Tuesday, September 18, 2018

(LML) Dormancy in M. leprae


Leprosy Mailing List – September 18,  2018

Ref.:  (LML) Dormancy in M. leprae

FromJoel Almeida, Mumbai and London


Dear Pieter,


Dr. Umerov's hypothesis about M. leprae being dormant is quite plausible.


Phenotypic (non-heritable) resistance of bacteria to all antimicrobials is well recognised (1). Many microbes (including M. smegmatis, for example) have been shown to enter a state of altered and minimal metabolism. These "persisters" remain unaffected by all anti-microbials until the persisters become metabolically active, when they again become susceptible to anti-microbials.


M. leprae could well be particularly good at entering this dormant state, because of its apparent dependence on catabolic products from host cells. Bacterial dormancy is linked to survival in adverse environments. M. leprae retain viability for several months in a shaded environment in India, regrowing when introduced into mouse foot pads.(2)


Persisters in treated patients are a recognised challenge in TB and leprosy. Dormant bacteria in contacts or in the environment could well be a challenge to control or eventual eradication of leprosy. Visitors to the homes of Indian leprosy patients already treated with MDT show an increased risk of developing the disease, compared to the risk in the local population. (3) This remains true even after the patients have apparently been "cured" by MDT. Dormant M. leprae in patients, contacts or the environment could explain this observation.


Thanks to Dr. Umerov for the insightful contribution, and to LML for serving as such a uniquely valuable meeting place for the global fraternity of people interested in fighting M. leprae and mitigating its adverse impacts. The more attention we pay to science, the better our prospects of protecting people against M. leprae and its impacts.


Joel Almeida





(1) Balaban NQ, Merrin J, Chait R, Kowalik L, Leibler S. Bacterial persistence as a phenotypic switch. Science. 2004 Sep 10;305(5690):1622-5.


(2) Desikan KV, Sreevatsa. Extended studies on the viability of Mycobacterium leprae outside the human body. Lepr Rev. 1995 Dec;66(4):287-95.


(3) P. Vijayakumaran et al. Does MDT Arrest Transmission of Leprosy to Household Contacts? Int. J. Lepr. (1998) 66(2): 125-130. 

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

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Monday, September 17, 2018

(LML) India's Supreme Court re leprosy elimination

Leprosy Mailing List – September 17,  2018

Ref.:   (LML)  India's Supreme Court re leprosy elimination

From:  Joel Almeida, Mumbai and London

Dear Pieter,


The underestimation of cases of leprosy and the declaration of elimination of leprosy has resulted in the integration of leprosy in general health services thereby leading to diversion of funds which would have otherwise been dedicated to eliminating leprosy," from Supreme Court of India judgment


The SC has ordered specific measures to help end discrimination and improve services. The Indian justice system has proved to be a strong defender of the human rights of populations at risk of leprosy, and those disfigured by leprosy.


Congratulations to the citizens and civil society groups who brought cases before the SC and all those who helped by working behind the scenes.


Lack of sufficient funding leads to too few skilled and competent personnel. This opens the door to avoidable disfigurement and stigma among those who develop leprosy.


It might help to:


1. Keep correcting exaggerated claims or over-optimistic predictions, while advocating for vastly expanded funding for all streams of leprosy work (including improved front-line services, research and better inclusive opportunities for people disfigured by leprosy).


2. Fund periodic sample surveys using skilled personnel, so that we have a reasonably well-informed and up-to-date view of the incidence rate of leprosy and disabilities attributable to leprosy, respectively. The Supreme Court ordered that the previously concealed national sample survey of leprosy should be brought into the public domain.


3. Fund population-based demonstration projects that measure the impact of the best tools and practices currently available on the incidence rate of disease and disability respectively. Without measures of impact, we keep walking blindfolded. These large projects can also serve as field testing centres for trials of new technology in the big endemic countries.


4. Fund well-documented demonstration projects to try and eradicate M. leprae from a few small islands. Lessons will become available one way or another.


5. Draw in more young talent of increasing calibre. Stop pretending or proclaiming that M. leprae are vanishing.


6. Keep open the pipeline of new discoveries.


7. Insist on normal scientific standards and open scientific scrutiny in the formulation of policy, instead of the closed-door committee process that has proved unreliable and counter-productive so far.


It would be good to build on this landmark judgment. Instead of persisting with past errors, we could learn from disease control programmes that have succeeded to a greater extent, in one way or another. There are components that leprosy work has conspicuously lacked. Successful programmes have them. We need to be open to learning and improving, so that we can create a better future for the vulnerable people who trust us.


