Fw: Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

 

 

Leprosy Mailing List – July 30,  2024

 

Ref.:  (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

From:  Joel Almeida, Mumbai, India

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Dear Pieter and colleagues,

Jannine Ebenso (ref: (LML) 24 July 2024) enquires whether high MB (multibacillary) HD (leprosy) numbers and high G2D (grade 2 disability / visible deformity) numbers in Dadra Nagar Haveli might be backlog cases. And if Karigiri's successes might be illusory.

The short answer is "No". That is because

The Schieffelin Centre in Karigiri from 1962 to 1997 did repeated surveys: starting with total population (door to door), contact tracing surveys, school surveys etc. (1-4) It was among the world's earliest and largest series of population-based epidemiological studies after the advent of effective chemotherapy. It produced tens of classic papers that advanced our understanding of the epidemiology of HD apart from introducing the world first to large-scale use of dapsone and then to large-scale use of MDT (originally until smear negativity). What Jannine Ebenso apparently became aware of regarding contact tracing and screening in the late 1990s through SAPEL/LEC drives was known to colleagues in Karigiri as early as 1962. The 16% annual decline in new LL (lepromatous) HD demonstrated by Karigiri is real.

Dadra Nagar Haveli (DNH) did door-to-door surveys repeated several times a year. The findings of the meticulous Indian national sample survey of around 2011 (5) are consistent with the repeated DNH surveys. The near-zero G2D (grade 2 disability / visible deformity) among newly detected HD cases in DNH prior to the introduction of SDR PEP / LPEP is real, as is the dramatic increase in G2D / visible deformity after the introduction of SDR PEP / LPEP.

The same national sample survey went systematically door to door in the various states of India, including Maharashtra and Gujarat. Maharashtra had only 8.43 G2D/million population accumulated among newly detected HD patients while Gujarat had only 2.88 G2D/million population similarly accumulated. (5) By contrast, DNH had near zero G2D/million population/year among newly detected HD patients before the introduction of SDR-PEP / LPEP. After SDR-PEP this shot up to  50+/million population/year G2D among newly detected HD patients (6-9).

Further, the foreign investigators in DNH themselves reported a near-zero baseline level of G2D (visible deformity) among newly detected HD patients in DNH prior to the introduction of LPEP / SDR PEP. Their own reports then documented the dramatic increase in G2D among newly detected HD patients in DNH after the introduction of LPEP/SDR PEP. (6-9)  Nevertheless, they declared SDR PEP / LPEP to be safe. Some of these same investigators were then shown in Annex 1 of the WHO treatment and prevention guidelines of 2018 as having financial conflicts of interest.

 

  

The burden of excess G2D/visible deformity following SDR PEP / LPEP among household contacts, neighbours and social contacts of newly diagnosed HD patients falls disproportionately on HD patients and their families. This infliction of grievous hurt and visible deformity is contrary to their human rights and amounts to a particularly egregious form of discrimination against them. G2D / visible deformity tends to indicate underlying permanent nerve damage. Affected limbs tend to deteriorate steadily: going slowly but relentlessly from repeated painless wounds and infections, to attrition of extremities, to disintegration of extremities and too often to eventual amputation. Visible deformity also tends to evoke extreme social exclusion and extreme destitution. All this among persons who had no symptoms or signs of HD and did nothing wrong apart from being family members or neighbours or social contacts of a newly diagnosed HD patient. Worse, tribals (a particularly vulnerable group with 24% illiteracy) formed a majority of the DNH population.

We are a non-mercenary and noble-minded community dedicated to beating HD, with full respect for the Universal Declaration of Human Rights, the Nuremberg code on human experimentation and all relevant legislations and precedents. We have great talents in endemic countries. Are we against shaking off the yoke of any individuals or organisations who have financial conflicts of interest, and instead setting free the capable professionals in endemic countries to protect the best interests of their own people? Then we can match or exceed the 16%/year decline in incidence rate of LL HD that was achieved by Karigiri even in a low-income population near the equator. Average incomes are still conspicuously low in that area, and reinfection of LL HD patients is no longer prevented after the introduction of fixed duration treatment. Addition of MIP vaccine for highly bacillated patients could well accelerate the decline of new LL HD beyond 16%/year.

 

Raising funds is not the main reason for fighting HD, but investment too tends to chase good outcomes and epidemiological impact. Seeking first the health and wellbeing of the people we serve is likely to be the surest route to success in every  sense.

 

Thanks to Jannine Ebenso for her comments.

With all sincerity,

Joel Almeida


References

 1.      Rao PSS, Karat ABA, Kaliaperumal VG.Incidence of leprosy in Gudiyatham Taluk, South India. Indian J. Med.Res. 60 (1972) 97-105.

2.     Rao PSS, Karat ABA, Kaliaperumal VG, Karat S.Prevalence of leprosy in Gudiyatham Taluk, South India. Part I. Specific rates with reference to age, sex
and type. Int. J. Lepr. 40 (1972) 157-163.

3.     Rao PSS, Karat ABA, Karat S. Epidemiological studies in leprosy in Gudiyatham Taluk. II. Patterns of familial aggregation of leprosy in an endemic area. Lepr. Rev. 40 (1969) 93-98.1.      Katoch K, Aggarwal A, Yadav VS, Pandey A. National sample survey to assess the new case disease burden of leprosy in India. Indian Journal of Medical Research, 2017; 146(5): 585-605.

4.     Jesudasan K, Bradley D, Smith PG, Christian M. The effect of intervals between surveys on the estimation of incidence rates of leprosy. Lepr Rev (1984) 55, 353-359

5.     Katoch K, Aggarwal A, Yadav VS, Pandey A. National sample survey to assess the new case disease burden of leprosy in India. Indian Journal of Medical Research, 2017; 146(5): 585-605.

