(LML) UK red squirrels are carrying leprosy and have been for decades

Leprosy Mailing List – November 17,  2016

Ref.: (LML)   UK red squirrels are carrying leprosy and have been for decades

From:  New Scientist

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Dear  LML readers,

 

An interesting article from the New Scientist, November 10, 2016.

 

Best wishes,

 

Pieter AM Schreuder

Editor LML

 

By New Scientist staff and Press Association

A study of 110 dead red squirrels from around the UK and Ireland has found that the animals carry several strains of leprosy.

Red squirrels in Scotland, Ireland and the Isle of Wight were found to be carrying Mycobacterium lepromatosis, a bacterial strain that is closely related to a virulent form of human leprosy endemic in Mexico and the Caribbean. Animals on Brownsea Island in Poole harbour carried a different type, Mycobacterium leprae, which is known to have affected people living in southern England over 700 years ago.

The chances of catching the disease from a squirrel are extremely low, and researchers have urged people living close to the animals not to panic. Instead, the finding is more of a concern for those trying to conserve the animals, which are already threatened by squirrelpox and habitat loss.

“We need to understand how and why the disease is acquired and transmitted among red squirrels so that we can better manage this iconic species,” says Anna Meredith, at the University of Edinburgh.

Human strain

Not all the infected squirrels were displaying symptoms. Those that did showed signs of swelling and hair loss from the ears, muzzle and feet.

In humans, leprosy causes nerve and muscle damage which can lead to deformity, disability and blindness if left untreated. However, most healthy people are naturally immune to leprosy and are unlikely to be affected if they are exposed to the bacteria.

The strain carried by the Brownsea Island squirrels was particularly surprising, bearing a similarity to a type of leprosy that was previously found in the 730-year-old skeleton of a leprosy victim buried in Winchester, just 43 miles away.

The discovery of this medieval leprosy strain in the Brownsea Island so long after it was eliminated from humans was completely unexpected, says team-member Stewart Cole, at the Ecole Polytechnique Federale de Lausanne in Switzerland. “This has never been observed before.”

There are currently around 250 red squirrels on Brownsea Island. Of the 25 dead squirrels the team tested, every one was infected with this leprosy strain.

The last recorded case of indigenous leprosy contracted in the UK dates back to 1798.

Carried for centuries

The team’s findings suggests that the Brownsea squirrels may have been affected by leprosy for centuries.

“Brownsea’s wild red squirrel population has been living with leprosy for at least four decades,” says Angela Cott, National Trust general manager for Brownsea Island. “By working with the University of Edinburgh and Dorset Wildlife Trust, we hope to understand how best to look after Brownsea’s wild red squirrels.”

Fewer than 140,000 red squirrels remain in the UK, and the animals may be extinct in Britain within the next 10 years.

 

References:

-       Avanzi C, Del-Pozo J, Benjak A, Stevenson K, Simpson VR, Busso P, McLuckie J, Loiseau C, Lawton C, Schoening J, Shaw DJ, Piton J, Vera-Cabrera L, Velarde-Felix JS, McDermott F, Gordon SV, Cole ST, Meredith AL. Red squirrels in the BritishIsles are infected with leprosy bacilli. Science. 2016 Nov 11;354(6313):744-747. PubMed PMID: 27846605.

 

-       Stinear TP, Brosch R. Leprosy in red squirrels. Science. 2016 Nov 11;354(6313):702-703. PubMed PMID: 27846589.

 

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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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(LML) I was dreaming

Leprosy Mailing List – November 16,  2016

Ref.:    (LML)  I was dreaming

From:  Ben Naafs, Munnekeburen, the Netherlands

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Dear Pieter,

 

I was dreaming, may be half a sleep, last night, trying to understand nerve damage in leprosy.

 

A person is infected by M.leprae. Thereafter he will have bacilli alive, or dead and decaying, circulating in his blood. These antigens will be exposed to the innate and adaptive immune system. Most of the antigens will be opsonised by macrophages. He may develop or has already developed a more or less effective immune reaction depending on his genetic constitution, the place of entry of the mycobacteria and earlier contact with other bacteria or antigens relevant for the immune response to M.leprae.

