Wednesday, June 16, 2021

Ref.: (LML) Impact of covid-19 in leprosy services articles


Leprosy Mailing List – June 16,  2021 


Ref.:  (LML) Impact of covid-19 in leprosy services articles 


From:  Barbara De Barros, London, UK 


Dear Pieter,  


I hope you are well. 

I would be very grateful if you could circulate the following message.

I would like to share with the LML the article I recently wrote with colleagues from ENLIST and LEPRA reporting findings from a survey on the impact of covid-19 in leprosy services. 

This is an important issue we are facing. I hope you enjoy the reading.

Here is the link: 


Best regards


Clinical Research fellow ENLIST Group 

Skype: barbarradebarros_1 


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

LML blog link: 

Contact: Dr Pieter Schreuder <<  



Ref.: (LML) Leprosy Review - June 2021

Leprosy Mailing List – June 16,  2021 


Ref.:  (LML) Leprosy Review - June 2021 


From:  Paul Saunderson, Ålesund, Norway 


Dear Pieter, 

I'm pleased to forward to your readers the Table of Contents of the June issue of Leprosy Review (pages 95-200), now freely available online at <>

Diana N. J. Lockwood, C. Ruth Butlin, Gerson O. Penna. 
Current leprosy multi-drug treatment duration for MB patients (12 months) produces good clinical outcomes over many years.

Original papers
Maria Dias Torres Kenedi, Elifaz de Freitas Cabral, Kazue Narahashi, Silvana Teixeira de Miranda, Catarina Mabel da Cunha Moreira, Diogo Correia e Silva, Cleumar Silva do Nascimento, Wanderlei Ruffato, Antonio José Ledo Alves da Cunha, Maria Kátia Gomes.
Progression of peripheral nerve injury in leprosy: Evaluation of the effect of nerve decompression surgery in an endemic region of Brazil.

Desiree Alves dos Santos, Maria Dias Torres Kenedi, Felipe José Jandre dos Reis, Antonio José Ledo Alves da Cunha, Maria Kátia Gomes; 
Laterality judgement task in people affected by leprosy.

Selma Bakar Dertlioğlu, Gülden Eser Karlıdağ, Serpil Ağlamış. 
Clinical findings in patients with leprosy who are infected with COVID-19: a case series from Elazığ, Turkey.

Bruna Canci, Erica Gomes Pereira, Karen Sakata-So, Lucia Nichiata. 
The development of a Portuguese mobile application for clinical support in detecting leprosy 

M. David Prakash Kumar, M. Sathish Paul, B. Siva. 
Computer designed orthotic device for offloading plantar ulcers—Technical paper.

Desi Oktariana, Fifa Argentina, Zen Hafy, Eddy M. Salim, Nova Kurniati, Kemas Yakub Rahadiyanto, Evi Lusiana. 
Association of −819 T/C IL-10 gene promoter polymorphisms with susceptibility to leprosy in South Sumatera Indonesia.

Anna T. van 't Noordende, Wim H. van Brakel. 
Towards a cross-neglected tropical disease perception study toolkit: a prototype toolkit developed in the field of leprosy.

Short Reports
Geoff Warne, Monty Mukhier. 
Application of digital technologies to leprosy programmes.

Geoff Warne, Monty Mukhier. 
Tackling the worldwide loss of leprosy expertise.

David Scollard. 
Occasional series of scientific tricks and tips: The best presentation of the meeting. 


Thank you.

Paul Saunderson

Ediotr Leprosy Review


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

LML blog link: 

Contact: Dr Pieter Schreuder <<  


Fw: Ref.: (LML) Notice about the future of printed copies of Leprosy Review



Leprosy Mailing List – June 16,  2021


Ref.:  (LML) Notice about the future of printed copies of Leprosy Review


From:  Paul Saunderson, Ålesund, Norway


Dear Pieter,

I would be very grateful if you can forward this message about the future of printed copies of Leprosy Review, to your readers:

The mailing list for printed copies of Leprosy Review has become very out-of-date and we assume that most readers can now access the online version, which gives free access to all current and past issues of the Journal via

We will continue to send printed copies to training institutions and medical facilities, where a number of people may be able to see each issue, but personal names will be dropped from these addresses. We will be happy to receive updated addresses from such institutions, and requests from other institutions that do not currently receive printed copies of the Journal. Any institutions that no longer require printed copies because of online access can help us by advising us of this, by email.