6.     Barth-Jaeggi T, Steinmann P, Mieras L, et al. Leprosy Post-ExposureProphylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin. BMJ Open 2016;6:e013633.doi:10.1136/bmjopen-2016-013633.

7.      Mieras L, Singh MK, Manglani PR et al. A single dose of rifampicin to prevent leprosy; quantitative analysis of impact on perception, attitudes and behaviour of persons affected, contacts and community members towards leprosy in India, Nepal and Indonesia. Lepr Rev (2020) 91, 314–327 doi:10.47276/lr.91.4.314

8.      Steinmann P, Cavaliero A, Aerts A et al. The Leprosy Post-Exposure Prophylaxis (LPEP) programme: update and interim analysis. Lepr Rev (2018) 89, 102–116

9.      Richardus JH, Tiwari A, Barth-Jaeggi T et al. Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme. Lancet Glob Health. Lancet Glob Health. 2021 Jan;9(1):e81-e90. doi: 10.1016/S2214-109X(20)30396-X.

 

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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

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Fw: Ref.: (LML) Does Rifampicin PEP for household contacts alter the risk of multibacillary HD?

 

Leprosy Mailing List –  July 28,  2024

 

Ref.:  (LML) Does Rifampicin PEP for household contacts alter the risk of multibacillary HD?

From: Joel Almeida, Mumbai, India 

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Dear Pieter and colleagues,

 

Thanks to Epco Hasker for his comments. (Ref.: (LML), 24 July 2024).

 

He rightly indicates that the comparison of arm 2 (household SDDR PEP) with arm 1 (non PEP) showed an excess of new MB HD cases in arm 2. This comparison was between the ENTIRE arm 2 and the ENTIRE arm 1 populations. No sub-group involved. It is a comparison explicitly described in the published protocol: "Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome". (1) The said analysis was inexplicably omitted by Hasker et al, but it reveals a 65% excess of new MB HD in the SDDR PEP household contacts arm (IRR 1.655, 95% c.i. 1.0203 to 2.6834). 

 

Beyond that Epco Hasker and associates did several things that were not pre-defined in the protocol analysis. Such post-hoc analysis tends to be unreliable for superiority trials because post-hoc regrouping or exclusions or re-allocation of subjects can mislead even the best-intentioned analyst. This danger is heightened when the trial data are not shared openly. Further, Poisson regression assumes that the dependent variable has a Poisson distribution. This distribution expresses the probability that a given number of events will occur in a fixed interval, assuming that these events occur at a known constant rate on average and that each event is independent of the others. This assumption might not be safe in the present context because incident cases can be the source of further incident cases.

 

The most remarkable part of the Hasker et al report is the section on adverse outcomes. (2) "We did not conduct active follow-up for adverse events. Probably there were no serious adverse events since none were reported." However, the Helsinki Declaration requires that the protocol include "provisions for treating and/or compensating subjects who are harmed as a consequence of participation in the research study." Simply closing one's eyes to adverse events is not sufficient. We now know that the LPEP study in DNH showed a vast boost of G2D (visible deformity) following SDR-PEP for household contacts, neighbours and social contacts. A similar boost in G2D / visible deformity cannot be excluded in the PEOPLE trial run by Hasker et al. This is what people need to know before they give informed consent to HD chemoprophylaxis: their risk of G2D (visible deformity) is likely to be boosted greatly.

 

Hasker asks why those who did not receive SDDR PEP might have developed MB HD. MB HD is caused by M. leprae, above all the concentrated viable bacilli shed by undiagnosed or reinfected LL (lepromatous) HD patients. The published protocol stated, "Leprosy diagnosis will be clinical, based on the presence of three cardinal signs: patch with loss of sensation, enlarged peripheral nerves and/or slit-skin smear (SSS) positive for acid fast bacilli. All leprosy cases diagnosed will be verified by experienced leprosy national control program staff." This is unpromising for diagnosis of LL HD patients, because the first two of the three listed cardinal signs are often absent from new "de novo" LL HD patients. Wherever diagnosis of LL HD is unreliable, HD will spread. Hasker et al could consider improving their skills, so as to miss fewer "de novo" LL patients.

We are still learning about mycobacteria, anti-mycobacterials, immune responses, etc. The biology shows surprising twists. More twists are sure to emerge. The twists extend beyond the release of TLR-9 ligands from M. leprae by the use of anti-mycobacterial drugs and the consequent cytokines storm of ENL.(3) The people of Comoros, like those in DNH, periodically go barefoot and might well be co-infected by protective environmental (non TB non HD) mycobacteria that are susceptible to anti-M.leprae drugs. Killing such protective mycobacteria by HD chemoprophylaxis would be like knocking out the BCG-style natural wide-spectrum vaccination (5-10) which possibly had helped to limit MB HD and G2D / visible deformity among the Comorians. 

 

There is more. For example, rifampicin plasma concentrations decline rapidly following a single dose. This exposes M. leprae for a significant period to relatively low concentrations of rifampicin. Mycobacterial tolerance can be provoked by exposure to inhibitors of RNA polymerase such as rifampicin. RNA polymerase-specific phenotypic resistance/tolerance is demonstrably triggered by the transient increased expression of the beta subunit of RNA polymerase (rpoB) which in turn is due to divergent effects of rifampicin on two rpoB-rpoC promoters. Usually expression from Promoter I inhibits expression from Promoter II. Rifampicin preferentially inhibits Promoter I allowing maximal rpoB expression and mycobacterial growth. In one type of rpoB-accumulating mycobacteria (labelled Type V), rifampicin is followed not by inhibition but by division of cells and growth.(11) Whether or not this partly or wholly explains the "intense transmission" reported from places such as Alta Floresta (Mato Grosso, Brazil) following PEP RDU / LPEP / SDR PEP, we cannot exclude an increase in the virulence of M. leprae arising from phenotypic changes induced by rifampicin.