 

The nerves of the person are exposed to micro traumata being stretched by bending joints (elbow, wrist, knee, ankle) or other traumata (Weddell). The vasculature in the traumatised area will develop receptors for cleaning and repairing cells, among them the bacilli and antigen containing macrophages (Scollard). These than will enter the traumatised area: the endoneurium, containing these blood vessels. The macrophages will die or change, take up more material and will expose Schwann cells to their antigenic material ao LAM, PGL1 and bacilli. It is difficult for them to leave the endoneurium, for the endoneurium has no lymph vessels while the perineurium is not permeable.

 

The bacilli may have started to multiply inside the macrophage or not. In 80% of the infected people they may not, because the macrophage either destroys the bacilli or deprives them from the nutrients and enzymes which they need to survive. Then the bacilli, if still alive, or at least their antigens particularly LAM, come in contact with the Schwann cell lying around or in contact with axons. The bacilli may enter the Schwann cell the way Rambukana proposed and may just stay as persisters, multiply or disintegrate. LAM may come in contact with the Schwann cell and activates the complement system as proposed by El Idrissi and Das. This may cause a little inflammation but most importantly it will lead to formation of MAC which will make “holes” in the Schwann cell and whereas the Schwann cell will disintegrate, the demyelisation will be a fact. The hall mark of leprosy: segmental demyelination.

 

The demyelisation may be minute, even not detectable with the methods used. This may be the case in contacts. But it may as well continue and give further demyelination in particular in MB patients (by now they have become patients since the nerve damage may become detectable). In PB patients a CMI against M.leprae antigenic determinants develops with granuloma which may destroy perineurium and endoneurium and even may cause abscesses.

 

In course of time reactions T1R and T2R may happen. T1R in Borderline patients and T2R in Borderline and lepromatous patents.

 

In T1R the CMI gives rise to oedema. Since the perineurium is not permeable and since there are no lymph vessels in the endoneurium the pressure inside will increase. This will lead to further demyelisation and compression of the axons, which will collapse and prevent nutrients from reaching the peripheral part of the axon. In due time the distal part of the axon will die. This can beautifully be shown by Nerve Conduction Studies as have been done by Garbino who found a decreasing conduction speed and a smaller surface of the compound action potential during T1R, a reaction which may take many months to resolve and leaves a lot of damage.

 

In T2R there is an inflammation due to immune complex formation and consequently complement activation. These reactions last for about one week till one month (as written by De Souza Arauyo already in 1929). These will lead to severe compression on the axons in the endoneurium and even to a conduction block (Garbino). Since the reaction is relatively short it will not do much damage, but will cause problems when it happens too often.

 

Occasionally, when the reaction has abated the pressure in the nerves remains high. This could be due to the fact that arterioles and venules obliquely pass through the often thickened perineurium. They are then being compressed due to the endoneural pressure. This diminishes the outflow of the venules which pressure is lower than that of the arterioles and which maintains the endoneural pressure and causes more oedema (Naafs). Further damage will be the result which may lead to anoxaemia when the inflow through the arterioles becomes less. In the end there will be only a near fibrosed nerve left. Still there may be reactions and demyelisation due to remnant antigens and pressure on the nerve. Neuropathic pain may persist in a further near almost useless nerve. 

 

Finally something about Lepra bonita. There is no demyelisation because most likely there is no complement activation by LAM. The Lucio phenomenon is just a blocking of the venules in the skin due to the number of bacilli which leads to infarction.

 

Ben Naafs

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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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(LML) InfoNTD| Information on cross-cutting issues in NTDs November 2016

Leprosy Mailing List – November 15,  2016

Ref.:  (LML) InfoNTD| Information on cross-cutting issues in NTDs November 2016

From:  Ilse Egers and Evelien Dijkkamp, Amsterdam, the Netherlands

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Dear Pieter,

 

Greetings from Infontd   In this newsletter you will find a selection of news items and recent publications on cross-cutting issues in NTDs. Each month we make a selection. Our starting point is to add articles covering a wide variety of cross-cutting issues and NTDs. Unfortunately, this is not always possible due to a publication bias and lack of articles on these issues. Feel free to contact us with any questions or to receive the full text versions if a link to the full text is not included (infontd@leprastichting.nl) . Our document delivery service is free! Kind regards,   Ilse Egers & Evelien Dijkkamp InfoNTD Information officers