Joel Almeida

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

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com



Friday, September 14, 2018

(LML) Single-dose rifampicin chemoprophylaxis



Leprosy Mailing List – September 14,  2018

Ref.:  (LML) Single-dose rifampicin chemoprophylaxis 

From:  Zhaudat Umerov, Moscow, Russia


Dear Pieter,


Dr Joel de Almeida (LML, July 23, 2018) raised an important question about the reliability of evidence for the effectiveness of SDR chemoprophylaxis in leprosy. In many endemic countries of the world different variants of leprosy chemoprophylaxis have been tested for several decades. Despite careful preparation and multicentre randomized trials, the results did not meet expectations. Therapeutic drugs such as rifampicin, which has a powerful antibacterial effect, had only a slowing effect on the development of leprosy in contact persons.


This feature of leprosy chemoprophylaxis can probably explain the results of scientific research. According to scientific data, the unconvincing result of leprosy chemo-therapy is caused by the resistance of the pathogen to all anti-leprosy drugs in contact persons without developed disease.


Thus, S. Cole's research group (2001) was discovered this feature of ML (1). The deciphering of the genome ML showed the presence of large numbers translationally inert pseudogenes (50%) that prevent propagation of the pathogen. Consequently, this non- doubling form of ML may not respond to rifampicin or other anti-leprosy drugs since their target is blocking ML DNA replication. For example: rifampicin blocks transcription; dapsone target folic acid biosynthesis; fluoroquinolones, ofloxacin bind to the DNA gyrase and inhibit DNA replication.


The pathways spreading of this non-doubling invader into the body of contact persons are perfectly demonstrated the Smith's study 2. Researchers examined transmission of ML in three leprosy endemic villages on Maharashtra State in India. The results indicated that only 1.6% of 2552 nasal swabs were PCR positive and 68% of saliva samples were positive for ML-IgA. PCR positivity did not persist and most PCR positive results were in the wet season. It is evidence that ML persists in endemic communities as transient, mycobacterial carriage in the upper respiratory tract of clinically healthy individuals without immunological recognition and response. It can be assumed that SDR intervention of this population will not have an impact.


There is good reason to assume that the some of invaders can leave the host, others remain in non-activated tissue resident macrophages or dendritic cells of regional lymph nodes, include endothelial cells, without clinical manifestation  till onset leprosy (from 1 year to 30 years according to epidemiological observation) or forever.


This natural resistance of contact persons to the development of leprosy is kept in check by the body's immune regulatory T-cells, B-cells controls, which under influence genetic factors coupled with exposure to environmental factors. Damage of this protective control leads to the beginning of ML doubling using the products of host's macrophages cell catabolism and the development of leprosy signs. Certainly, among the healthy contacts individuals will be persons with a developed subclinical leprosy, which will be cured by rifampicin. This may slow the emergence of new cases for 2 years but it will not protect other contacts from development disease.


As it seems, these research findings help to explain the failure of chemoprophylaxis of leprosy. The most promising area of prevention of leprosy is the development of medical therapy to strengthen the host's immune control system of contact individuals.


1. Cole ST, et al. Nature, 2001; 409: 1007- 1011.                       

2. Smith WCR, et al. Int. J. Lepr. & Other Mycobact. Dis, 2004; 72(3): 268-277.     


Best wishes,


Zhaudat Umerov


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

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Thursday, September 13, 2018

(LML) New publications on cross-cutting issues and NTDs, September 2018

Leprosy Mailing List – September 13,  2018

Ref.:  (LML)   New publications on cross-cutting issues and NTDs, September 2018

From:  Ilse Egers, Amsterdam, the Netherlands

Dear colleagues,

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 PDF if a link to the full text is not included.
Our document delivery service is free!

Ilse Egers
InfoNTD Information officer





Samoa rolls out triple drug therapy to accelerate elimination of lymphatic filariasis.
24 August 2018 | Manila | Geneva -- Samoa has become the first country to implement the new triple drug regimen recommended by WHO for the treatment of lymphatic filariasis (LF), a disabling and disfiguring neglected tropical disease.
Read more: http://www.who.int/neglected_diseases/news/Samoa-lympahtic-filariasis/en/






New publications



Community involvement in the care of persons affected by podoconiosis—A lesson for other skin NTDs.
Tora A, Mengiste A, Davey G, et al. TropicalMed. 2018; 3(3).
Abstract Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling, which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis.
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Young adults in endemic areas: An untreated group in need of school-based preventive chemotherapy for schistosomiasis control and elimination.
Korir H, Riner D, Kavere E, et al. Trop Med Infect Dis. 2018; 3(3):100.
Abstract Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test.
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Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016.
Bezerra JMT, de Araújo VEM, Barbosa DS, et al. PLoS Negl Trop Dis. 2018; 12(9):e0006697.
Abstract The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change.
Download PDF

