Leprosy Mailing List – November 12, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
I agree fully with dr Narashima Rao and Joel Almeda, also with Jaison, but I have some problems with Sinesio Talhari’s letter.
But I want to add some comments and may be some frustrations. The WHO goes on in the same line of thinking and should have real experts from the fields in their team. They have to prevent damage by treating. Now patients who are not detected in time become worse during “treatment”. Fieldworkers may get enough of their slogans, having been deceived and disappointed so often. Their recommendations are very difficult to execute when you have a problem in the Field. They are not tailored to actual practical fieldwork. Even in reference centers they are difficult to interpret.
I can follow Sinesio in his arguments and I believe that he is convinced, but I do not see this in a paper. In none of the papers, he mentioned, the outcome of U-MDT in comparison with R-MDT is given in terms of sensory loss or voluntary muscle loss. In only one of the papers there is mentioning of reactions. They mention only that in U-MDT there are more reactions in MB than in R-MDT and that it becomes the same after 2 years after the start of treatment. That is also the case in the R-MDT when the protection for reactions from Clofazimine has disappeared.
When we treat PB with U-MDT; nothing much will change much, only people are tempted not to take the drugs because of the color due to clofazimine.
I have gone around seeing the problem of ENL or relapse, taking all the time of the doctor in charge. Shortening MB treatment to 6 months may increase the relapses but certainly the ENL, as these were suppressed by Clofazimine. Leprosy, I cannot say it enough, is an “immunological disease induced and/or maintained by M. leprae”. MB patients after treatment have nearly always persistent bacteria and may relapse when the circumstances for multiplication are there e.g. immunosuppression due to old age, other diseases, treatment by immunosuppression, prednisone, immunobiologicals.
With regards
dr Ben Naafs
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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