 

 

News

 

 

Lymphatic filariasis and trachoma are on track for eradication; they may be eliminated in the world’s poorest countries by 2020. This is a result of a partnership of governments, charitable foundations and pharmaceutical companies. http://www.voanews.com/a/two-tropical-diseases-on-track-for-eradication-in-4-years/3549663.html News from WHO Leprosy: lessons to be learnt in overcoming discrimination and stigmatization 8 November 2016 | Seoul | New Delhi | Geneva –– The World Health Organization (WHO) has welcomed an initiative by countries to repeal antiquated laws that for centuries allowed discrimination against people affected by leprosy (Hansen’s disease). Although the disease has been eliminated as a public health problem worldwide, discrimination and stigmatization pose huge barriers to equitable treatment and social inclusion. Read more: http://www.who.int/neglected_diseases/news/Leprosy_lessons_to_be_learnt/en/

 

 

New publications

 

 

Psychological and psychosocial consequences of zoonotic cutaneous leishmaniasis among women in Tunisia: Preliminary findings from an exploratory study. Chahed MK, Bellali H, Ben Jemaa S, et al. PLoS Negl Trop Dis. 2016; 10(10):e0005090. Abstract The incidence of zoonotic cutaneous leishmaniasis (ZCL) makes it the most widespread parasitic disease in Tunisia and the Arab world. The purpose of this study was to examine the psychosocial impact of ZCL scars among Tunisian women. The results showed that anticipation of rejection and avoidance of stress are strongly correlated with a negative perception of ZCL. This makes it vital to strengthen preventive health education. Download PDF Community-based detection of post Kala-azar dermal leishmaniasis (PKDL) and its risk-factors in an endemic region of Bihar, India. Scott J, Rabi Das VN, Siddiqui NA. J Trop Dis. 2016; 4(4). Abstract A large-scale survey-based study of PKDL prevalence was conducted in the endemic region of Araria in Bihar, India. The results of the study indicate a sample prevalence of as high as 7.9 cases per 10,000 individuals. Our results suggest that factors of caste, cattle shed proximity, and gender all contribute to the characterization of the PKDL-afflicted population. Consideration of these factors can provide a clear starting point for further in-depth examination of their contribution to PKDL patterns. Download PDF Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria. Meka AO, Chukwu JN, Nwafor CC, et al. Trans. R. Soc. Trop. Med. Hyg. 2016; 110:502-509. Abstract Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria. Download PDF Progress of trachoma mapping in mainland Tanzania: Results of baseline surveys from 2012 to 2014. Mwingira UJ, Kabona G, Kamugisha M, et al. Ophthalmic Epidemiol. 2016:1-8. Abstract Only three districts qualified for mass drug administration with azithromycin. Trichiasis is still a public health problem in many districts, thus community-based trichiasis surgery should be considered to prevent blindness due to trachoma. Download PDF Integrated healthcare delivery: A qualitative research approach to identifying and harmonizing perspectives of integrated neglected tropical disease programs. Means AR, Jacobson J, Mosher AW et al. PLoS Negl Trop Dis. 2016; 10(10):0005085. Abstract Qualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. Download PDF Can lymphatic filariasis be eliminated by 2020? Rebollo MP, Bockarie MJ. Trends Parasitol. 2016; S1471-4922(16):30165-9. Abstract In this Opinion article we review the prospects for achieving LF elimination by 2020 in the light of the renewed global action against NTDs and the global efforts to achieve the sustainable development goals (SDGs) by 2030. We conclude that LF can be eliminated by 2020 using cross-sectoral and integrated approaches because of the compound effect of the other SDG activities related to poverty reduction and water and sanitation.ported functional limitations in Cameroon and India. Read abstract Epidemiology of soil-transmitted helminth infections in Timor-Leste. Campbell SJ. The Australian National University. 2016:365p. Thesis. Abstract This thesis explores: what is the prevalence of STH, and what WASH risk factors contribute towards infections? What are the associations between STH infections and plausible STH-related health outcomes, and finally, what are the associations between aspects of WASH and the village environment with intensity of STH infection, in these communities? Environmental variables, but again few WASH variables, were associated with intensity of STH infection in this analysis. Despite this, WASH is the only identified mechanism that could reduce or prevent transmission in this high-transmission environment. It should be included in integrated control strategies. Download PDF Getting a GRiPP on everyday schistosomiasis: experience from Zimbabwe. Mutapi F. Parasitology. 