Sunday, October 29, 2017

(LML) Promising new leprosy vaccine moves into human trials

Leprosy Mailing List – October 29,  2017

Ref.:  (LML)  Promising new leprosy vaccine moves into human trials  

From:  P.K. Das, Birmingham, UK

Dear Pieter,

In reference to Ben's straight forward presentation (LML, October 26. 2017), though sounds abrupt, does have some substance.


Since 1978 (when I just entered the leprosy research field by engaging only 25% of my research time with zeal and sincerity) I had been hearing all sorts of claims, and vaccine was surely one of the hot points. I vividly remember  Barry Bloom (renowned immunologist, mentor of Robert Modlin), as the chairman of WHO-IMLEP ascertained that vaccine for leprosy is the answer for complete eradication. Unfortunately, Barry's dream for WHO delivering the Vaccine is still a distant future and romantic belief, in the meantime lots of money was spent.


Myself being a little man and little so & so in the field of leprosy, I could not and even now more so can not see how an effective proven Vaccine is possible, because of various rational scientific reasoning. I refrain from discussing them here, at least glimpse of such reasoning has been touched by Ben's present staright forward letter.


Sometimes, I wonder whether vaccine at all is necessary, when (as claimed) so many "sure do" successful diagnostic (including early diagnosis)  and prognostic lab tests to monitor the patients  and population at large are available. May be,  ALM and IDRI 's romantic enthusiasts are obsessed in enlighten us  and rescue us from the dark age of our knowledge (a catch phrase appeared in Brazil, several years ago). On the other hand, understanding  immunity to leprosy is challenging and mystic's dream, should continue. I shall rather encourage AML and IDRI to chase their dreams.




LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Saturday, October 28, 2017

(LML) Steroid Dependency

Leprosy Mailing List – October 28,  2017

Ref.:    (LML) Steroid Dependency

From:  José Augusto, Rio de Janeiro, Brazil


Dear Pieter,


The comments from Dr Barbara (LML, October 18, 2017) are very interesting . I want to put some reflection about the need of use of corticosteroids (which is a very important and necessary drug in Leprosy): immuno-suppresive dose in the initial stage, independent of severity in the reactional states type 1 or type 2, and making the discontinuation of corticosteroids with precision about time and dose (anti-inflammatory dose). 


When we reach a dose, for example, 30 mg/ day, 20 mg/day or 10 mg/day, these should be discontinued very slowly, so it would be 2-3 months for each one of these previous dose. Mainly when these reactional states are in multibacillary patients, which behaviour is different from Paucibacillary groups. Do not forget that one alternative in the severe reactional states or previously refractory states to the use of oral corticosteroids is the use of EV pulsotherapy (methylprednisolone).


I agree that methotrexate is an important drug as cyclosporine, and azathioprine or cloranbozil, but I am very worried about having the utilization of these drugs by  professionals who don't have experience working with these drugs in this field. That is why we should always learn from the experience of a dermatologist or rheumatologist, who traditionally use these drugs in other diseases (Collagenosis, Psoriasis, etc), like in our Institute of Dermatology Professor Rubem David Azulay at Rio de Janeiro, Brazil and I suppose that so on in other services worldwide. 



Best regards, 


Dr. José Augusto da Costa Nery

Laboratório de Hanseníase/ ASA

Instituto Oswaldo Cruz - Fiocruz

Av. Brasil 4365, Manguinhos, Rio de Janeiro - RJ CEP 21040-360 - Tels.(21)2562-1588

email secretária:

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Friday, October 27, 2017

(LML) Jacques Kongawi Kinda

Leprosy Mailing List – October 27,  2017

Ref.:   (LML) Jacques Kongawi Kinda

From:  Jacques Kongawi Kinda, Kinshasa, CDR


Dear Pieter,

Please accept warmest greetings from DR Jacques Kongawi Kinda

I had been working for leprosy patients  from 1992 to 2014 as ALM
representative in DRC.
I was awarded for Damian Dutton in New York in 2009.