Neglected tropical skin diseases in a Nigerian tertiary hospital.
Henshaw EB, Otike-Odibi BI, Okpa HO, et al. Nigerian Journal of Medicine. 2018; 27:117-122.
Abstract: Neglected tropical skin diseases (NTSD) are common in the urban dermatology clinic. The most prevalent (scabies) is a highly contagious disease, whose diagnosis remains sub-optimal among healthcare practitioners. Dermatologists are best positioned to ensure early diagnosis of a good number of NTD and stem their progression before the morbidity, disfigurement, stigmatization, and attendant short, andlong-term complications develop.
Read more

Evaluation of mass drug administration against lymphatic filariasis in Bidar district, Karnataka, India.
Bhovi RA, Mane VP. Int J Community Med Public Health. 2018; 5(9):4107-4111.
Abstract Lymphatic filariasis is a major public health problem in India not only because it causes considerable suffering, deformity and disability but also due to social stigma and economic loss associated with it. The Government of India in 2004 began a nationwide mass drug administration (MDA) campaign. Objectives of the study were to estimate coverage and compliance to mass drug administration (MDA) in Bidar district and to identify the various reasons for non-compliance to MDA.
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Sustainability assessment tool for NTD control programmes.
CIFF, Dalberg. 2018:48.
Abstract The NTD Sustainability Assessment is a forwardlooking Excel-based tool that is set up to measure the sustainability of NTD programming. Sustainability is measured by the degree of government ownership of NTD programming. The Assessment is comprised of an integrated excel-tool as well as user manual outlining the process and templates for implementing the tool. The final output is a Findings Report with recommendations for future programming.
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"Zika is everywhere": A qualitative exploration of knowledge, attitudes and practices towards Zika virus among women of reproductive age in Iquitos, Peru.
Weldon CT, Riley-Powell AR, Aguerre IM, et al. PLoS Negl Trop Dis. 2018; 12(8):e0006708.
Abstract Zika virus was reported in the rainforest city of Iquitos, Peru in 2016. The potential associations between Zika and fetal neurological disorders were reported extensively in the media regarding neighboring Brazil, and led to great concern about the impact Zika could have on people's health in Iquitos when it arrived. The aim of this study was to explore the knowledge, attitudes, and preventative practices related to Zika virus and its transmission among women of childbearing age in Iquitos, Peru.
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When should the emphasis on schistosomiasis control move to elimination?
Secor W, Colley D. Trop Med Infect Dis. 2018; 3(3):85.
Abstract The stated goal of the World Health Organization's program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water.
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Implementation and evaluation of strategies for control of schistosomiasis and soil transmitted helminthiasis in Pemba Island, Zanzibar.
Ame SM. London School of Hygiene & Tropical Medicine. 2018.
Abstract The context of this work in Pemba was (i) the initial reestablishment of School-Based Treatment (SBT) with praziquantel (PZQ) and albendazole (ALB) for control of urogenital schistosomiasis and soil-transmitted helminths (STH), respectively, and (ii) the subsequent implementation of mass drug administration (MDA) with or without additional snail control or behavioural modification which was aimed at evaluation of the possibility of elimination of schistosomiasis.
Read more

Elimination of schistosomiasis haematobia as a public health problem in five governorates in Upper Egypt.
Haggag AA, Rabiee A, Abd Elaziz KM, et al. Acta Trop. 2018.
Abstract The prevalence and intensity of Schistosoma haematobium infection was determined among schoolchildren living in five governorates in Upper Egypt. Between November 2016 and March 2017, urine samples were collected from 30,083 schoolchildren (6-16 years of age) from the governorates of Assiut (n = 7,496; 6 districts), Bani Sweif (n = 4,493; 7 districts), Fayoum (n = 4,597; 6 districts), Menia (n = 7,500; 9 districts) and Sohag (n = 5,997; 11 districts).
Read more

A literature review on medicinal plants that are being used in traditional medicine for the management of the snake bites in Sri Lanka.
Mansoor NR, Sanmugarajah V. Asian plant research journal. 2018; 1(1):1-18.
Abstract Traditional Medicine is time-tested and still caters to the health needs of the society and provides health care through prophylactic treatment and rejuvenation. Today poisonous snake bites are life-threatening problems resulting in high morbidity and mortality all over the world including Sri Lanka. The medicinal plants available locally and used widely by traditional healers. Therefore they need attention in this aspect.
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Descriptive epidemiology of snakebites in the Veraguas province of Panama, 2007–2008.
Pecchio M, Suárez JA, Hesse S, et al. Trans. R. Soc. Trop. Med. Hyg. 2018.
Abstract Panama has the highest incidence of snakebites in Central America, however, few studies have looked at the epidemiology of human snakebites in Panama. This retrospective, single-center study reviewed individuals who sustained a snakebite from 2007–2008. Demographic data, disease severity, species of snake, treatment, infectious complications and antibiotic usage were collected from the hospital records.
Read more