2016:1-9. Abstract This paper considers the contributions to global schistosome control efforts made by research conducted in Zimbabwe and the historical context and developments leading to the national schistosomiasis control programme in Zimbabwe giving an example of Getting Research into Policy and Practice. Read abstract Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya. Njomo DW, Karimurio J, Odhiambo GO, et al. Trop Dis Travel Med Vaccines. 2016; 2(13). Abstract Poor practices and related socio-cultural perceptions are important risk factors in sustaining trachoma infection and transmission. Community members require health education for behavior change and awareness creation about surgery, MDA and its potential side effects for elimination of trachoma in Narok County, Kenya. Download PDF Influence of socioeconomic aspects on lymphatic filariasis: A case-control study in Andhra Pradesh, India. Mutheneni SR, Upadhyayula SM, Kumaraswamy S, et al. J Vector Borne Dis. 2016; 53(3):272-8. Abstract The cross sectional study showed that the population with low and medium socioeconomic status are at higher risk of filariasis. Read abstract Onchocerciasis elimination from Africa: One step in Northern Sudan. Kazura JW. Journal Am. J. Trop. Med. Hyg. 2016; 95(5):983-984. Abstract Onchocerciasis elimination strategies and “on the ground” programs should not be viewed as static or inflexible with respect to changes in MDA policy or local ecology that could affect transmission and its resilience to various interventions. Download PDF Women's empowerment and global health: A twenty-first century agenda.   Dworkin S, Gandhi M, Passano P. Univ of California Press. 2016; 352p. Book. Abstract What is women’s empowerment, and how and why does it matter for women’s health? Despite the rise of a human rights–based approach to women’s health and increasing awareness of the synergies between women’s health and empowerment, a lack of consensus remains as to how to measure empowerment and successfully intervene in ways that improve health. Women’s Empowerment and Global Health presents thirteen multidisciplinary case studies that demonstrate how science and advocacy can be creatively merged to enhance the agency and status of women. Download PDF Controlling neglected tropical diseases (NTDs) in Haiti: Implementation strategies and evidence of their success. Lemoine JF, Desormeaux AM, Monestime F, et al. PLoS Negl Trop Dis. 2016; 10(10):e0004954. Abstract By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale. Essential to this success have been in the detail of how MDAs were implemented. Key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign; strengthening community trust of the drug distributors; enforcing a "directly observed treatment" strategy; providing easy access to treatment; and ensuring quality data collection that was used to guide and inform MDA strategies. Download PDF Epidemiology of urinary schistosomiasis and knowledge of health personnel in rural communities of South-Western Nigeria. Awosolu OB. Journal of Parasitology and Vector Biology. 2016; 8(10):99-106. Abstract The high prevalence and intensity of Schistosoma haematobium infection in the current study area clearly indicated that this infection remains unabated and as such, local health personnel should be adequately trained on handling urinary schistosomiasis cases in these communities. Download PDF Promoting oral health in Africa: Prevention and control of oral diseases and noma as part of essential noncommunicable disease interventions. World Health Organization. Geneva. 2016. Manual. This manual aims at the prevention of oral diseases and promotion of good oral health. It emphasizes the fact that improving oral health is an integral part of the essential package of interventions against noncommunicable diseases at the primary health care level. Promoting Oral Health in Africa proposes a Basic Package of Oral Care, and includes a set of 10 protocols written specially for primary health care staff to aid in diagnosing and treating specific oral diseases. It also presents the overall rationale for health initiatives within school and community settings, and recommends a set of integrated activities at both levels. Download PDF Clinical research on neglected tropical diseases: challenges and solutions. Boelaert M. PLOS Neglected Tropical Diseases. 2016; 10(11):e0004853. Abstract Research pertaining to the neglected tropical diseases (NTDs) poses specific challenges that are linked to the diseases investigated, infrastructure (or lack thereof), culture, social-ecological systems, conflicting health policies, and ethics requirements, among otherr. Download PDF Improving coverage and compliance in mass drug administration for the elimination of LF in two ‘endgame’ districts in Indonesia using micronarrative surveys. Krentel A, Damayanti R, Titaley CR, et al. PLOS Neglected Tropical Diseases. 