Leprosy Mailing List – November 18, 2024
Ref.: (LML) Continuing Impacts of Training New Hansenologists in Brazil
From: Claudio Salgado, Pará, Brazil
Dear Pieter,
Continuing with the impacts of the training course for new hansenologistas (18 in 2023, and more 19 at the end of November, 2024) in the state of Mato Grosso, Brazil, an event that had not occurred for over 40 years, last week we had two more important advances that I would like to share with colleagues.
The first was a technical note from the Regional Medical Council of the State of Mato Grosso, an agency with constitutional responsibilities for overseeing and regulating medical practice, drafted after a public hearing primarily addressing the lack of alternative medications to multidrug therapy. The public hearing, which included representatives from various institutions, from the Ministry of Health to social movements, was a success. The result was the formation of the first technical chamber on Hansen's Disease that we are aware of within a regional medical council, followed by the publication of the technical note, which I attach in Portuguese, and summarize the main points below.
The Technical Note from the Regional Medical Council of Mato Grosso (CRM-MT) on Hansen's Disease highlights several important advances in the treatment and management of the disease in the state. Here are the main points:
1. Adoption of Substitute Therapeutic Schemes: The technical note recommends the immediate availability of medications such as clarithromycin and levofloxacin for use in substitute therapeutic schemes, according to WHO and PCDT guidelines, to meet the growing demand in the state of Mato Grosso.
2. Review of the Brazil Clinical Protocol and Therapeutic Guidelines (PCDT): An urgent review of the Hansen's Disease PCDT was requested to allow flexibility in treatment duration and enable changes in the therapeutic scheme based on clinical decisions, potentially extending treatment beyond the conventional 12 months. Resistance to essential drugs, such as Rifampicin, was one of the central themes discussed. Bacterial resistance, exacerbated by treatment interruption, can result in a higher risk of complications and disease spread. The difficulty in measuring the percentage of bacterial resistance using molecular biology techniques, as defined in the PCDT, was highlighted, considering that there are molecular sensitive rifampicin strains that, however, show resistance in other experiments; the molecular mechanisms of bacterial resistance to clofazimine are unknown; and there are bacterial resistance sites to dapsone that are not examined by the technique currently provided by the Ministry of Health for PQT-U resistance assessment. Additionally, it was discussed that individual enzymatic-metabolic issues can lead to different responses to the standard therapeutic scheme, further complicating the use of just one therapeutic scheme, for the same duration, for all patients.
3. Monitoring and Control: Implementation of a robust system for monitoring prescriptions and treatment adherence, focusing on substitute medications and training of health professionals.
4. Training and Continuing Education: Regular training sessions for health professionals on managing Hansen's reactions and new therapeutic approaches, in addition to ensuring the integration of family health strategies by specialized doctors.
5. Social Support for Patients: Strengthening the support network for patients in collaboration with social movements, ensuring continuous access to treatment and necessary support.
6. Post-Treatment Semiannual Control: Implementation of simplified neurological and clinical evaluations every six months to monitor late complications of Hansen's Disease, such as neuritis and muscle atrophy.
These advances aim to improve the control and treatment of Hansen's Disease in Mato Grosso, addressing challenges such as drug resistance and the need for alternative therapeutic schemes.
Subsequently, we had a meeting coordinated by the Court of Auditors of the State of Mato Grosso, bringing together specialists and authorities from various fields to discuss the Hansen's Disease scenario in Mato Grosso, its impacts, barriers in combating the disease, and the necessary strategies to change the current panorama, seeking concrete solutions together and making firm commitments to transform the reality of Hansen's Disease in the state.
At the seminar "Building Actions for a Hansen's Disease-Free Mato Grosso," in addition to the SBH, the Mato Grosso School of Public Health, and the Health Secretary, representatives from various state public institutions, social movements, and representatives from over 100 municipalities in Mato Grosso were present. At the end of the event, 20 recommendations were issued for the municipalities, all aimed at better diagnosis, treatment, and follow-up of Hansen's Disease patients in the state, with the understanding that there is a significant expanding endemic that needs to be adequately controlled.
Finally, the book "Hansen's Disease in Brazil: Mato Grosso in Focus" was launched, which critically discusses the epidemiology of the endemic worldwide, in Brazil, and in Mato Grosso, the concept of "elimination" and its consequences for the planet, classification, new complementary exams, treatment, and patient follow-up. The book can be read here, in Portuguese: https://www.tce.mt.gov.br/uploads/flipbook/livro-hanseniase/index.html.
I believe these are important news items for the LML readers, considering the current situation of Hansen's Disease in the world.
Claudio Guedes Salgado, MD, PhD
Full Professor
Institute of Biological Sciences
Pará Federal University
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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