An economic evaluation of the global strategy to eradicate yaws.
Fitzpatrick C. Ghent University. 2018.
Abstract The economics of mass treatment for yaws is dealt with in two papers. In the first, using a regression model, we establish benchmarks for the cost per capita of mass treatment for yaws, reviewing and synthesizing evidence on the cost of mass treatment campaigns for other NTDs. In the second, we use those benchmarks in a Markov model of the cost and costeffectiveness of the yaws eradication strategy in the known endemic countries.
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Podoconiosis today: challenges and opportunities.
Deribe K. Trans. R. Soc. Trop. Med. Hyg. 2018.
Abstract Podoconiosis is a disease of significant clinical and public health importance in several endemic countries. Over the last 15 years there has been remarkable progress in research, advocacy and implementation of podoconiosis inteventions. In 2011 the World Health Organization (WHO) recognized podoconiosis as one of the neglected tropical diseases (NTDs) under the category of 'other tropical conditions'. Subsequently Ethiopia, Rwanda and Cameroon recognized podoconiosis as a priority NTD and included it in their long-term health plans.
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Impact of community-based integrated mass drug administration on schistosomiasis and soil-transmitted helminth prevalence in Togo.
Bronzan RN, Dorkenoo AM, Agbo YM, et al. PLoS Negl Trop Dis. 2018; 12(8):e0006551.
Abstract Togo has conducted annual, integrated, community-based mass drug administration (MDA) for soil-transmitted helminths (STH) and schistosomiasis since 2010. Treatment frequency and target populations are determined by disease prevalence, as measured by baseline surveys in 2007 and 2009, and WHO guidelines. Reported programmatic treatment coverage has averaged over 94%. Togo conducted a cross-sectional survey in 2015 to assess the impact of four to five years of MDA on these diseases.
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The effect of deworming school children on anemia prevalence: A systematic review and meta-analysis.
Girum T, Wasie A. Open Nurs J. 2018; 12:155-161.
Abstract High prevalence of anemia attributable to intestinal parasite infection occurs among children in developing countries. As a result mass treatment of all children with anti-helminthic drugs particularly in school setting is being implemented. We aimed to conduct a systematic review on impact assessment of deworming on anemia prevalence or hemoglobin level of school children so that policy makers and other stalk holders could have pooled evidence on the direction to make decision.
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Venomous snakebite - An outcome based analysis in a tertiary care hospital.
Subramaniam R, Swarnalatha S. Eur J Pharm Med Res. 2018; 5(5):392-397.
Abstract Snake bite is the prime of all neglected tropical diseases wherein our health care systems have little success. Though there are voluminous data on the subject, few researchers have focused on the extrinsic factors leading to adverse outcome after a venomous bite. This study aimed to elucidate the modifiable extrinsic factors which are associated with adverse outcomes after a venomous bite.
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Sustainable access to deworming drugs in a changing landscape.
Lin WM, Addiss DG. Lancet Infect Dis. 2018.
Abstract The global effort to control and eliminate soil-transmitted helminthiasis (STH) currently depends on donations of albendazole and mebendazole, which reached more than 530 million children in 2016. As we approach 2020, the WHO goal of eliminating STH as a public health problem will not be met in most endemic countries, and ongoing treatment will be necessary. Additionally, the volume of drugs required might increase because global strategies for STH aim to interrupt transmission.
Read more

Toward the 2020 goal of soil-transmitted helminthiasis control and elimination.
Becker SL, Liwanag HJ, Snyder JS et al. PLoS Negl Trop Dis. 2018; 12(8):e0006606.
Download PDF




RSTMH Annual Meeting 2018
September 19-20, London, UK
The theme of the two-day Annual Meeting is intersections of neglected tropical diseases with non-communicable diseases and the Sustainable Development Goals. Voices from different sectors will be brought together.
Read more: https://rstmh.org/events/rstmh-annual-meeting

NNN Annual Conference
The 9th NTD NGO Network (NNN) annual conference will take place from Monday 24th through Wednesday 26th September 2018 in Addis Ababa, Ethiopia.
Read more: http://www.ntd-ngonetwork.org/conference-2018

First International Podoconiosis Conference
September 23, Addis Ababa, Ethiopia
The theme is 'Research to Implementation: A Call for Global Action'.
Call for abstracts from all those involved in podoconiosis research and implementation. In order to stimulate high levels of participation, the conference programme will include two sessions of research presentations, one of implementation presentations, and a poster display area.
Read more: https://www.napanethiopia.org/index.php/2011-05-02-12-33-35/72-first-international-podoconioisis-conference

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

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com