or more, and continue living with household contacts sick and not diagnosed. This occurs because the correct evaluation of contacts is, in many instances, not done, or substituted by BCG vaccination. Mostly no follow up is done or orientation given for the risk of disease in future. What is the impact of 6, 12 or 24 doses in a susceptible individual exposed continuously to M. leprae?
- Many times, it is very difficult to distinguish between relapse and reinfection. And we also have the question of primary resistance, of which we know so little.
As my professor Dr. Opromolla sad in the past: "It is possible that we eliminate leprosy, but it is also possible that we did not, just because we do not know it."
He was right.
Best regards
Jaison
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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