The current issue (June, 2021) will be the last one sent to individuals on the current mailing list, and from September onward, all individuals will be removed from the list, unless you specifically send us an email, containing your current mailing address and requesting a printed copy. We will be happy to send a printed copy, free-of-cost, to anyone who needs it and who makes a specific request by email to me: <>. Please mark the subject of the email "Request for printed copy of Leprosy Review".


Many thanks.


Paul Saunderson

Editor Leprosy Review

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Monday, June 14, 2021

Ref.: (LML) Predominant MB HD (multibacillary leprosy) and its significance



Leprosy Mailing List – June 14,  2021 


Ref.:  (LML) Predominant MB HD (multibacillary leprosy) and its significance 

From:  Joel Almeida, London and Mumbai 



Dear Pieter and colleagues, 

The points below concern the epidemiology of HD including in low endemic areas, including those that are affluent. Esteemed colleagues can feel free to improve on this understanding. The better our grasp of the underlying epidemiology, the more successfully can we achieve our desired outcomes in all areas.

Multibacillary HD (MB leprosy) patients include a subset known to shed as many as tens of millions of viable bacilli per day. (1) This subset consists of persons with active lepromatous (LL) HD who are not receiving anti-microbial protection. When, and only when, a person with sufficient genomic and current phenotypic susceptibility to HD bacilli becomes infected with a sufficient dose of viable bacilli, then that person eventually shows physical signs of disease. Sensitive tests reveal that people newly infected in low endemic areas can show no physical signs of disease. (2)

Prompt detection of physical signs of HD depends on:

A) the index of suspicion among health professionals and among the general population,

B) the level of knowledge and clinical excellence among health professionals, and

C) the frequency of examinations among the general population.

Areas with a low index of suspicion will tend to overlook nearly all transient forms of HD, leaving predominantly MB forms available for detection. Only those areas with frequent (e.g., monthly or annual) examinations of the general population will detect transient forms of HD whose incidence rate is a considerable multiple of that for MB forms.

This follows from the formula:

Point prevalence of physical signs of disease =
incidence rate of new cases with physical signs x duration of the physical signs 


Examinations at intervals exceeding the duration of transient physical signs will depress the point prevalence of physical signs of disease.

The failure to detect transient forms of HD does not mean that they did not occur, rather that the interval between examinations exceeded the typical duration of transient physical signs. Infrequent examination of the entire population is understandable in low endemic areas, where a particularly vast number of persons would have to be examined thoroughly in order to find a single new case with physical signs. That is why in low endemic areas MB forms predominate among detected cases.

The highest reported proportion of a population recorded as ever having physical signs of HD is 350,000 per million (i.e., 35% of the entire population). (3) This was revealed by frequent examinations in the pre-sulfone era, done as frequently as monthly. Clinical skills were not conspicuously poor then, and skin smear microscopy was used routinely. One of the clinicians there even correctly discerned that temperature sensation in anaesthetic skin lesions was the first to be lost, which suggests a degree of clinical acumen that is remarkably good by today's standards. A certain proportion of the cases will have been doubtful diagnoses or wrong diagnoses, but probably not much more than would be expected among competent clinicians today. The annual incidence rate of new cases with physical signs of HD there was reported to be over 14,000 per million population. This included transient forms of HD.

Populations examined at yearly intervals still show a notable predominance of transient forms of HD among the HD cases newly detected. (4) The age-specific incidence rate of PB forms reported here exceeded that of MB forms of HD by a factor of up to 13. For every MB HD case newly detected there were as many as 13 PB HD cases newly detected by yearly examination of the entire population.