Whatever the underlying biology, the likely impact on those who receive HD chemoprophylaxis and then develop G2D (visible deformity) is hastened destitution. That in itself is an additional risk factor for HD.

 

Worryingly, exposure of mycobacteria to rifampicin combined with other drugs (eg., isoniazid) still caused up-regulation of rpoB.(11) Therefore the unintended harms of HD chemoprophylaxis might prove surprisingly hard to shake off. Other antimycobacterials too might hold surprises. Human beings need to be protected even (or especially) if they are on low incomes in endemic countries.

 

Thanks to Epco Hasker for his questions. Nearly all of the most knowledgeable HD experts in the world are on LML, and nearly all are duly respectful of human rights and ethics. Are Hasker and associates opposed to respect for the patients and populations of endemic areas? Surely not.

 

With all sincerity,

 

Joel Almeida

 

References

 

1.     Ortuno-Gutierrez N, Younoussa A, Randrianantoandro A, et al.Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts. BMC Infect Dis 2019; 19: 1033.

 

2.     E Hasker, Y Assoumani, A Randrianantoandro et al. Post-exposure prophylaxis in leprosy (PEOPLE): a cluster randomised trial. The Lancet Global health, 2024, 12(6), e1017‐e102614.    

 

3.    Dias AA, Silva CO, Santos JPS, Batista-Silva LR, Acosta CCD, Fontes ANB, et al. DNA sensing via TLR-9 constitutes a major innate immunity pathway activated during erythema nodosum leprosum. J Immunol(2016) 197:1905–13. 10.4049/jimmunol.1600042

 

5.    Pinheiro RO, Schmitz V, de Andrade Silva BJ et al.  Innate Immune Responses in Leprosy. Front Immunol. 2018; 9: 518. Published online 2018 Mar 28. doi: 10.3389/fimmu.2018.00518

 
6.      Kleinnijenhuis J,Quintin J, Preijers F et al. Bacille Calmette-Guérin induces NOD2-dependent nonspecific protection from reinfection via epigenetic reprogramming of monocytes. Proc Natl Acad Sci U S A. 2012 Oct 23; 109(43): 17537–17542. Published online 2012 Sep 17. doi: 10.1073/pnas.1202870109

7.      Fine PEM, Floyd S, Stanford J et al. Environmental mycobacteria in northern Malawi: implications for the epidemiology of tuberculosis and leprosy. Epidemiol Infect, 2001; 126: 379–387.

8.      Denise L, Faustman AL, Hostetter ER. Multiple BCG vaccinations for the prevention of COVID-19 and other infectious diseases in type 1 diabetes. Cell Rep Med. 2022 Sep 20; 3(9): 100728. Published online 2022 Aug 15.   doi: 10.1016/j.xcrm.2022.100728

9.      Zhou,J, Jingzhu Lv, Carlson C et al. Trained immunity contributes to the prevention of Mycobacterium tuberculosis infection, a novel role of autophagy. Emerg Microbes Infect. 2021; 10(1): 578–588. Published online 2021 Mar 30. doi: 10.1080/22221751.2021.1899771

10.    Jensen KJ, Larsen N, Biering-Sørensen S.Heterologous Immunological Effects of Early BCG Vaccination in Low-Birth-Weight Infants in Guinea-Bissau: A Randomized-controlled Trial  J Infect Dis. 2015 Mar 15; 211(6): 956–967. Published online 2014 Sep 9. doi: 10.1093/infdis/jiu508

 

11.     Zhu J-H, Wang B-W, Pan M. Rifampicin can induce antibiotic tolerance in mycobacteria via paradoxical changes in rpoB transcription Nature Commun. 2018 Oct 11;9(1):4218. doi: 10.1038/s41467-018-06667-3.

 

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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

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Fw: Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

 

 

Leprosy Mailing List –  July 24,  2024

 

Ref.:  (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

From:  Jannine Ebenso, Brentford, UK

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Dear Pieter and colleagues

 

Joel Almeida continues to make the same cause-effect argument about SDR-PEP. However, he never mentions that PEP is delivered in association with contact tracing and screening. (Be that SDR or the new regimens in the RCTs taking place in different countries).

All active case-finding initiatives show us the same thing – if you actively look for leprosy, you WILL find it – and if there are lots of hidden cases, then intensive screening will discover them! (cf Special Action Programmes for the Elimination of Leprosy (SAPEL) and Leprosy Elimination Campaigns (LEC) in the late 1990s).

The reverse is also true – if we don't look for leprosy, we will not find it – so have we checked that the lovely figures from Tamil Nadu reflect the reality? Again, I refer to findings from SAPEL and LECs. Areas that were recording very low numbers with mainly passive case finding, suddenly found many times more new cases with intensified case-finding. I believe that Dr Benedict Quao has also reported similar findings in recent surveys in Ghana. In my own experience with SAPEL and LEC in SE Nigeria, the MB and disability rates were very high – but from the patients' history, the new cases were infected and developed the disease many years previously.

In the non-PEP states referred to by Joel Almeida – is intensive contact tracing and screening taking place too?

Has Joel Almeida looked at the number of people screened over the same number of years to see if the high MB numbers and the high G2D numbers might actually be 'backlog cases' after years of not looking for leprosy? (like our own experience in Nigeria). In that case, SDR-PEP has nothing to do with it. Newly diagnosed, does not mean newly acquired.

