Leprosy Mailing List – November 12, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Jan Hendrik Richardus, Rotterdam, the Netherlands
Dear Pieter,
The draft WHO Leprosy Strategy 2016-2020 has just been circulated on the leprosy mailing list. It states the intention to stop leprosy and its transmission. It has long been observed and discussed intensively at many levels that past strategies, primarily based on early detection and provision of MDT, have failed to bring down new case detection (incidence) levels significantly and that transmission is continuing unabated in many areas of the world. Extensive research has been ongoing in the past decades to investigate novel interventions aimed at early diagnosis and prevention, including chemoprophylaxis and immunoprophylaxis for contacts of leprosy patients. Much RCT-based evidence has accumulated over the years and some interventions, such as chemoprophylaxis with single dose rifampicin, are piloted in implementation studies in various countries under the LPEP project of the Novartis Foundation. Interrupting transmission cannot be achieved without such new interventions and this was in fact stated in the previous WHO Leprosy Strategy 2011-2015.
It is disappointing to observe that the proposed new Leprosy Strategy does not fundamentally address the issue of ongoing transmission. The only activity that may impact on transmission is systematic application of contact investigations, but mathematical modelling has shown that its impact on transmission is limited if it is not followed by additional preventive interventions among these contacts. Otherwise the activities are ‘business as usual’. I find the sudden emphasis on “Uniform MDT” surprising. Is this motivated by an attempt to reduce the prevalence statistics or to provide evidenced-based care to leprosy patients? A new and robust Leprosy Strategy should surely be based on available evidence and a thorough analysis and application of scientific progress made since the year 2000. In my view, the new strategy must prioritize interventions to reduce transmission in order to achieve true elimination defined as zero incidence.
With kind regards,
Jan Hendrik Richardus, MD PhD
Professor of Infectious Diseases and Public Health
Erasmus MC, University Medical Center Rotterdam
The Netherlands
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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