Therefore, the total number of cases newly detected with physical signs of HD can be increased or reduced at will. This happens simply by altering the frequency, coverage and competence of examinations. This holds true for children as well as adults. Therefore a zero new case detection rate (or new child case detection rate) can be achieved immediately by simply keeping our eyes closed for long enough. Conversely, the case detection rate (including among children) can be increased fairly quickly in endemic areas by simply examining a large proportion of the population frequently and repeatedly. This happened in the run-up to the year 2000.. 


If the case detection rate (or child case detection rate) depends largely on the intensity of case-finding activities, how are we to discern the real underlying epidemiological trend over years or decades? 


MB HD holds the key. It almost never self-heals. Sooner or later, MB HD cases come to the attention of health professionals. Therefore the case detection rate of MB HD is a reasonably reliable indicator of the underlying epidemiological trend of HD in a population (or age group). Even more so once any backlog of MB HD cases is registered, as happened in the run-up to the year 2000. Stochastic variation can be smoothed out by averaging the MB HD case detection rate, over some years. The moving average of the MB HD case detection rate is more informative than short-term fluctuations.  

The probability of developing physical signs among members of a population is directly related to known factors including

a) the quantum of viable bacilli available to that population (notional area under the curve of number of viable bacilli shed per unit time from any source, plus the concentration per unit surface area or unit space of viable bacilli surviving in the environment),

b) the frequency of HD-susceptible genomes in that population, (usually similar in most populations apart from small isolated populations with frequent intermarriage between persons with HD-susceptible genomes)

c) the total person-hours of direct or indirect contact between sources of concentrated viable bacilli and genomically susceptible individuals,

d) the cumulative duration for which infectious and susceptible individuals meet in poorly ventilated spaces.(given that the bacilli are sized between 1 and 8 microns, similar to several other infectious agents capable of spread by droplets and airborne routes). 

e) the extent to which skin abrasions are prevalent and exposed to the environment  


f) phenotypic susceptibility owing to inadequate nutrition and other features of very low income 


In areas of low endemicity, especially in affluent areas, all of these tend to be of low absolute magnitude. In addition, there is an inverse relationship with 


g) the coverage by effective anti-microbial protection (including MDT given till smear negativity, or even more bactericidal regimens given to anergic patients) 


h) the coverage of effective vaccines (e.g., BCG or MIP) in the population 


i) the fraction of the population protected by periodic mass multi-drug administration using effective regimens (e.g., ROM rifampicin + ofloxacin + minocycline).

Therefore it is predicted from a) to f) above, and observed, that in low-endemic affluent areas even undiagnosed MB HD patients rarely give rise to new cases with physical signs of HD. This does not mean that HD is a non-communicable disease, merely that the viable bacilli shed by untreated LL HD patients seldom reached "fertile soil", metaphorically speaking. The most "fertile soil" is a person with a genome conferring extreme susceptibility to bilaterally disseminated and highly bacillated forms of HD. (5. 6, 7) Susceptibility to clinical HD may be expressed in terms of the dose of viable bacilli sufficient to produce overt HD in 50% of a defined population (ID50). In persons with polar LL genomes, the ID50 is likely to be a very small number of viable bacilli.

Unless an infectious patient (or other source of concentrated viable bacilli e.g. infected armadillos) becomes the effective contact of a genomically susceptible person, few or no new cases with physical signs of HD are expected to arise. A low and declining frequency of infectious individuals reduces the probability of effective contact between them and genomically susceptible individuals. Therefore it is predicted, and observed, that in low endemic areas even undiagnosed and infectious MB HD cases seem to lead relatively rarely to physical signs of HD in other local people. This is especially true when examinations of the whole population are infrequent or absent, because then transient physical signs can easily escape detection. 


There are predictable exceptions to the situation described above. Shared genomes (5-7) among twins or even siblings are predicted to enable multiple cases to occur in a single household in even low endemic areas, as long as some source of concentrated viable bacilli is available. Likewise, segregated settlements with an over-representation of people who experienced HD can show atypically high incidence rates of physical signs of HD, given a source of concentrated viable bacilli.

