Leprosy Mailing List – July 18, 2026
Ref.: (LML) FIND TREAT END (FTE)
From: Joel Almeida, Mumbai, India
____________________________________________________________________________
Dear Pieter and colleagues,
For a long time M. leprae have outwitted us. A central challenge is that persons who look completely normal, with zero signs or symptoms, can shed astronomical numbers of viable bacilli in nasal discharges. Also, reinfection means that a cluster-wide sweep is needed.
The FIND TREAT END strategy relies on user-friendly reliable and scalable tools to rapidly eliminate concentrated viable bacilli from nasal discharges in a human cluster, while protecting nerves, eyes, hands, feet and helping to generate jobs for persons with lived experience. They often live in endemic areas.
· FIND: Barcoded, georeferenced nasal swab screening of all asymptomatics in clusters and migratory corridors using semi-quantitative mLAMP (isothermal, no thermocycler, no cold chain, naked-eye readout of color or turbidity). This rapidly distinguishes persons with high-shedding cryptic asymptomatic LL (unique sources of concentrated viable bacilli) from casual nasal carriers of trivial numbers of bacilli. Swab collection can even be by an army of persons with lived experience after basic training. Reporting is in real time via mobile phone apps with georeferences.
· TREAT: Prompt full anti-microbial treatment started for only high-shedders and clinical cases, combined with regular nerve function monitoring via four simple muscle weakness tests performed by trained persons with lived experience who also encourage uninterrupted completion of treatment. This eliminates concentrated viable bacilli in nasal discharges of the local human population within days/weeks. Silent nerve damage is more likely to be detected.
· END: Periodic mop-up surveillance rounds to confirm and sustain the elimination of concentrated viable bacilli from the cluster.
Elimination of concentrated viable bacilli in nasal discharges from a human cluster can be demonstrated within days/weeks, using nasal swabs. Cluster by cluster, in sequence or in parallel, the success can sweep across whole districts, countries and beyond. Go into a cluster on Monday, do a sweep for nasal swabs & semi-quantitative mLAMP by Tuesday, start full treatment on Wednesday of every cryptic asymptomatic LL high-shedder. Take nasal swabs in periodic follow-up sweeps. It used to require decades to make a dent in transmission, now it is possible in weeks. That is because no cryptic asymptomatic LL high-shedder goes undetected or unprotected..
The entire system is designed to be literacy-independent, helping to rehabilitate persons with lived experience through dignified employment as aides to health workers. Persons with lived experience can also assist with respectful rehab and obtaining social entitlements while steadily replacing public fear with public respect. Health workers, universities and experts can guide and document the grassroots activities and their impact.
The FIND TREAT END strategy not only rapidly stops transmission but also conserves macrophage defences by confining anti-microbial use to only high-shedding asymptomatic LL cases and any persons with clinical signs of HD. Socio-economic improvements and BCG or MIP or other vaccines would support the strategy.
Cluster by cluster, the FIND TREAT END strategy can make a thousand Maltas bloom. This is a vision that can compete successfully for investments in an era of financial constraints, because it offers rapid, measurable payoffs.
With all sincerity,
Joel Almeida
____________________________________________________________________________
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << edit...@gmail.com
You received this message because you are subscribed to the Google Groups "Leprosy Mailing List" group.
To unsubscribe from this group and stop receiving emails from it, send an email to leprosymailinglist+unsubscribe@googlegroups.com.
To view this discussion visit https://groups.google.com/d/msgid/leprosymailinglist/376bd70b-3c59-411f-914d-95f0845cca50n%40googlegroups.com.
No comments:
Post a Comment