Leprosy Mailing List – January 9, 2017
Ref.: (LML) Chemoprophylaxis in Leprosy
From: H K Kar, Delhi, India
I agree with Prof Bhushan Kumar and Prof Diana Lockwood and others regarding their concern on development of Rifampicin resistance from SDR (single dose rifampicin) prophylaxis, being implemented as an extra tool to restrict spread of infection from potential positive contacts to population as a whole as well as conversion to clinal form of leprosy among positive contacts.
The same concern was raised during sixties and seventies when Dapsone prophylaxis was implemented in patchy areas of India. Although Dapsone prophylaxis was working well to the tune of 60% protection as long as prophylaxis was going on daily basis, it was discarded because of the same reason, concern for Dapsone resistance. In case of SDR prophylaxis, similar protection around 60% was achieved till two years after SDR dose among outside contacts, rather than close contacts, may be because of repeated entry of bacilli among close contacts from index cases, explanation was given by the earlier published authors.
Keeping in mind the above factors, Multidrug Chemoprophylaxis monthly pulse regimen (PEP++: in close contacts an effective additional strategy is screening of contacts of new cases using an immunological screening test and giving those testing positive an enhanced prophylaxis regimen with two antibiotics, the intervention is known as PEP++, while the others who are not positive receive a single dose of rifampicin) for few months is an feasible initiative taken by NLR as a research project for three countries, India, Brazil and Indonesia among close contacts. Let us hope for a good out come from PEP++ research project in the absence of an effective vaccine in near future.
NLEP, India and other national managers from Brazil and Indonesia are aware of the fact, that is the reasons, all national managers from three countries are cooperating for the above initiation and participation for the above research project initiated by NLR. Myself is one of the international technical committee members of this research project. All my statement given above is my personal opinion.
Dr H K Kar
LML - S Deepak, B Naafs, S Noto and P Schreuder
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