2016; 10(11):e0005027. Abstract Micronarrative surveys were shown to be a valid and effective tool to detect operational issues within MDA programs. District health staff felt ownership of the results, implementing feasible changes to their programs that resulted in significant improvements to coverage and compliance in the subsequent MDA. This kind of implementation research using a micronarrative survey tool could benefit underperforming MDA programs as well as other disease control programs where a deeper understanding is needed to improve healthcare delivery. Download PDF Disability Strengthening health information systems for disability-related rehabilitation in LMICs. McPherson A, Durham J, Richards N, et al. Health Policy and Planning. 2016:1-11. Abstract Effective health related disability planning requires reliable data on disability prevalence, functional status, access to rehabilitation services and functional outcomes of rehabilitation. For low-resource settings, and where routine HIS are already challenged, planning to include disability and rehabilitation foci starting with a minimum dataset on functioning, and progressively improving the system for increased utility and harmonization, is likely to be most effective and minimize the potential for overburdening fragile systems. Download PDF Measuring functional and patient-reported outcomes after treatment of mutilating hand injuries: A global health approach. Giladi AM, Ranganathan K, Chung KC. Hand Clin. 2016; 32(4):465-475. Abstract This article discusses these social and medical system issues and reviews components of a comprehensive approach to measuring outcomes after these injuries. Patient-reported outcomes are highlighted. Methods of optimizing outcomes measurements and studies, disability assessments, and associated research are also discussed. Read abstract Physically disabled women and sexual identity: a PhotoVoice study. Payne DA, Hickey H, Nelson A, et al. Disability & Society. 2016; 31(8):1030-1049. Abstract The study aimed to explore four young physically disabled women’s experiences and perspectives regarding sexuality and disability. We used PhotoVoice, a participatory action research method which uses photographs, to capture and convey our participants’ concerns. Through their photographs they showed that everyday interactions with others, particularly strangers or meeting people for the first time, were made difficult by how they were always seen as having a disability. Other parts of their identity were not recognised. The change the young women wanted was for people to see them as young women and not just as disabled. Download PDF Factsheet: Disability and health. Reviewed November 2016. World Health Organization WASH Status of sanitation and hygiene practices in the context of "Swachh Bharat Abhiyan" in two districts of India. Swain P, Pathela S. Int J Community Med Public Health. 2016; 3(11):3140-3146. Abstract Study finding shows that 76% of total respondent were not aware about the “Swachh Bharat Abhiyan” and 56% were not aware about the significance of keeping good sanitary conditions. It was also observed that among the total respondents only 54% were defecating in the toilet and 8% of respondents don’t wash their hands after defecation and 11% of the respondents never wash their hands before meals. As observed, only 33% of female respondents were using sanitary pads during their menstruation. Download PDF 'If an eye is washed properly, it means it would see clearly': A mixed methods study of face washing knowledge, attitudes, and behaviors in rural Ethiopia. Aiemjoy K, Stoller NE, Gebresillasie S, et al. PLoS Negl Trop Dis. 2016; 10(10):e0005099. Abstract Interventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors. Download PDF Assessing the impact of sanitation on indicators of fecal exposure along principal transmission pathways: A systematic review. Sclar GD, Penakalapati G, Amato HK, et al. Journal International Journal of Hygiene and Environmental Health.2016; 219(8):709-723. Abstract The studies found little to no effect from sanitation interventions on these transmission pathways. There was no evidence of effects on water quality (source or household), hand or sentinel toy contamination, food contamination, or contamination of surfaces or soil. There is some evidence that sanitation was associated with reductions in flies and a small effect on observations of feces. Studies show an inverse relationship between the distance of a water supply from a latrine and level of fecal contamination of such water supply. Read abstract