Because I am devoted for leprosy patients, I want to continue serving
the patients I love.  In case there is an opportunity any where for
someone who has experiences on leprosy , please let me know.

If needed, I can send you my CV


Dr. Jacques Kongawi Kinda


Notes editor:

-       In general we do not accept for publication these kind of applications. We have made an acception for Dr. Kinda. As far as I remember this is only the second time we made such an exception since I am the editor. Please, do not try your luck.

-       You may have noticed that we are sending our letters by in stead of through OUTLOOK. For unknown reasons OUTLOOK is blocking our communications since a few weeks. How long this will last we do not know.


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Thursday, October 26, 2017

(LML) Promising new leprosy vaccine moves into human trials

Leprosy Mailing List – October 26,  2017

Ref.:  (LML)  Promising new leprosy vaccine moves into human trials 

From:  Ben Naafs, Munnekeburen, the Netherlands


Dear Pieter,


The LML message of ALM and IDRI sounds nice (LML< October 23, 2017). However, in history there have been many claims of this kind. IDRI is notorious in claiming successes in their work for mankind: e.g. Leishmania vaccine, tuberculosis vaccine and the LID test.


It is correct that they acknowledge - without saying so - that only people who can get leprosy will benefit from the vaccine, and that is only 20% of the world population.  Also in the past vaccines have been developed for leprosy, though indeed not fully chemical.  These vaccines too were effective in the treatment of leprosy.

However, politicians and leprosy NGO's too, only intended to vaccinate against leprosy. Since the vaccines had only a 0-80% effectivity, depending on the type of boosting environmental mycobacteria present in the vicinity, they lost confidence.  Though, in infected patients it had a definite effect, in some patients causing reversal reactions, curing others, and diminishing the frequency and severity of ENL.

The new vaccine IDRI and ALM introduce needs investigation into all those effects the former vaccines had.

Above all I wonder whether their vaccine will do much better.

With regards


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Wednesday, October 25, 2017

(LML) Leprosy and related issues

Leprosy Mailing List – October 25,  2017

Ref.: (LML)   Leprosy and related issues

From:  P.K. Das, Birmingham, UK

Dear Pieter,


Thank you for the LML letter of October 13, 2017: A veterinarian view of M. leprae complex. The story (rather a truly scientific study) shows that red squirrels not "grey ones" are susceptible to a M.leprae like mycobacterium. In that study Professor Stuart Cole is involved (that is I am sure of). I think this work (a molecular/histopathological elegant study) was published in one of the top journals, like Lancet or NEJM, (off hand, I don't remember, can find it out, on a later date).

Although no one can argue about the validity of the above-mentioned study.  At the time, I had some nagging questions, {while reading the two articles}, whether

- i) red squirrels' infectious agent is responsive to MDT,

- ii) whether they suffer from demyelination and axonal damage,

- iii) are there IgM antibody to M. leprae PGL-1 present in the infected animals' sera and not but the least, whether

- iiii) immunohistochemically staining show the M. leprae specific LAM /and-or PGL-1 antigen in association with the deposition of terminal complex of complement activation(MAC).

Following my nagging questions or curiosity, I wrote to the investigators, whether we could have some biopsies and sera of these infected animals (i.e red squirrels) for exploring my nagging curiosity, unfortunately I never received any response from them.

Now, your message, entitled, "Leprosy - we've much left to learn, but are looking to squirrels, cows and cats for insights." J Feline Med Surg. 2017 Sep;19(9):977-978 A veterinarian view of M. leprae complex", makes me to be inspired to rejuvenate (at the age of 76 years old) to pick up research on this enigmatic disease, which despite being almost forgotten, certainly is neglected, but enigmatic disease keeps on arousing news flash.

In this respect, and on the basis of molecular findings that soils from endemic area show the presence of M .leprae, I wonder whether any one looked into the body and flesh of earth worm for the presence of M.leprae?


Kind regards.