My response is not in defence of SDR-PEP, nor do I want to disrespect anyone – I merely ask are other factors that have not been presented in Joel Almeida's argument? (Dr Ben Naafs also asks for other things to be considered, in his LML post of 13 July)

 

Regards

Jannine Ebenso

The Leprosy Mission International, Brentford, UK

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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

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From: Leprosy Mailing List <leprosymailinglist@googlegroups.com>
Sent: 24 July 2024 16:05
To: Leprosy Mailing List <leprosymailinglist@googlegroups.com>
Subject: Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

 

 

Leprosy Mailing List –  July 24,  2024

 

Ref.:  (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

From:  Jannine Ebenso, Brentford, UK

---

Dear Pieter and colleagues

 

Joel Almeida continues to make the same cause-effect argument about SDR-PEP. However, he never mentions that PEP is delivered in association with contact tracing and screening. (Be that SDR or the new regimens in the RCTs taking place in different countries).

All active case-finding initiatives show us the same thing – if you actively look for leprosy, you WILL find it – and if there are lots of hidden cases, then intensive screening will discover them! (cf Special Action Programmes for the Elimination of Leprosy (SAPEL) and Leprosy Elimination Campaigns (LEC) in the late 1990s).

The reverse is also true – if we don't look for leprosy, we will not find it – so have we checked that the lovely figures from Tamil Nadu reflect the reality? Again, I refer to findings from SAPEL and LECs. Areas that were recording very low numbers with mainly passive case finding, suddenly found many times more new cases with intensified case-finding. I believe that Dr Benedict Quao has also reported similar findings in recent surveys in Ghana. In my own experience with SAPEL and LEC in SE Nigeria, the MB and disability rates were very high – but from the patients' history, the new cases were infected and developed the disease many years previously.

In the non-PEP states referred to by Joel Almeida – is intensive contact tracing and screening taking place too?

Has Joel Almeida looked at the number of people screened over the same number of years to see if the high MB numbers and the high G2D numbers might actually be 'backlog cases' after years of not looking for leprosy? (like our own experience in Nigeria). In that case, SDR-PEP has nothing to do with it. Newly diagnosed, does not mean newly acquired.

My response is not in defence of SDR-PEP, nor do I want to disrespect anyone – I merely ask are other factors that have not been presented in Joel Almeida's argument? (Dr Ben Naafs also asks for other things to be considered, in his LML post of 13 July)

 

Regards

Jannine Ebenso

The Leprosy Mission International, Brentford, UK

---

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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Fw: Ref.: (LML) Does Rifampicin PEP for household contacts alter the risk of multibacillary HD?

 

Leprosy Mailing List –  July 24,  2024

 

Ref.:  (LML) Does Rifampicin PEP for household contacts alter the risk of multibacillary HD?

From:  Epco Hasker, Antwerp, Belgium

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Dear Pieter,

 

I would like to respond to the posting by Joel Almeida on the LML on 23 June. He presents a sub group analysis of data from the PEOPLE trial on single dose rifampicin post-exposure prophylaxis (SDR-PEP) for leprosy. He compares arm 2, in which SDR-PEP was provided to household contacts, to arm 1, the comparator arm, in which no PEP was provided. The analysis is restricted to MB cases only and conclusions focus on SDR-PEP provided to household contacts. Indeed in arm 2 there were 42 incident MB cases versus 27 in arm 1, while total follow-up time was comparable between the two arms. Almeida then concludes that SDR-PEP has caused an increase in incidence of MB leprosy.

As can be seen from the trial profile figure presented in the article [1], only seven incident patients in arm 2 had received SDR-PEP. Out of those four were PB, three were MB. So even if the theory that SDR-PEP given to household contacts would increase the risk of developing MB leprosy, how could it ever explain the 39 MB cases in arm 2 that had not received any PEP?

In addition, SDR-PEP was provided to household contacts not only in arm 2 but also in arms 3 and 4 of the PEOPLE trial. In these arms numbers and proportions of MB incident cases were substantially lower than in arm 1 (19/68 in arm 3 and 13/44 in arm 4). If we run the individual model comparing those who did and did not receive SDR-PEP, restricted to household contacts only and with MB-leprosy as outcome, the incidence rate ratio among SDR-PEP recipients is still 0.49, though not statistically significant because of the much smaller study population (p=0.34).

I strongly recommend that this discussion is continued in the peer reviewed literature, where inconsistencies in argumentation would have been flagged by reviewers before publication.

 

Kind regards,

 

Epco Hasker

 

1. Hasker E, Assoumani Y, Randrianantoandro A, Ramboarina S, Braet SM, Cauchoix B, et al. Post-exposure prophylaxis in leprosy (PEOPLE): a cluster randomised trial. Lancet Glob Health. 2024;12(6):e1017-e26. doi: 10.1016/S2214-109X(24)00062-7. PubMed PMID: 38762282.

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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

 

 

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Fw: Ref.: (LML) Widukind Lenz and thalidomide

 

 

Leprosy Mailing List – July 21,  2024

 

Ref.:  (LML) Widukind Lenz and thalidomide

From:  Joel Almeida, Mumbai, India

---

 

 

Dear Pieter and colleagues,

 

Widukind Lenz has a special place in the history of epidemiology. He died on 25 Feb 1995.

 

"On November 11, 1961, a date he remembered well, he first began to suspect that the sedative Contergan (thalidomide) could be the cause of this 'new' malformation syndrome. Three days later, his suspicion turned into certainty and he communicated these observations to the manufacturer — Grünenthal — and recommended withdrawal of the agent. Only 13 days later, the company withdrew the drug from the market.