Esteemed colleagues can fine tune and improve this account. We can help one another better to elucidate the underlying epidemiology. That shows how and why 84% reduction of new HD cases in hyperendemic "hot spots" is achievable within 2 yearsas demonstrated by the SHF/WHO project using periodic mass ROM administration (rifampicin + ofloxacin + minocycline) in FS Micronesia. Also how and why even low income high endemic areas such as that served by Karigiri (India) achieved a 16%/year decline in the incidence rate of LL HD, without relying on segregation and without waiting for incomes to increase first. The huge epidemiological impact of adequate anti-microbial protection highlights the importance of delaying drug-resistance by using only multi-drug combinations invariably, for treatment or prophylaxis. The better our epidemiological understanding, the less risk of serious mistakes and the more surely and rapidly we will spread success. 

Joel Almeida 


1.      Davey TF, Rees RJ. The nasal dicharge in leprosy: clinical and bacteriological aspects. Lepr Rev. 1974 Jun;45(2):121-34.

2.      Dockrell HM, Young S, Macfarlane A. Possible Transmission of Mycobacterium Leprae in a Group of UK Leprosy Contacts. Lancet, 338 (8769), 739-43 1991 Sep 21
DOI: 10.1016/0140-6736(91)91454-3

3.       Wade H, Ledowsky V. The leprosy epidemic at Nauru. Int J Lepr 1952; 20(1): 1-29.

4.       Wardekar RV. Chemoprophylaxis in leprosy. Lepr India; 1969; XLI(2): 240-6 


5.       Chakravarti MR, Vogel F. A twin study on leprosy Georg Thieme Publishers, Stuttgart, Germany; 1973 


6.       Zhang FR, Huang W, Chen SM et al. Genomewide Association Study of Leprosy. N Engl J Med 2009; 361:2609-2618 DOI:10.1056/NEJMoa0903753 


7.       Wang N, Wang Z, Wang C et al. Prediction of leprosy in the Chinese population based on a weighted genetic risk score. PLoS Negl Trop Dis. 2018 Sep 19;12(9):e0006789. doi: 10.1371/journal.pntd.0006789. 

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

LML blog link: 

Contact: Dr Pieter Schreuder <<  


Thursday, June 10, 2021

Fw: Ref.: (LML) Register: UN Side Event on Leprosy


Leprosy Mailing List – June 10,  2021


Ref.:  (LML) Register: UN Side Event on Leprosy


From:  Tim Burton, Brentford, UK

Dear Pieter,

I am writing with details of an event that might be of interest to the LML.

The Leprosy Mission will be hosting a United Nations CRPD side event on the impact of the pandemic on the fight to defeat leprosy. We will be hearing directly from persons affected by leprosy about their fears surrounding the post-Covid world.

It is possible to register for the event here:

Many thanks,

Tim Burton

Global Communications Lead
Please note, I am attending training on Wednesday and Thursday afternoons and replies will be delayed.
The Leprosy Mission International, 80 Windmill Road, Brentford, Middlesex, TW8 0QH
T: +44 (0)20 8326 6731  M: +44 (0)7407 803 025  E:  Skype: tim.burton.tlmi
Pronouns: he/him

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

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Contact: Dr Pieter Schreuder <<

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Thursday, June 3, 2021

Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy - June '21

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Leprosy Mailing List – June 3,  2021


Ref.:  (LML) Infolep monthly overview of new publications on leprosy - June '21


From:  Anniek Akerboom, Amsterdam, the Netherlands


Dear colleagues,

This month is full of interesting online events. On June 8, the WHO and USAID will be co-hosting a webinar on the WHO sustainability framework that complements the new NTD road map and aims to embed sustainability considerations into national health policies. Also, the COR-NTD Secretariat will be co-hosting a series of virtual events, named the COR-NTD Research Links SeriesFor more information and register links, please scroll down to the section "Interesting events" below the list of new publications.

On 8-9 April, 220 attendees from 33 countries joined the Leprosy Research Initiative (LRI) virtual spring meeting. During this event progress and results of research projects funded by LRI and R2STOP were presented. LRI recently published the LRI Spring meeting report containing recordings of most of the keynote sessions.