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Tuesday, October 24, 2017

(LML) MDTU and the risk of emergence of resistant strains


Leprosy Mailing List – October 24,  2017

Ref.:   (LML) MDTU and the risk of emergence of resistant strains

From:  Jaison Barreto, Bauru, Brazil


Dear Pieter


I would like to express my fear about the future of the leprosy treatment with MDT WHO. Recently, a paper was published about the effectiveness of 6 doses of MDT for all leprosy patients in some areas of Brazil. Unfortunately, the authors probably did not read any of the classical papers made in the last century.


-       Ganapati (1992) compared the MDT 12 and 24 doses with a follow up of 1 to 5 year and did not find any difference in the effectiveness.

-       Ji (1996) advocated the effectiveness of 3 to 6 months of MDT, but 5 years later (2001) published that patients with trillions of M.leprae (LL patients) who abandoned treatment had best results after 10 doses (less relapses).

-       Jamet (1995) reported 7 relapses among 35 patients with high BI thet were treated with MDT 24 doses; the mean time interval for the occurence of relapses was 6 years.

-       Girdhar (2000) found almost the same results among 561 patients, and showed that the more longer follow up, more relapses happened.


The time interval for a the appearance of single tuberculoid lesion is 3 to 5 years. The time interval for parasitism restricted to Schwann cell in a LL patient is 10 years. What about 1 to 5 years of follow up? The mean time of relapses of MDT 12 doses is 7 to 10 years in our service. For those treated with 24 doses, this time is 13 to 15 years.Avelleira (2003) evaluated 10 LL patients after 12 doses, and found that 3 patients had viable M. leprae in mouse foot pad assays.


What are five years of follow up for M. leprae?

I have seen many cases of relapses among LL patients treated with 12 doses.

In my PhD thesis, I found 4 relapses among 46 LL patients after 11 years of discharge treated with 24 doses in a non endemic area of Brazil, and 23% still had positive serology or PCR in nasal mucus.


I hope that leprologists do not accept experiments with leprosy patients without strong scientific basis, i.e., chronic diseases wrongly treated because the follow up was not long enough.


Best regards,




LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<

Monday, October 23, 2017

(LML) Promising new leprosy vaccine moves into human trials

Leprosy Mailing List – October 23,  2017

Ref.:    (LML)  Promising new leprosy vaccine moves into human trials

From:  Sarah Hesshaus, Greenville, USA


Dear Pieter,


I thought you would like to know that the world's first leprosy-specific vaccine has started Phase I clinical trials. American Leprosy Missions has been working on this project for 15 years, so we are thrilled!


Attached please find the press release. 


Many thanks,



Sarah Hesshaus

Communications Director


American Leprosy Missions

One ALM Way, Greenville, South Carolina 29601

Direct: 864.241.1731 | Toll-Free: 800.543.3135 |



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Thursday, October 19, 2017

(LML) Steroid Dependency

Leprosy Mailing List – October 19,  2017

Ref.:    (LML) Steroid Dependency

From:  Barbara M. Stryjewska and John F. Prestigiacomo, Baton Rouge, USA


Dear Pieter,


Thank you, Dr. Grace Warren and Dr Jose Augusto for bringing up the important topic of steroid dependency in the treatment of Leprosy reactions.  

We would like to share with LML readers the approach that is taken by the National Hansen's Disease Programs in the United States when steroids are needed for treatment of Type I or Type II reactions. 

In order to treat our reaction patients we use a combination of Prednisone and Methotrexate. 

For the past several years, we have been adding weekly methotrexate (10mg to 20mg) to the patient's treatment regimen as a steroid sparing drug. Also given is daily folic acid (1mg) to prevent and / or suppress methotrexate side effects. 

With many of our patients being diabetic, it is preferable to use the lowest dose of steroid necessary to control their reaction. 

Our approach helps us use much lower doses of steroids, prevent steroid dependent complications like glaucoma and prevent steroid withdrawal since our doses in the long term are relatively lower. 

Another observation we would like to share is that discontinuation of steroids must be low and slow. We use prednisone and taper the dose by 1 mg every 4 weeks when the patient's steroid dose reaches 5mg per day. 