In the meantime, Lenz had communicated on the matter at the meeting of the Rheinisch-Westfälische Pediatrics Society in Düsseldorf, where he pointed out that fourteen mothers of children with this syndrome had taken a specific compound; of twenty mothers with 'normal' children, only one had taken the same compound (and that at the end of her pregnancy)."

 

Epidemiologists sometimes analyse facts. Sometimes the facts disclose an emergency affecting the integrity of human limbs. Then time is of the essence.

 

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 << editorlml@gmail.com

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Fw: Ref.: (LML) Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

 

Leprosy Mailing List –  July 19,  2024

 

Ref.:  (LML)  Visible deformity after HD (leprosy) chemoprophylaxis among India tribals

From:  Ben Naafs, Munnekeburen, the Netherlands

---

 

Dear Editor,

 

I think I didn't make it clear in my criticism of Joel Almeida's previous email that I am not at all in favour of SDR or even 2 days of Rifampicin. My criticism was mainly that he used a not so good Brazilian article to support his opinion. As for the Indian data, they are better. 

 

I think it is indeed possible that more disability can occur in a period of 2 years after SDR-PEP. But even better is to compare it after 5-10 years. 

 

The possible cause is that if the patient is not given medication, the adaptive immune system can gradually upgrade to cured or downgrade to lepromatous. After giving medication, the patient suddenly is exposed to additional and different antigenic determinants, this upgrade response can be further enhanced by an enhanced immune system by the BCG. This leads to a T1R that needs to be diagnosed and treated. Otherwise you will indeed get damage.

 

I hope I make it clear what I meant.

 

regards

 

Ben

 

Note editor: we want to stress again that LML is an open forum. Please react, especially when some conclusions could be considered by some quite premature

---

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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Fw: Ref.: (LML) New Publications On Cross-Cutting Issues In NTDs. July, 2024.

 

 

Leprosy Mailing List –  July 19,  2024

 

Ref.:  (LML) New Publications On Cross-Cutting Issues In NTDs. July, 2024.

From:  Roos Geutjes and Sophie Vissers, Amsterdam, the Netherlands

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Dear colleagues, 

The July newsletter edition is packed with practical materials and publications from the WHO, including the latest guidelines for the treatment of human African trypanosomiasis. This month's special edition focuses on Decolonization and Power Asymmetry in Global Health, offering plenty of thought-provoking content to ponder over the upcoming month.
 
In this newsletter, we offer a selection of the content that has been added to our platform. Please visit the website to access all new publications.

We are excited to announce that the InfoNTD website will soon have a fresh new look and feel! In the upcoming weeks, you will find two new sections in the navigation menu: News & Events and Online Courses. Additionally, the search functionality has been further optimized for a better user experience. Keep an eye on the website and let us know what you think of these new developments!

Stay up to date on the opportunities for learning, networking and growth by reviewing the news articles, events and call for proposals at the end of the newsletter.

 

Warm regards,

Roos Geutjes and Sophie Vissers

www.InfoNTD.org
info@InfoNTD.org
 

Practical materials

Guidelines for the treatment of human African trypanosomiasis (WHO manual)

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Target product profile for a diagnostic test to confirm cure of visceral leishmaniasis (WHO technical brief)

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One Health Toolkit (Internews Health Journalism Network toolkit)

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Integrated Campaign Digitization (ICD) Toolkit (Health Campaign Effectiveness Coalition toolkit)

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Accessibility GO! A Guide to Action (CBM guideline)

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Strengthening climate-resilient health systems: opportunities and challenges at policy and facility level (ReBUILD for Resilience & Oxford Policy Management webinar)

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Reducing stigma and discrimination faced by children and adults with disabilities (COSP17 Side Event recording)

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CBM Global and OPD partners share climate advocacy journey so far (Sensing Climate Conversation Series recording)

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Infectious Disease Data Observery Data Repository (IDDO Database)

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Case report form for uncomplicated visceral leishmaniasis (DNDI & IDDO form)

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Chagas disease case report form (IDDO form)

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A Guide to the Clinical Management of Vipera Snakebite in Italy (Guideline)

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Elimination Exchange (Global Institute for Disease Elimination Podcast Series)

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Innovative Strategies to Combat Neglected Tropical Diseases in Kenya (Amref Health Africa podcast)

Decolonization & power asymmetry

Reimagining the language of engagement in a post-stakeholder world
Reed MS, Merkle BG, Cook EJ, et al. Sustainability Science. Springer Science and Business Media LLC. 2024; 19 (4) : 1481-1490.

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Podcasts as a tool to disrupt knowledge hierarchies and silos to decolonize global health
van Niekerk L, Topp SM, Pasternak N, et al. Nature Medicine. Springer Science and Business Media LLC. 2024; 30 (5) : 1227-1228.

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Decolonial framework for applying reflexivity and positionality in global health research
Naidu T, Gingell G, Zaidi Z. Global Health Promotion. SAGE Publications. 2024.

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Towards authentic institutional allyship by global health funders
Oti SO, Robinson J, Pai M. PLOS Global Public Health. Public Library of Science (PLoS). 2024; 4 (3) : 1-4.

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Rethinking Global Health
Burgess RA. Routledge. 2024.

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Missing in action: a scoping review of gender as the overlooked component in decolonial discourses
Nassiri-Ansari T, Rhule ELM. BMJ Global Health. BMJ. 2024; 9 (4) : 1-9.

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Against Decolonisation: Taking African agency seriously.
Táíwò O. Hurst Publisher. 2023.

