Leprosy Mailing List – December 8, 2023
Ref.: (LML) The impact of SDR PEP (LPEP) on new MB HD cases in Brazil
From: Belen Dofitas, Manila, the Philippines
Dear Colleagues,
I have read the letter of Joel Almeida (LML, December 1, 2023) with much interest but also with some scepticism. Please be reminded that this is an opinion piece, not a peer-reviewed article, and thus should be viewed with caution rather than viewed as hard evidence.
I believe in the effectiveness of community skin screening to detect hidden cases of leprosy and other NTDs. This is why SDR-LPEP should not be carried out alone so that leprosy patients may be detected and treated with MDT, not SDR-LPEP.
LPEP is currently being tested with other drugs to increase its efficacy (SDR+). Let us await the results.
SDR LPEP that is carried out as mass drug administration will not pinpoint index leprosy cases in the village— unless confidentiality is breached by the health workers there. Only then will stigma occur for the index patient.
Dr Paul Saunderson pointed out to me that Brazil stopped SDR LPEP but continued BCG as prophylaxis. We can not ascertain that SDR was solely responsible for the rise in incident leprosy cases there. When we establish LPEP in our country, it will also lay the foundation for future prophylaxis through vaccines.
An increase in the number of new leprosy cases may be influenced by increased case detection activities, such as household contact examination and skin camps.
The risk of Antimicrobial resistance of M leprae to a single dose of rifampicin is theoretically low. I have yet to see the results of AMR PCR studies after SDR-LPEP that determined a de novo AMR from a single dose.
Let us appraise the evidence and assess the quality before accepting the author's conclusions and disseminating it. We all know how convincing but damaging some opinions (disguised as evidence) can be.
Warm regards,
Belen
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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