 

 

Events

 

 

COR-NTD 2016 The annual meeting for the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) will take place on November 10-11, prior to the American Society of Tropical Medicine and Hygiene (ASTMH) Meeting in Atlanta, Georgia, USA.  The goal of the COR-NTD meeting is to strengthen the community of researchers, program implementers and their supporters to address knowledge gaps in a coordinated way, thus informing the agenda of future research and facilitating the global efforts of the World Health Organization and endemic countries to overcome NTDs. 65th Annual ASTMH Meeting November 13-17, Atlanta The American Society of Tropical Medicine & Hygiene The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students and all health care providers working in the fields of tropical medicine, hygiene and global health. The Annual Meeting is a five-day educational conference, that includes four pre-meeting courses, and draws approximately 4,400 attendees. All Roads Lead to Rome: the Path to the Vatican Conference on NTDs. The Pontifical Council for Health Care Workers is hosting an International Conference on neglected tropical diseases (NTDs) and rare diseases November 10-12, 2016 at the Vatican, “Towards a Culture of Health that is Welcoming and Supportive at the Service of People with Rare and Neglected Pathologies.” Sabin President Dr. Peter Hotez will deliver the opening keynote on NTDs, an patient with the NTD lymphatic filariasis (elephantiasis) has been invited to offer a reflection and the event will end with an audience of more than 5,000 conference participants, patients, and family members with Pope Francis in Paul VI Hall. Uniting four countries in the fight against NTDs Health experts, including Lazenya Weekes from SCI, attended an MRU Health meeting to discuss how best to tackle NTDs across four countries. The Mano River Union (MRU), is an international association between Liberia, Sierra Leone, Guinea and Côte d'Ivoire. This year’s meeting between 19-21 October was the first in 3 years, due to the Ebola outbreak in the sub-region. It aimed to reinvigorate efforts against NTDs, and share ideas and experiences in the field.

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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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(LML) A day on the ground

Leprosy Mailing List – November 15,  2016

Ref.:   (LML) A day on the ground

From:  Joel Almeida, London and Bombay

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Dear Pieter,

 

Lepromatous leprosy is much rarer than self-limiting forms of leprosy. It is also more difficult to suspect or recognize. Even the person affected does not suspect any illness. This is true of previously untreated patients as well as those reinfected after MDT.  Unfortunately, people with lepromatous leprosy spread far more M.leprae than do others with the disease. We ignore this at our peril.

 

Silent neuritis, without overt signs of inflammation, is responsible for 85% of nerve damage among South Asian populations on MDT. Even the person affected does not suspect the problem until it is too late. If we ignore this, and are content to focus on "reactions" with obvious signs of inflammation, then patients who develop silent neuritis during MDT can be condemned to avoidable visible deformity.

 

So, despite our best intentions and vigorous efforts with MDT, leprosy continues to spread and to disfigure people. We need to be pro-active in tackling these challenges, not waiting for people to come to our health centres. Unsuspecting individuals can't be expected to seek help for problems of which they're unaware. Instead, the expertise needs to go out to people wherever they are. The Indian government's increasingly pro-active approach is a step in the right direction.

 

Trained leprosy workers need to cover a large population so that they can make a big difference.  That's because lepromatous leprosy has an incidence rate much lower than the incidence rate of other forms of leprosy. Nerve damage is confined to under about 30% of all patients on MDT.  By covering a large population, each skilled leprosy worker can yield a rich harvest of good outcomes.

 

Skilled leprosy workers need to be mobile, so that they can cover a large population. In urban areas, they can cover a population of millions. In rural areas, they can cover hundreds of thousands of people. This means that even a huge country such as India could transform outcomes with as few as 1000 to 2000 trained, skilled and mobile leprosy workers. 

 

We raise tens of millions of dollars per year in contributions for leprosy work, and a fraction of that would suffice each year. We could train and employ the skilled, mobile leprosy workers needed to transform outcomes. Workers with leprosy expertise are so valuable that they deserve a generously funded career path. Then they will rush to be trained in leprosy.

 

Let's implement the simple measures that bring huge benefits. Then we can hope to reverse the rising tide of leprosy in India. Otherwise we continue to give M. leprae a free pass, and expose nerves to avoidable permanent damage. Then we wring our hands and wonder why M. leprae continues to outwit us.