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Other new publications

Annual report 2023: Expanded Special Project for Elimination of Neglected Tropical Diseases
World Health Organization, Regional Office for Africa, Control of Neglected Tropical Diseases team. 2024.

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Report of the sixth meeting of the WHO Diagnostic Technical Advisory Group for Neglected Tropical Diseases: Geneva, Switzerland, 14–15 February 2024
World Health Organization, Control of Neglected Tropical Diseases team, Diagnostics Technical Advisory Group team. 2024.

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WHO Alliance for the Global Elimination of Trachoma: progress report on elimination of trachoma, 2023
World Health Organization. 2024.

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Anticipatory action for climate-sensitive infectious diseases: Latin America Regional Assessment
Red Cross Red Crescent Climate Centre. 2024.

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Overview and Summary of GLIDE's Inaugural Symposium: Integrated Approaches to Disease Elimination
Global Institute for Disease Elimination. 2024.

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Capacitating One Health in Eastern and Southern Africa: Experiences and Implications in Ethiopia
Tadesse Y, Mor S, Knight-Jones T, et al. 2024.

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Active Community-Based Case Finding of Endemic Leishmaniasis in West Bengal, India.
Guha S, Sardar A, Misra A, et al. Journal of epidemiology and global health. 2024.

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Leveraging wastewater-based epidemiology to monitor the spread of neglected tropical diseases in African communities.
Ofori B, Agoha R, Bokoe E, et al. Infectious diseases (London, England). 2024.

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Using Medical Illustration to Improve Understanding and Communication of Skin Neglected Tropical Diseases
Butler J. Faculty of Health and Medical Sciences. University of Surrey. 2023. 

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Integrating eye care into primary healthcare in Nigeria: Challenges of the primary healthcare workforce
Christian BN, Shomuyiwa DO, Christian NG, et al. Public Health Challenges. Wiley. 2024; 3 (2) : 1-7.

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GD07 Skin neglected tropical diseases and global health: migration and integration beyond borders
Parajuli N. British Journal of Dermatology. Oxford University Press (OUP). 2024.

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Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003-2022: a systematic review.
Kaburi B, Harries M, Hauri A, et al. BMC public health. 2024; 24 (1) : 1-15.

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Buruli ulcer, tuberculosis and leprosy: Exploring the One Health dimensions of three most prevalent mycobacterial diseases: A narrative review
Spiliopoulos O, Solomos Z, Puchner KP. Tropical Medicine & International Health. Wiley. 2024.

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Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania
Bisanzio D, Butcher R, Turbé V, et al. International Health. Oxford University Press (OUP). 2023; 16 (4) : 416-427.

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Effects of cutaneous leishmaniasis on patients' quality of life.
Yizengaw E, Nibret E. BMC infectious diseases. 2024; 24 (1) : 1-5.

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Navigating the Path to Elimination: Lessons from Lymphatic Filariasis and Trachoma Dossiers
USAID , Act to End NTDs East , RTI International . Technical Brief Series. 2024.

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An integrated inventory of One Health tools: Mapping and analysis of globally available tools to advance One Health
Behravesh CB, Charron DF, Liew A, et al. CABI One Health. CABI Publishing. 2024.

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AI sees an end to filariasis
Gaunt MW, Crainey JL, Kamhawi S. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2024; 18 (7) : 1-3.
Link to download AI tool. 
Link to youtube video.

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Report of the fifth WHO stakeholders meeting on gambiense and rhodesiense human African trypanosomiasis elimination, Geneva, Switzerland, 7–9 June 2023
World Health Organizaiton, Control of Neglected Tropical Diseases team. 2024.

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Dracunculiasis eradication: global surveillance summary, 2023
World Health Organization, Control of Neglected Tropical Diseases team. 2024.

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Report of the first meeting of the Global Onchocerciasis Network for Elimination: Saly, Senegal, 1-2 November 2023
World Health Organization, Control of Neglected Tropical Diseases team, Global Onchocerciasis Network for Elimination team. 2024.

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Understanding the burden of poor mental health and wellbeing among persons affected by leprosy or Buruli ulcer in Nigeria: A community based cross-sectional study
Ossai EN, Ekeke N, Esmai-Onyima A, et al. PLOS ONE. Public Library of Science (PLoS). 2024; 19 (6) : 1-15.

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Vascular Damage in Neglected Tropical Diseases
Silvestri V, Mushi V, Ngasala B. Springer Nature Switzerland. 2024.

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Capacities and needs of health care facilities for schistosomiasis diagnosis and management in elimination settings.
Ndum N, Trippler L, Mohammed U, et al. Parasites & vectors. 2024; 17 (1) : 1-14.

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Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil
Teixeira DS, Fortes S, Kestenberg C, et al. Frontiers in Medicine. Frontiers Media SA. 2024.

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DeepLeish: a deep learning based support system for the detection of Leishmaniasis parasite from Giemsa-stained microscope images.
Tekle E, Dese K, Girma S, et al. BMC medical imaging. 2024; 24 (1) : 1-12.

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Artificial Intelligence in Dermatopathology: updates, strengths, and challenges.
Cazzato G, Rongioletti F. Clinics in dermatology. 2024.

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Improving access to eye care services in Ghana using community health structures
Ofosu A, Osei I, Hagan M, et al. African Vision and Eye Health. AOSIS. 2024; 83 (1) : 1-9.

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A climatic suitability indicator to support Leishmania infantum surveillance in Europe: a modelling study
Carvalho BM, Maia C, Courtenay O, et al. The Lancet Regional Health - Europe. Elsevier BV. 2024.

