Fw: Ref.: (LML) How invincible is HD?

 

 

Leprosy Mailing List –   April 4,  2026

 

Ref.:  (LML) How invincible is HD?

From: Joel Almeida, Mumbai, India

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Dear Pieter and colleagues,

Cuba has used short-term chemoprophylaxis (PEP) since 2002 with little or no reduction in newly detected MB HD cases/year: about 150 in 2004 vs about 140 in 2024. [WHO Wkly Epid Reports 2005 & 2025] By contrast, Malta completely eliminated HD (H Disease) using reliable diagnosis of LL HD and prolonged anti-microbial protection of LL patients against reinfection, without any  use of short-term chemoprophylaxis. [1] Weifang in Shandong, China, achieved >15%/year decline in new HD and MB HD, again without short-term chemoprophylaxis and at a time when Shandong had lower per capita income than Yunnan has today [2] Similarly rapid declines were achieved in Karigiri (India), Karonga (Malawi), Vietnam, Thailand, Pakistan, Ecuador, Jordan, Chile, all without short-term chemoprophylaxis. Good diagnosis of LL HD and preventing reinfection of LL by full free treatment seem highly effective in stopping HD, aided no doubt by improving nutrition, income and schooling.

Even more rapidly effective in a case cluster would be to promptly find and treat all the sources of concentrated viable bacilli. The nose is the main site of entry as well as exit of bacilli [3]. Not a single one of 208 new BL patients had a BI of 5+ or 6+ in nasal discharges, whereas many LL patients did so. Unfortunately LL HD can have few or no signs in nerves or skin. Nasal swabs for semi-quantitative mLAMP enable rapid low-cost identification of  persons with astronomical numbers of bacilli, as in LL HD (within <1 hour without the need for thermocycler). Several centres are working on mLAMP kits. Anti-microbials make nasal discharges non-infectious within days. This means that a case cluster or village can be rendered devoid of sources of infection within days, providing that nasal swabs are taken in a short period from all asymptomatic persons in a case cluster. Once all sources of concentrated viable bacilli in a cluster are rendered non-infectious, transmission is difficult to sustain. A cluster or village free of concentrated bacilli is achievable within weeks. That is worth doing in every endemic village or cluster until Malta-like success is achieved in every endemic country. Sites where migrant workers congregate would require a similar approach. Armadillo states would require PPE and public education.

Science, respect and justice offer a highly effective and rapid path to stopping HD, while sparing contacts from a boosted risk of visible deformity before diagnosis. [4] We can make a thousand Maltas bloom, safely and respectfully. The best part is that an army of persons with lived experience is available to collect nasal swabs, after basic training.

With all sincerity,

Joel Almeida

 References

1.     Jacobson RR, Gatt P. Can leprosy be eradicated with chemotherapy? An evaluation of the Malta Leprosy Eradication Project. Lepr Rev 2008; 79(4):410-5

2.      Li HY, Weng XM, Li T et al. Long-Term Effect of Leprosy Control in Two Prefectures of China, 1955-1993. Int J Lepr 1995 Jun;63(2):213-221.

 

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

4.      Almeida JG, Talhari S, Salgado CG et al (2025). Visible Deformity after HD
(Leprosy) Chemoprophylaxis among Tribal People in India: Quantitative Analysis of Data Extracted from Published Sources. Indian J Lepr. 97: 175-188

 

 

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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 << edit...@gmail.com

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