Below you will find the list with new publications on leprosy and interesting events, including online courses. Feel free to contact me to receive full-text versions if these cannot be found through the Infolep portal. Also, I would be happy to assist you with literature searches on Infolep.

Warm regards,

Anniek Akerboom

Infolep Coordinator




Neglected tropical diseases and One Health: Gearing up against antimicrobial resistance to secure the safety of future generations
World Health Organization. 2021; 
Learn more

Mycobacterium leprae transmission characteristics during the declining stages of leprosy incidence: A systematic review.
Hambridge T, Chandran S, Geluk A, et al. PLoS neglected tropical diseases. 2021; 15 (5) : e0009436.
Learn more



Leprosy & COVID-19


The effect of Corona virus disease 2019 on the care and prevention of leprosy, the case of Boru Meda, Amhara region, Ethiopia, 2020
Zewdu FT, Hassen AS, Endeshaw GN. Journal of Dermatology Sciences Research Reviews & Reports. 2021; 2 (2) : 1-3. 
Learn more



New publications


A social network approach for the study of leprosy transmission beyond the household.
Kendall C, Kerr L, Miranda J, et al. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2021;
Learn more

One Health and Hansen's disease in Brazil.
Deps P, Rosa P. PLoS neglected tropical diseases. 2021; 15 (5) : e0009398. 
Learn more

Low rate of relapse after twelve-dose multidrug therapy for hansen's disease: A 20-year cohort study in a Brazilian reference center.
Nery J, Sales A, Hacker M, et al. PLoS neglected tropical diseases. 2021; 15 (5) : e0009382. 
Learn more
Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls.
Shrestha D, Napit I, Ansari S, et al. BMC public health. 2021; 21 (1) : 873. 
Learn more

Self-care in leprosy from the perspective of operative groups: a qualitative approach
Souza NMN, de Lima Belmonte M, Alves MGT, et al. Online Brazilian Journal of Nursing. 2021; 
Learn more

Health Seeking Processes of Leprosy Patients in a Hill District of Nepal
Engelbrektsson U, Subedi M. AMC Journal. Nepal Journals Online (JOL). 2021; 2 (1) : 1-24. 
Learn more

Latent leprosy infection identified by dual RLEP and anti-PGL-I positivity: Implications for new control strategies.
da Silva M, Li W, Bouth R, et al. PloS one. 2021; 16 (5) : e0251631. 
Learn more

New global targets for NTDs in the WHO roadmap 2021–2030
Casulli A, Brindley PJ. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2021; 15 (5) : e0009373. 
Learn more

Aiming for zero leprosy: 30th anniversary of World Health Assembly Resolution and WHO Global Leprosy Strategy 2021-2030 are opportunities to accelerate efforts against the disease
Sasakawa Leprosy Initiative. 2021; 
Learn more

Addressing Stigma in Leprosy
Shashi Kumar BM, Savitha AS. Essentials of Psychiatry for Dermatology and Aesthetic Practice. Apsara Prakashana. 2021; 
Learn more

Development of a Loop-mediated isothermal amplification (LAMP) technique for specific and early detection of Mycobacterium leprae in clinical samples.
Garg N, Sahu U, Kar S, et al. Scientific reports. 2021; 11 (1) : 9859. 
Learn more

High resolution ultrasound, nerve conduction study, and other non-invasive investigations in leprosy
Indu Krishnan MU, Sobhanakumari K, Jose P, et al. Journal of Skin and Sexually Transmitted Diseases. Scientific Scholar. 2021; 
Learn more

An individual randomised efficacy trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy in Nepal: the TABLE trial protocol
Napit IB, Shrestha D, Bishop J, et al. Research Square Platform LLC. 2021; 
Learn more
A study correlating nerve biopsy with clinical diagnosis and its impact on improving management in peripheral neuropathies
Goel J, Anadure R, Nair M, et al. Interdisciplinary Neurosurgery. Elsevier BV. 2021; 
Learn more

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study.
Mohta A, Jain S, Agrawal A, et al. Dermatology practical & conceptual. 2021; 11 (2) : e2021032 
Learn more

