(LML) Early detection is the critical part

Leprosy Mailing List – February 3,  2019

Ref.:  (LML) Early detection is the critical part 

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear Pieter,

I like to react to the letter from Wolfgang Hippke (LML, January 8, 2019): "Compared to any transmittable disease, Leprosy is in a bad situation:

1. We do not have a vaccine against Leprosy.

2. We only have estimations about the time of incubation.
3. We don't have any idea, from when, after infection, a person become infective for others. 
4. We don't know, who is infective.
5. We do not treat infected, non-clinical patients, those without any clinical sign."

1. Yes, we do not have a universal vaccine against leprosy. But we have still BCG, M.vaccae and The Indian vaccine from Talwar. These vaccines give protection in areas where there are environmental (myco)bacteria who boost the effect of the vaccine over the years. But be aware that 80% of the people get never leprosy because there are other factors than immunity that prevent them from developing the disease.
2. I agree for the ones who develop leprosy; we do not know. But we have to search for methods to detect them. We have to develop tests which are not testing immunological response to M. leprae itself but to factors which show that the cells have been or can be programmed to sustain the growth of M. leprae.
3. It is even worse I am afraid that there are carriers with infective M.leprae in their nose who are infective for sensitive individuals.
4. True, but we have PCR here, but a positive PCR does not always mean that they are infective even not when alive.
5. We indeed do not treat them. But 80% does not need treatment. But till today we do not know who the 20% who can develop leprosy are.

But I think a greater problem is that now that we have start to understand how M. leprae survives in the environment, we have to start to stop contact of susceptible people with this environment by for instance piped water and no contact with infected soil and animals.

Being aware of 4 and 5 certainly may be of help. But how to detect them.

With regards,

Ben Naafs

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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 << editorlml@gmail.com