 

Our message to governments and noble-minded donors can be clear: train and employ skilled leprosy workers, and reduce the spread of leprosy while protecting patients against disfigurement. We can explain exactly what the skilled, mobile workers are needed for:

 

1) Actively detect, monitor and protect people with lepromatous leprosy (both before and after MDT)

2) Actively detect and reverse silent neuritis, by monitoring patients during the first 2 years after starting MDT.

 

Zero transmission and zero disability will come only if we pay attention to what happens on the ground. For the past 15 years we have been fighting (and losing) a war while breaking the legs of our own soldiers. Now we can start restoring the skilled front-line workers who can transform outcomes.

 

Regards,

 

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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(LML) A day on the ground

Leprosy Mailing List – November 10,  2016

Ref.: (LML) A day on the ground

From:  Francesca Gajete and Teresa Gabriel, Manilla, Philippines

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Dear LML readers,

 

In reaction to the LML letters of Joel Almeida and Grace Warren “A day on the ground”, an interesting and very stimulating exchange developed between Dr. Francesca Gajete, previous national coordinator NLCP of the Philippines and member of the board of ILA, and Dr. Teresa Gabriel, the Chairperson of the Dermatology department and Leprosy Unit of the Research Institute on Tropical Medicine ( RITM), the research facility of the Department of Health of the Philippines, also recognized and accredited by WHO for the training of Fellows in TB/Leprosy & NTDs. She is Past President of the Philippine Dermatological Society (PDS) and member of the World Association of Dermatologists. Currently, the Chair of PDS Leprosy Interest Group.

 

Pieter AM Schreuder

Editor LML

 

“Dear Colleagues,

 

I do agree with Dr Grace Warren (LML< November 1, 2016)  that it's about time we address the issue on involving the Academe, CHED, DepEd.

 

This has been our longtime dream. Let's make it happen now, my dear friends.

 

Francesca Gajete
November 3, 2016”

 

 

“Dear Dr. Gajete,

In order for us to identify patients with early leprosy, we need to train also the medical technologists from health care centers, far flung areas and institutions that diagnose Leprosy only through clinical manifestations. 

 

We have informed them that we are willing to train medical technologists for at least 2 weeks but we have not received any interested participants from the regions that were involved in the workshop on leprosy and common skin diseases. 

 

As part of the workshop, we encourage the participants to do contact tracing to address possible reinfection from index family members and be able to treat leprosy early.

 

I am very thankful to NLCP for their continuous support in capacity building of health care personnel nationwide and projects geared to address stigma among leprosy patients.

 

Dr. Gabriel

Manilla, November 3, 2016”

 

 

“Dear  Dr Gabriel, 

 

Thank you for opening  the  doors in training of Leprosy Control Program frontline health workers particularly the Medical Technologies. 

 

I have included in the thread Program Managers and Cluster Heads. I would also suggest that the Philippine Association of Medical Technologist (PAMET) should be made aware of the various trainings available in your institution particularly in Leprosy & NTDs. 

 

God Bless and my warm regards,

 

Dr Gajete
Manilla, November 7, 2016”

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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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(LML) Protocol for a Randomized Controlled Trial Investigating Decompression for Leprous Neuropathy (The DELN Protocol)

Leprosy Mailing List – November 10,  2016

 

Ref.: (LML) Protocol for a Randomized Controlled Trial Investigating Decompression for Leprous Neuropathy (The DELN Protocol)

From:  Linda Lehman, Belo Horizonte, Brazil

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Dear Eric and team,

 

I want to congratulate your randomized controlled trial investigating decompression neuropathy in Leprosy (LML, November 8, 2016).  It is a very important work.

 

I understand from Dr. Theuvenet that there will be a new protocol including additional NFAs for future investigations.  I would be very interested in seeing this protocol as well as giving feedback on the Leprosy Review article of past work.

 

Best regards,

 

Linda

 

Linda F. Lehman, OTR/L MPH C.Ped

Senior Advisor for Morbidity Management & Disability Prevention

 

American Leprosy Missions

One ALM Way, Greenville, South Carolina 29601 USA

R. Castelo de Alenquer 390 Apt 302  Belo Horizonte, MG 31330-050 BRASIL

 

Brasil Cell (only when Brasil): +55 31 99637 5576

Whatsup (always available) & USA Cell (only when in USA):  +1 505 504 8749

llehman@leprosy.org | www.leprosy.org

 

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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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