In regards to ENL, the most severe outbreaks that we see are usually due to steroid dose reduction that is done too quickly or when steroids have been abruptly discontinued.





Barbara M. Stryjewska, M. D.

Chief, Clinical Branch

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA  70816

Ph #: (225) 756-3712

Fax#: (225) 756-3706

NHDP Web Site:

Online Course:  "Awareness of Hansen's Disease in the US"


John F. Prestigiacomo, MD, MBA

Medical Officer

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #:  (225) 756-3709

Ph #:  (800) 642-2477

Fax #: (225) 756-3706


NHDP Web Site:

Online Course:  "Awareness of Hansen's Disease in the US"


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Wednesday, October 18, 2017

(LML) InfoNTD monthly mail with the latest publications on cross-cutting issues and NTDs – October 2017

Leprosy Mailing List – October 18,  2017


From: Ilse Egers, Amsterdam, the Netherlands

Dear Pieter,

This newsletter provides you with a selection of news items and recent publications on cross-cutting issues in NTDs. Our starting point is to add articles covering a wide variety of issues. Unfortunately, this is not always possible due to a limited diversity in and shortage of articles on cross-cutting issues and NTDs.

Feel free to contact us
(  with any questions or to receive the full text versions if a link to the full text is not included. Our document delivery service is free!

Kind regards,
Ilse Egers
InfoNTD Information officer




WHO has added snakebite to the NTD list: these things need to happen next.
Author : Benjamin Waldmann
Benjamin Waldmann leads the snakebite campaign for Health Action International, including secretariat support for the Global Snakebite Initiative. Snakebite envenoming kills more than 125,000 people each year and leaves more than 400,000 victims with severe disability.
Read more






New publications



Support needs of people living with Mycobacterium ulcerans (Buruli ulcer) disease in a Ghana rural community: a grounded theory study.
Hemingway A, Ersser SJ, Effah S. Int. J. Dermatol. 2017.
Abstract Mycobacterium Ulcerans (also known as Buruli ulcer) disease is a rare tropical skin disease which causes contracture and severe scarring and thus affect the functional activities of people who suffer from it as well as their quality of life. An assessment of the effects of BU on patients' quality of life helps health professionals to meet the needs of such patients. Therefore the aim of this paper is to assess the quality of life of people living with the consequences of Buruli ulcer (BU).
Read more

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda.
Sanya RE, Tumwesige E, Elliott AM, et al. PLoS Negl Trop Dis. 2017; 11(10):e0005982.
Abstract Praziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. In this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials.
Download PDF

Schistosomiasis in international refugees and migrant populations.
Adeel AA. Curr Trop Med Rep. 2017.
Abstract Importation of schistosomiasis by migrant populations is increasingly being recognized as a global health issue in non-endemic countries, with consequences for the infected individuals and for public health. The purpose of this review is to assess the extent of the problem and the possible ways to mitigate its impacts.
Read more

Crossing the Billion. Preventive chemotherapy for neglected tropical diseases. (report)
World Health Organization. 2017.
Abstract Crossing the billion tells the story of a simple intervention that takes a massive effort to deliver. Preventive chemotherapy – one of the interventions deployed by the World Health Organization (WHO) to combat at least five diseases – involves administering six medicines in seven different combinations, making it possible to treat more than one disease at a time. This publication celebrates the 10 years since the strategy of combining preventive chemotherapy and integrating strategies to treat those diseases amenable to the intervention began.
Download PDF

Constructions of stigma. (book chapter)
O'Reilly M, Lester JN. Examining mental health through social constructionism. 2017:137–167.
Abstract This chapter focuses on the concept of stigma as related to mental distress, as stigma has been of central concern to the field of mental health. The language and discourses of mental distress are intrinsically linked to stigma, prejudice, and discrimination, and our discussion focuses on the importance of stigma when presenting arguments about mental distress and language. In this chapter, we consider the central theorists in terms of their contribution to the study of stigma and mental distress.
Read more