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Media advocacy and the actualization of "Vision 2020: the right to sight" in Nigeria
Gambo S, Shem W, Essien CF. REVISTA ESPAÑOLA DE COMUNICACIÓN EN SALUD. Universidad Carlos III de Madrid. 2024; 15 (1) : 86-97.

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What is the state of the art on traditional medicine interventions for zoonotic diseases in the Indian subcontinent? A scoping review of the peer-reviewed evidence base
Asaaga FA, Tomude ES, Rahman M, et al. BMC Complementary Medicine and Therapies. Springer Science and Business Media LLC. 2024; 24 (1) : 1-19.

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The role of social media in public health awareness during times of war in Sudan: snakebites and scorpion stings
Baleela RMH, Mohammad A, Saeed SAK. BMC Public Health. Springer Science and Business Media LLC. 2024; 24 (1) : 1-18.

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Strengthening the collection, interpretation and use of data to target expansion and integration of case detection and management interventions against neglected tropical diseases.
Simpson HN. Faculty of Infectious and Tropical Diseases. London School of Hygiene & Tropical Medicine. 2024.

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Rocky Mountain spotted fever is a neglected tropical disease in Latin America.
Álvarez-Hernández G, Paddock C, Walker D, et al. PLoS neglected tropical diseases. 2024; 18 (7) : 1-7.

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Dental auxiliaries' knowledge, attitude, and practices regarding noma prevention: A cross-sectional study in Northwestern Nigeria
Bala M, Kaura MA, Tsafe AB, et al. Journal of Oral Research and Review. Medknow. 2024; 16 (2) : 91-96.

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News & Events

Kenya expands schistosomiasis fight to children under five (news article)

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Funding to study neglected tropical diseases and develop new technologies is very limited (news article)

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Call for research proposals on skin-related Neglected Tropical Diseases (NTDs) CfP-NTD2025 
The Diorapthe foundation will support preclinical, clinical and operational research. Deadline for submission is October 4 (18:00 CEST) 2024. For all the information please check the call for research proposal document.

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PAHO's Initiative for the elimination of communicable diseases
Theme: "Advancing the Agenda - Achievements and Future Directions"
July 31, 2024; 9:30 am - 11:10 am (EDT); webinar.
This webinar aims to share knowledge and best practices related to the PAHO Initiative, a strategic effort by PAHO and countries in the Americas to eliminate over 30 communicable diseases and related conditions by 2030. Please make sure to register in advance.

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The Royal Society of Tropical Medicine & Hygiene hosts several events including their annual meeting, webinars with interesting guests, events foccused on early career researchers and a regional meeting taking place in Nigeria focussing on West-Africa. Please check out their website for all the events.

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Africa Evidence Week 2024: Celebrating EIDM in Africa
August 19-23, 2024; online event.
Africa Evidence Week 2024 is a virtual celebration of African EIDM and the decision-makers who make it possible. To participate you have to submit live in-person events, live online events, pre-recorded webinars,  Twitter chats, blog posts, video content, publications or any other digital content aligned to the objectives of the event. The deadline for submission is July 19 (17:00 PM SAST) 2024.

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The 7th CBR/CBID Africa Conference 
September 2-5, 2024; Entebbe, Uganda. 
This three-day CBR/CBID Africa conference will provide a platform for various stakeholders to come together, exchange ideas on the role of CBR/CBID in promoting disability inclusive development. Early Bird Registration is until August 15.

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Bridge CRPD-SDGs Pacific Region Module 1
September 12-18, 2024; in-person training; Fiji.
The Pacific Disability Forum, the International Disability Alliance (IDA), and the International Disability and Development Consortium invite people with disabilities from the Pacific region to join the Bridge CRPD-SDGs training. The countries include Papua New Guinea, Fiji, Solomon Islands, Vanuatu, Samoa, Cook Islands, Tuvalu, Niue, Micronesia, Kiribati, Marshall Islands, Palau, Nauru. Check how to apply on their website. The deadline for application is July 20 2024.

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Swiss TPH Hybrid Symposium: Defining the Noma Research Agenda
September 20, 2024; hybrid event; Allschwil, Switzerland.
Join the symposium to unite efforts to better understand, prevent and treat noma. The symposium is co-organised with Elysium, the first noma survivors' association. For updates check their website.

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NNN Conference 2024
October 1-3, 2024; Kuala Lumpur, Malaysia.
The NNN Annual Conference 2024 will take place from 1st of October - 3rd of October, 2024, in Kuala Lumpur Malaysia. The theme for the conference is: "Collaboration for Change: Fostering Global Equity and Strengthening Community Engagement in NTDs." The Early Bird registration is now open. You can find more information by clicking here.

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UNC Water and Health Conference 
October 14-18, 2024; hybrid event; Chapel Hill, United States of America.
The annual UNC Water and Health Conference reflects Water Institute's commitment to improving public health by achieving universal access to safe drinking water, sanitation and hygiene (WaSH) services that are safe, affordable and sustainable. In-person registration is open and online participation registration is coming soon.

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Unite Global Summit – Building Trust for Global Health. Parliamentarians' Leadership for Change
October 16, 2024; in-person event; Berlin, Germany. 
The UNITE Global Summit 2024's agenda will be divided into the main pillars: human rights & equitable access to health, global health architecture & security, strenthening of healthcare systems and sustainable financing for health. The event is the world's leading Forum for forging partnerships between parliamentarians and leaders from the global health community. Early bird registation until July 31.

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Global Eye Health | Online Short course (LSHTM)
November 11-14, 2024; Online.
The goal of the workshop will be to familiarise participants with: Public eye health principles, the aims, objectives and strategies of Universal Eye Health Coverage. The course programme will also look at survey methodologies and strategies for control of the major eye health-related diseases. Application deadline for scholarships and general application is 20th of July.