Cytomorphological Patterns of Nerve Aspirates in Pure Neuritic Leprosy-A Single Centre Cross-Sectional Observational Study.
Sandhu S, Raman D, Sood A, et al. Journal of cytology. 2021; 38 (1) : 14-20. 
Learn more

Leprosy cases diagnosed by contacts examination in a hyperendemic capital city of northeastern Brazil.
Soares A, Corrêa R, Santos K, et al. Anais brasileiros de dermatologia. 2021; 
Learn more

Exploring clustering of leprosy in the Comoros and Madagascar: a geospatial analysis.
Ortuño-Gutiérrez N, Mzembaba A, Ramboarina S, et al. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2021; 
Learn more
Descriptive Study of High Leprosy Endemic Pockets and Exploring Occurrence Factors of Multicase Families in the Village of Salaunikhurd of Chhattisgarh State
Gitte S, Rewaria L, Santaram V, et al. International Journal of Medicine and Public Health. EManuscript Technologies. 2021; 11 (2) : 113-117. 
Learn more

Internal Migration and Leprosy in Shanghai from 2000 to 2019: an Epidemiological Study of New Cases.
Zhu J, Shi C, Yang D, et al. Acta dermato-venereologica. 2021;
Learn more

Structure-Guided Computational Approaches to Unravel Druggable Proteomic Landscape of Mycobacterium leprae.
Vedithi S, Malhotra S, Acebrón-García-de-Eulate M, et al. Frontiers in molecular biosciences. 2021; 
Learn more

All mycobacteria are inventive, but some are more Daedalean than others.
Geluk A. Immunological reviews. 2021; 
Learn more

Large-Scale Gene Expression Signatures Reveal a Microbicidal Pattern of Activation in -Infected Monocyte-Derived Macrophages With Low Multiplicity of Infection.
Leal-Calvo T, Martins B, Bertoluci D, et al. Frontiers in immunology. 2021; 
Learn more



Interesting events



WHO/USAID Webinar: Ending the neglect to attain the sustainable development goals: a sustainability framework for action against neglected tropical diseases 2021-2030
The WHO Sustainability framework complements the 2021-2030 NTD road map. It aims to embed sustainability considerations into national health policies, strategies and plans and to facilitate the achievement of the 2030 road map targets and universal health coverage. This webinar will help us better understand the framework and what we could do differently.
8 Jun 2021 | Virtual
Register here

COR-NTD Research Links Series (virtual):
In the lead up to the 2021 COR-NTD meeting, the COR-NTD Secretariat will co-host a series of webinars, working meetings, research updates, and other virtual events. These events – comprising the "Research Links Series" – will take place throughout the year instead of breakouts at the 2021 COR-NTD meeting in November.

Online courses from the London School of Hygiene & Tropical Medicine:



Websites & Services



Info Hansen - A innovative hub for knowledge sharing about Hansen's Disease

ALLF - Official website of the Association des Léprologues de Langue Française

LML - Leprosy Mailing List - a free moderated email list that allows all persons interested in this theme to share ideas, information, experiences, and questions.

InfoNTD - Information on cross-cutting issues in Neglected Tropical Diseases (NTDs)



Newsletters & Journals



ILEP newsletter archive
GPZL newsletter archive

WHO Goodwill Ambassador's Leprosy Bulletin
Leprosy Review
Leprosy Review Repository (1928-2001)
Fontilles Revista de Leprología
Indian Journal of Leprosy
Hansenologia Internationalis



GDPR & the Infolep newsletter



New EU data protection regulations came into force on 25 May 2018. We have been reviewing our practices with regard to the GDPR, including our privacy statement and mailing list. Infolep sends out monthly e-mails to its subscribers with an overview of recent publications on leprosy. The purpose of this activity is to keep subscribers up to date. Infolep will only process the data we have (names, email addresses) for the purpose of sending you the newsletter. We take your security seriously and will never share your contact details with anyone else. You can update your preferences or unsubscribe from this list at any time.

Copyright © 2021 Infolep, All rights reserved.

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