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.
Ortu G, Williams O. Infect Dis Poverty. 2017; 6(1):147.
Abstract Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered.
Download PDF

Estimating the prevalence and intensity of Schistosoma mansoni infection among rural communities in Western Tanzania: The influence of sampling strategy and statistical approach.
Bakuza JS, Denwood MJ, Nkwengulila G, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005937.
Abstract Schistosoma mansoni is a parasite of major public health importance in developing countries, where it causes a neglected tropical disease known as intestinal schistosomiasis. However, the distribution of the parasite within many endemic regions is currently unknown, which hinders effective control. The purpose of this study was to characterize the prevalence and intensity of infection of S. mansoni in a remote area of western Tanzania.
Download PDF

Household costs of hospitalized dengue illness in semi-rural Thailand.
Tozan Y, Ratanawong P, Sewe MO, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005961.
Abstract Dengue-related illness is a leading cause of hospitalization and death in Thailand and other Southeast Asian countries, imposing a major economic burden on households, health systems, and governments. This study aims to assess the economic impact of hospitalized dengue cases on households in Chachoengsao province in eastern Thailand.
Download PDF

Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?
Leite de Sousa-Gomes M, Romero GAS, Werneck GL. PLoS Negl Trop Dis. 2017; 11(9):e0005772.
Abstract The urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.
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Nationwide cross-sectional survey of schistosomiasis and soil-transmitted helminthiasis in Sudan: study protocol.
Cha S, Hong S-T, Lee Y-H, Lee KH, et al. BMC Public Health. 2017; 17(1):703.
Abstract Schistosomiasis and soil-transmitted helminthiasis (STHs) are target neglected tropical diseases (NTDs) of preventive chemotherapy, but the control and elimination of these diseases have been impeded due to resource constraints. We present a detailed methodological description of the integrated mapping of schistosomiasis and STHs on the basis of our experiences, hoping that this protocol can be applied to future surveys in similar settings.
Download PDF

Global health policy and neglected tropical diseases: Then, now, and in the years to come.
Fürst T, Salari P, Llamas LM, et al. PLoS Negl Trop Dis. 2017; 11(9):e0005759.
Download PDF

Supporting local health decision making with spatial video: Dengue, Chikungunya and Zika risks in a data poor, informal community in Nicaragua.
Curtis A, Quinn M, Obenauer J, et al. Appl Geogr. 2017; 87:197-206.
Abstract One option that has previously been utilized to assess cholera risk is spatial video. Here it is used to map potential mosquito breeding sites in an endemic Dengue and Chikungunya, and emerging Zika impacted community. We show how this method can provide mapping support in the hands of non-specialist public health workers who, working in collaboration with out-of-area geographic information systems (GIS) teams, can identify where to target limited intervention resources.
Read more






Project Zero
October 24, Webcast
The Carter Center
Experience two new, 360° virtual-reality videos from HuffPost's "Project Zero," which documents neglected tropical diseases, including the Carter Center's work on river blindness and lymphatic filariasis in Nigeria. A panel will discuss the challenges of eliminating the diseases worldwide and their experiences creating stories with this cutting-edge technology.
Read more

Call for papers

Neglected Tropical Diseases and Human Rights
June 2018
Potential paper topics will focus specifically on NTDs and the right to health. Topics might include:

  • Specific case studies where rights-based approaches were used, including, for example, NTD program efforts to ensure community participation, or gender-based NTD efforts
  • Strengthening health systems to improve their capacity to respond to the human rights entitlements of people living with NTDs
  • Human rights based accountability mechanisms related to NTDs
  • Human rights informed advocacy efforts to expand NTD programs
  • Examination of NTD-related stigma and discrimination
  • Conducting NTD programs in conflict regions
  • Addressing disability associated with NTD morbidity

Papers will demonstrate strong methodological approaches, high writing quality, and robust rights-based analysis.

Submission Details

Questions about this special section can be directed to Joseph Amon at, David Addiss at, Alvaro Bermejo at or Carmel Williams, Executive Editor, Health and Human Rights Journal at

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<