Leprosy Mailing List – October 19, 2026
Ref.: (LML) The self-defence printed card
From: Joel Almeida, Mumbai, India
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Dear Pieter and colleagues,
The FTE strategy (Find Treat End) with near-simultaneous nasal swabs on all asymptomatic contacts for semi-quantitative mLAMP (detection of high concentrations of M. leprae complex) and prompt start of full anti-microbial treatment on all highly bacillated persons offers a rapid, safe end to transmission in a human cluster, with follow-up sweeps at intervals for sustained zero transmission. Persons with lived experience can play a central role in the defeat of HD: e.g., as the collectors of nasal swabs, comforters of the distressed, encouragers of uninterrupted complete treatment, monitors of muscle weakness by means of simple tests, facilitators of social entitlements, educators of the public etc. More information: https://tinyurl.com/33djwbkp
For a manual labourer, even a small absolute increase in the probability of irreversible nerve damage or visible deformity carries a catastrophic personal and family cost: loss of earning capacity and destitution, with serious risk of total exclusion. What is the practical self-defence that can empower such a semi-literate manual labourer who is a contact of a newly diagnosed HD (leprosy) patient?
Perhaps a printed card held by them stating:
“I refuse short-term chemoprophylaxis under my right to informed consent. I demand a full, expert clinical examination for signs of Hansen Disease (Kushth or similar local names) and a nasal swab test for me and my household members. If positive, I demand full, free anti-microbial treatment with regular neurological check-ups.”
The universal and well-conserved biology is well demonstrated, of the macrophage cGAS-STING cascade with boosted OASL and suppression of autophagy and vit D-induced cathelicidin following lipofection of macrophages with M. leprae DNA ( doi:10.1126/science.1232458, DOI: 10.1093/infdis/jiw144 ). There is no evidence at all that the 90 to 99.9% bactericide achieved by a single dose of a bactericidal drug somehow fails to damage bacilli within macrophages or to release bacillary debris including DNA into the macrophage cytosol. Human eyes, hands and feet are not disposable experimental material, especially not when the recipients of an intervention are semi-literate and reliant on those eyes, hands and feet to escape destitution.
The onus is on proponents of short-term chemoprophylaxis to demonstrate that universal and well-conserved macrophage biology is somehow absent following short-term chemoprophylaxis. That burden of proof has not been discharged at all. The printed card is one small step towards safety for the vulnerable. Esteemed colleagues will be able to suggest even more steps. There is no substitute for empowering persons with lived experience and low-income people at risk of serious harm.
With all sincerity,
Joel Almeida
PS Further information is available:
Ind J Lepr articles: https://tinyurl.com/2un6rtye, https://tinyurl.com/zrkam3ww
LML letters: https://tinyurl.com/vs7tj2xt , https://tinyurl.com/55ff8wan
The internet (and sub-repositories within it) is not a peer-reviewed journal but it holds the contents of many peer-reviewed journals including the Indian Journal of Leprosy (founded in 1929) which is also available in traditional printed form. Its reviewers are well informed about the Indian context and often at the cutting edge of scientific discovery. Subscription to the Indian Journal of Leprosy permits access to the printed copies.
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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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