Leprosy Mailing List – December 27, 2017
Ref.: (LML) Season's greetings and 2018
From: Maria Elena Alonso, Cuba; Pieter Schreuder, the Netherlands
Apreciado Pieter Schreuder,
Mis felicitaciones en estas fiestas navideñas para usted y todos los colegas que trabajan en Lepra, deseándoles un año 2018 con muchos éxitos profesionales redundando en el beneficio de nuestros pacientes.
Disculpe la utilización de esta vía para este fin que no es lo adecuado.
Maria Elena Alonso
La Habana, Cuba
On behalf of the editorial board of LML, we wish you all a very happy and prosperous 2018. We also thank you for your interest in LML. For the new subscribers, I refer you to the Leprosy Review Editorial for more information about LML: "The leprosy mailing list". Lepr Rev (2012) 83, 331-334.
Presently, we have about 550 email subscribers, excluding those who read our LML blog (http://leprosymailinglist.blogspot.it/). Our readers are from all over the leprosy world: leprosy control field programmes, health centres and hospitals, NGOs and governments, and universities and research institutes. We need to hear all voices and learn from each other, which is one of the objectives of LML.
Grace Warren, our eldest contributor, wrote several letters this year sharing her broad experiences starting from long before MDT; her wise lessons should not be forgotten. Manfred Göbel wrote me a letter showing a child of 4 years with BL/LL leprosy and one of 9 years with both hands affected and both with wrist drop. Joel Almeida warned that in India (and not only in India – editor) the percentage of new patients with grade 2 disabilities is increasing, pointing towards late detection.
Ideally, the percentage of grade 2 disabilities in new patients should be zero, but that aim is currently not achievable. Those who have witnessed devastating reversal reactions in new patients can confirm this. Keeping this under five percent would be marvellous, but rates above 10% are simply not acceptable. We know from experience that official figures (including those from the WHO) are often unreliable and under-report the real situation.
For determining the extent of the problem, the importance of rapid village surveys in (hyper)endemic areas cannot be stressed enough. In low endemic areas, extended contact examinations could be an effective tool. A leprosy control programme can only be run when experienced supervisors and medical doctors are able to travel extensively.
Diana Lockwood pointed out last week that SDR (single-dose Rifampicin) as a preventive measure in contacts is not the solution everybody was hoping for, and even carries serious risks with it. Before SDR becomes the new hype, more research has to be done to address these questions. For the time being, only a well-run control programme supported by community involvement which aims at early case detection and disability prevention – like care groups – would serve the population in endemic areas. New developments are very welcome, but not at the cost of control programmes like what happened after the political hype of the leprosy elimination campaigns (this is my personal assessment and is not necessarily shared by the editorial board).
Pieter AM Schreuder
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << email@example.com