Leprosy Mailing List – August 12, 2026
Ref.: (LML) Long-lasting adverse impact of chemoprophylaxis & what actually works
From: Ben Naafs, Munnekeburen, the Netherlands
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Dear Pieter,
Joel Almeida. Long-lasting adverse impact of chemoprophylaxis & what actually works. LML - August 7, 2026.
I think Joël has some clear points. Most are well known and do not need any discussion. He starts with some answers to Benedict. Most importantly he mentions that treatment is not chemoprophylaxis. I ask myself how long Joël wants to treat? Since the short treatment for MB patients advised by WHO looks like a fiasco in endemic areas.
The existence of bacilli-shedders being MB patients indeed is mentioned by Davey and Rees. But it is not a proof. According to me it is common knowledge and does not need a proof. Just a small experiment I did in ALERT in 1976. We properly cleaned a room and verified that there were no AFB present in the room. We assigned an LL patient who would start treatment the next day to the room. The next day we took smears from the floor and everywhere many AFB were present, making it very likely that the patient shed a lot of them. Job and about the same time, Fleury showed that it unlikely is that any shedding of bacilli occurred via the skin.
I do not have many comments about Maranhão research
I fully agree with his remark that if serious harm is demonstrated from an intervention, then the ones in favour of this intervention must show its safety.
Not all readers will know that RCT means randomized controlled trial. No comment on his analyses.
I feel his article: Visible Deformity after HD (Leprosy) Chemoprophylaxis among Tribal People in India: Quantitative Analysis of Data Extracted from Published Sources by JG Almeida, S Talhari, CG Salgado, B Kumar, CC Talhari, HS Goncalves, provides obvious support to his point.
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Claudio Salgado. Long-lasting adverse impact of chemoprophylaxis & what actually works. LML – August 7, 2026.
I am very glad about the letter of Claudio Selgado. He read the letter of Joël with knowledge and understanding, having written a important paper with him about damage after PEP. I thank him for the considered contribution.
Important is his remark: “what level of evidence is required before a preventive intervention is considered sufficiently safe for widespread implementation?”
Claudio states rightly that:” Operational feasibility is not equivalent to long-term clinical safety, and explains why”
Then he asks how well the contact evaluation was done, since clinical knowledge is disappearing.
From experience he states, “Operational feasibility is not equivalent to long-term clinical safety” He doubts of the lack of clinical knowledge is compensated by laboratory and or ultrasound.
He mentioned that several questions in the trials with PEP remain unanswered and I fully agree with him.
But does PEP harm? There is not looked for, except may be in the paper mentioned by Joël and co-authored by Claudio.
He is right that the leprosy community should be encouraged “to generate the level of evidence that such a globally promoted intervention deserves”. “Future studies should move beyond operational feasibility and short-term case detection to include rigorous clinical assessment by experienced leprologists, systematic evaluation of nerve function, disability, multibacillary disease, reactions, molecular diagnosis, antimicrobial resistance, and prolonged follow-up”
With high regards
To all contributor,
Ben
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
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