Leprosy Mailing List – May 16, 2019
Ref.: (LML) Protecting cured LLp patients
From: Paul Saunderson, Alesund, Norway
Dear Pieter,
I would like to respond to Joel Almeida's recent posting (May 12th) about protecting cured LLp patients.
The hypothesis that anergic people remain at high risk of being reinfected with leprosy and of becoming 'super-spreaders' of disease, who are then largely responsible for maintaining the epidemic, is fairly plausible, but difficult to prove. Mention is made of different parts of the world where leprosy has remained endemic despite control efforts, while other areas have seen a decline in cases, progressing to local eradication. Joel focuses on Shandong Province in China, where there is good evidence that leprosy has been locally eradicated.
As I understand it, Joel proposes that the anergic LL patients in Shandong were managed in a way that could be emulated today with specific interven-tions. However, on reading the paper (Li HY, et al 1985) describing the program in Shandong, it is clear that they undertook leprosy control measures that were standard practice in those days, with no special attention to LL patients. They were using dapsone monotherapy and all MB patients were treated with 100mg daily until clinically cured, then with 50mg daily for another 5 years, after which they were examined annually for 5 years. Variations of this approach were practiced throughout the world in the pre-MDT era. So, what can we do differently to address this situation today?
I am personally hopeful that LepVax (1), the vaccine being developed by IDRI (the Infectious Disease Research Institute is a non-profit organization based in Seattle, in the United States, and which conducts global health research on infectious diseases), could be the intervention we're looking for, although it's still an open question as to how this small group of anergic patients will respond to it - will it be possible to stimulate a protective immune response in them? We'll have to wait and see!
In the meantime, although I don't believe that the Shandong experience gives us clear guidance, I would be interested to hear from Joel about what specific and practical measures he may suggest to better identify and manage this small group of patients. I agree with him that they remain an important potential source of infection.
With kind regards,
Paul
References:
1. Malcolm F. Duthie et al. LepVax, a defined subunit vaccine that provides effective pre-exposure and post-exposure prophylaxis of M. Leprae infection. npj Vaccines volume 3, Article number: 12 (2018)
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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