Leprosy Mailing List – July 24, 2024
Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals
From: Jannine Ebenso, Brentford, UK
Dear Pieter and colleagues
Joel Almeida continues to make the same cause-effect argument about SDR-PEP. However, he never mentions that PEP is delivered in association with contact tracing and screening. (Be that SDR or the new regimens in the RCTs taking place in different countries).
All active case-finding initiatives show us the same thing – if you actively look for leprosy, you WILL find it – and if there are lots of hidden cases, then intensive screening will discover them! (cf Special Action Programmes for the Elimination of Leprosy (SAPEL) and Leprosy Elimination Campaigns (LEC) in the late 1990s).
The reverse is also true – if we don't look for leprosy, we will not find it – so have we checked that the lovely figures from Tamil Nadu reflect the reality? Again, I refer to findings from SAPEL and LECs. Areas that were recording very low numbers with mainly passive case finding, suddenly found many times more new cases with intensified case-finding. I believe that Dr Benedict Quao has also reported similar findings in recent surveys in Ghana. In my own experience with SAPEL and LEC in SE Nigeria, the MB and disability rates were very high – but from the patients' history, the new cases were infected and developed the disease many years previously.
In the non-PEP states referred to by Joel Almeida – is intensive contact tracing and screening taking place too?
Has Joel Almeida looked at the number of people screened over the same number of years to see if the high MB numbers and the high G2D numbers might actually be 'backlog cases' after years of not looking for leprosy? (like our own experience in Nigeria). In that case, SDR-PEP has nothing to do with it. Newly diagnosed, does not mean newly acquired.
My response is not in defence of SDR-PEP, nor do I want to disrespect anyone – I merely ask are other factors that have not been presented in Joel Almeida's argument? (Dr Ben Naafs also asks for other things to be considered, in his LML post of 13 July)
Regards
Jannine Ebenso
The Leprosy Mission International, Brentford, UK
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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Sent: 24 July 2024 16:05
To: Leprosy Mailing List <leprosymailinglist@googlegroups.com>
Subject: Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals
Leprosy Mailing List – July 24, 2024
Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals
From: Jannine Ebenso, Brentford, UK
Dear Pieter and colleagues
Joel Almeida continues to make the same cause-effect argument about SDR-PEP. However, he never mentions that PEP is delivered in association with contact tracing and screening. (Be that SDR or the new regimens in the RCTs taking place in different countries).
All active case-finding initiatives show us the same thing – if you actively look for leprosy, you WILL find it – and if there are lots of hidden cases, then intensive screening will discover them! (cf Special Action Programmes for the Elimination of Leprosy (SAPEL) and Leprosy Elimination Campaigns (LEC) in the late 1990s).
The reverse is also true – if we don't look for leprosy, we will not find it – so have we checked that the lovely figures from Tamil Nadu reflect the reality? Again, I refer to findings from SAPEL and LECs. Areas that were recording very low numbers with mainly passive case finding, suddenly found many times more new cases with intensified case-finding. I believe that Dr Benedict Quao has also reported similar findings in recent surveys in Ghana. In my own experience with SAPEL and LEC in SE Nigeria, the MB and disability rates were very high – but from the patients' history, the new cases were infected and developed the disease many years previously.
In the non-PEP states referred to by Joel Almeida – is intensive contact tracing and screening taking place too?
Has Joel Almeida looked at the number of people screened over the same number of years to see if the high MB numbers and the high G2D numbers might actually be 'backlog cases' after years of not looking for leprosy? (like our own experience in Nigeria). In that case, SDR-PEP has nothing to do with it. Newly diagnosed, does not mean newly acquired.
My response is not in defence of SDR-PEP, nor do I want to disrespect anyone – I merely ask are other factors that have not been presented in Joel Almeida's argument? (Dr Ben Naafs also asks for other things to be considered, in his LML post of 13 July)
Regards
Jannine Ebenso
The Leprosy Mission International, Brentford, UK
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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