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Conference on Neglected Tropical Diseases 2024
November 14-16, 2024, Nairobi; Kenya.
The 1st edition of the Conference on Neglected Tropical Diseases, organized by AME is tentatively scheduled from 14-16 November in Nairobi, Kenya, as a hybrid meeting. The abstract-driven conference proposes a platform to disseminate new advanc
ements, real-world data, implementation challenges, and novel governing models to discuss and generate solutions for cross-cutting topics and ultimately reduce the disease burden and societal impact of NTDs. This proposal supports the progress in foundational pillars of the WHO Roadmap by facilitating evidence-based program implementation, leveraging the cross-cutting approach, and providing a forum to discuss a paradigm shift toward country ownership of elimination programs.

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One Health Clinic at a Time, Malawi Transforms the Patient Experience (news article)

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GHS pushes for the inclusion of elephantiasis patients in health insurance  (news article)

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Request for Proposals | Robert Carr Fund  
The Robert Carr Fund invites global and regional civil society networks and consortia of networks led by, and/or serving inadequately served populations to apply for a grant to support their core funding and activity needs for a three-year period (2025-2027). Deadline for proposal submission via online application portal 22 July 2024 12:00 (noon) CET. 

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Call for Applications of the Joint EMRO/TDR Impact Grants for regional priorities focused on implementation research in infectious diseases of poverty.
Funding: US$ 8000–$10 000 per grant. 
Deadline for submission September 15 (17:00 CEST) 2024. Only applicants from the WHO Eastern Mediterranean Region are eligible. For other criteria and information please check the website.

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IX Reunión ChagasLeish y XIX Simposio PECET Theme: "avances en la investigación de enfermedades tropicales"
August 15-16, 2024; in-person event; Medellín, Colombia. 
The event aims to disseminate advances and research outcomes in leishmaniasis and Chagas disease, fostering new research questions and promoting multidisciplinary collaboration. Check their website for information regarding registration.

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BSP Autumn Symposium 2024 - Highlighting female and male genital schistosomiasis
September 4-5, 2024; in-person event; London, United Kingdom.
The symposium will bring together clinicians and biologists interested in discussing knowledge gaps concerning the natural history of the disease, its diagnostic challenges as well as clinical management. The meeting will also encourage a diversity of speakers and early career researchers who shall give invited/open oral presentations and interact further during the open poster sessions. The deadline for abstract submission is August 1 and registration is expected to open shortly.

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Conference on Tropical Medicine and Global Health
September 19-21, 2024; Dusseldorf, Germany.
Some of the topics: Emerging Infectious Diseases and Pandemic Preparedness I Malaria update: prophylaxis and resistance I New vaccines I High Consequence Infectious Diseases I Interdisciplinary health concepts I Climate change and health I Non Communicable Diseases I Innovative diagnostics I Big Data and Artificial Intelligence in Tropical Medicine I Clinical cases I Update Tropical and Travel Medicine (incl. Refresher course Travel Medicine) I Sustainable travel I Clinical and scientific training and career opportunities. Early bird registration until June 30.

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COR-NTD Meeting for the Pacific Islands 
September 25-26, 2024; in-person event; Brisbane, Australia. 
The goal of this meeting is to bring together key stakeholders to address how to eliminate lymphatic filariasis, scabies, trachoma, leprosy and other NTDs from the region. We believe that together we can eliminate and maintain elimination of these NTDs. Registration will open soon.

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Conference on control strategies for schistosomiasis in Madagascar
October 11, 2024; Antananarivo, Madagascar.
The aim of the conference is to fuel the discussion and strengthen the networks between Malagasy stakeholders and policy makers, international experts, health professionals and scientist to work together to reach equity through elimination. Registration deadline is the 15th of September 2024.

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2024 Annual Meeting of National NTD Programme Managers 
Theme: "Innovating for acceleration: Pathways to NTD Elimination"
October 15-17, 2024; save the date.
Updates will follow but you can ask your questions by e-mailing to ESPENAFRO@who.int 

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4th International Conference on Indigenous Knowledge Systems and Practices Theme: "The Politics of Knowledge"
October 22-24, 2024; in-person event; Cape Town, South Africa. 
This conference serves as a platform for engaging critically with knowledge-making and the ​philosophical underpinnings of what it means to produce knowledge in the world ​today. Registration is expected to open shortly and the deadline for abstract submission is July 31.

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ASTMH - Annual Meeting 
November 13-17, 2024; in-person event; Louisiana, New Orleans
The scientific program is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students, and all healthcare providers working in the fields of tropical medicine, hygiene, and global health. Invitation letters for travel approval assistance are available here. Registration is open and the early rate deadline is September 30. The deadline for late-breaker abstracts is July 30.

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125th Anniversary Scientific Symposium
November 25-27, 2024; hybrid event; Liverpool, United Kingdom.
Topics throughout the three-day event will include Lung Health and TB, HIV, Malaria, Neglected Tropical Diseases, Resilient Health Systems, Resistance Research and Management, the Impact of Climate Change on Global Health, Health Policy and Systems Research, and Maternal, Newborn and Child Health. Registration is open.

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12th TEPHINET Scientific Conference and the Global Field Epidemiology Partnership Forum 
June 2-5, 2025; Berlin, Germany.
For more information, please visit the TEPHINET Website. The deadline for abstract submission is September 30, 2024. 

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InfoNTD sends out monthly e-mails with an overview of recent publications on NTDs and cross-cutting issues. The purpose of this activity is to keep subscribers up to date.

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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

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