Leprosy Mailing List – June 9, 2026
From: Joel Almeida, Mumbai, India
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Dear Pieter and colleagues,
Many people in endemic areas have relatively low incomes and some have only few years of schooling. How best to protect their safety?
If we eliminate concentrated viable bacilli from human populations, cluster by cluster, it will benefit everyone. We need to identify all high-shedding cryptic LL cases among asymptomatic contacts in a village or cluster (workplace, marketplace, etc) using non-invasive methods (eg nasal swabs for semi-quantitative mLAMP). Within days, their nasal discharges can be freed from concentrated viable bacilli by starting full anti-microbial treatment. Regular check-ups will help protect their nerves and prevent visible deformity. Once the local cluster has been freed from concentrated viable bacilli (within weeks), periodic mop-up drives will confirm and sustain the success. Cluster by cluster, we can replicate the successes of Weifang (China), Malta, Jordan, Chile and at a rapid pace.
Those visionary leaders who have drawn inspiration from past successes and never given up on the vision of elimination can now find an army of friends and supporters. It is persons with lived experience, who formerly were too often feared, excluded from opportunity, disrespected and ostracized. Armed with barcoded nasal swabs, and mobile phone apps for real-time reporting including georeferences, they can collect nasal swabs for rapid semi-quantitative mLAMP naked eye readouts by health workers, (eg. by colour change or turbidity change to distinguish high-shedding LL from casual carriers of trivial numbers of bacilli). They can comfort any newly diagnosed patients in case of distress. They can periodically test for muscle weakness, during and after treatment, to alert health workers to early signs of “silent” nerve damage. They can encourage uninterrupted and complete treatment, arrange for rehab, liaise with the authorities for social entitlements. Periodic mop-up surveillance would make full use of their abilities. The full participation of persons with lived experience in defeating the disease and enhancing opportunity has been championed by enlightened and far-sighted leaders who have never let the world forget HD. As aides to health workers, with basic training and a stipend, persons with lived experience can become an army of primary health care workers and leaders at the grassroots.
There is no need to sabotage macrophages of infected asymptomatics with short-term chemoprophylaxis that withdraws anti-microbials while concentrated viable bacilli remain available locally. That would be a recipe for continued reinfection, transmission, visible deformity before diagnosis, needless prejudice against family members of newly diagnosed persons, and more new cases in 2030 than in 2025. Sample surveys by independent experts unfortunately consistently find under-reporting.
It is safest to eliminate concentrated viable bacilli from human populations, cluster by cluster: find, treat, end transmission and exclusion.
What do esteemed colleagues advise, in order to make this happen everywhere?
With all sincerity,
Joel Almeida
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << edit...@gmail.com
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