Fw: Ref.: (LML) Florida, Yunnan, Brazil & reducing transmission of HD

 

 

Leprosy Mailing List – November 17,  2023

 

Ref.:  (LML) Florida, Yunnan, Brazil & reducing transmission of HD

From:  Joel Almeida, Mumbai, India

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Dear Pieter & colleagues,

 

Almost everyone would like to replace low incomes with high incomes, and illiteracy or poor schooling with ample schooling. However, it is not easy to transform incomes overnight. Does HD (leprosy) necessarily have to keep spreading until everyone is well schooled and has a good income? Is there any alternative until such time as everyone has plenty of schooling and income? 

 

Fig. 1 Newly detected MB cases over time

 

 

Persons with MB HD seldom self-heal. If not diagnosed promptly, they simply accumulate and are diagnosed eventually. Too often, delay in diagnosis permits irreversible nerve damage and visible deformity. The 5-year moving average of newly detected MB HD cases is a reasonably useful indicator of the underlying epidemiology.

 

From about 1993 active case-finding and MDT were stepped up greatly. This appears to have uncovered a backlog of accumulated, previously undiagnosed MB cases. Just when the number of newly detected MB cases reached an all-time high, HD was declared to be a non-problem. Since then, HD services have been curtailed greatly. Once the backlog of accumulated undiagnosed MB cases was cleared, the number of newly detected MB cases per year stagnated, despite widespread increases in income. 

 

Prior to 1995 several places had achieved dramatic and reasonably well-documented declines in the incidence rate of MB HD, including Karigiri (India, 1), Uele (DR Congo, 2) and Weifang/Shandong (China, 3). All of them had relatively low income levels at the time (see graphs below). All had ensured prolonged anti-microbial protection for LL (lepromatous) patients. This was the widespread practice until  the late 1990s. Thereafter even anergic LL patients were taken off anti-microbial protection after only 12 doses of rifampicin..

 

Fig. 2 New case detection rate over time compared between Wenshan (Yunnan, upper line) & Weifang (Shandong, lower line) 

 

 

From the late 1980s Wenshan (Yunnan) introduced fixed-duration treatment (FDT or MDT for no more than 24 months). By contrast.Weifang (Shandong) used prolonged MDT lasting at least until smear negativity (3). The course of the endemic diverged markedly (Fig. 2). In Weifang (lower line) the rapid, relentless decline in new cases led to near-zero transmission. In Yunnan, despite vast increases in income, the decline in MB HD has remained notably slower: between only 5%/year and 10%/year.(4) Yunnan today has a much higher GDP per capita than Shandong did in the late 1980s and early 1990s. Despite this markedly higher income, Yunnan continues to show a slower decline than 1980s Shandong in new HD cases. The difference in income levels between 1980s Shandong and 2020 Yunnan is the exact opposite of that predicted by claims that, in the battle against HD bacilli, improvements in income levels are more important than astute use of anti-microbials. 

 

Fig 3. Yunnan GDP per capita over time

 

Fig 4. Shandong GDP per capita over time

 

Elsewhere, Florida is not noted for conspicuously low incomes, compared to many HD endemic countries. Yet a few people in Florida develop signs of LL HD or MB HD each year even if they have never travelled to an endemic country and are not destitute. Intermittent contact with armadillo-contaminated soil appears sufficient for transmission of HD bacilli. Relatively high incomes apparently offer only limited protection against HD bacilli, once a genomically susceptible host encounters concentrated viable bacilli.

 

In Brazil, the type of HD in the presumed index case was a dominant factor in the risk of newly detected HD among contacts. The type of index case had a greater influence than even the illiteracy or relatively limited schooling of some contacts. (5)

 

 

Discussion

 

Everyone wants people to be well schooled and to earn a comfortable living. However, availability of concentrated viable HD bacilli and genomically susceptible hosts appears to be an even weightier factor in transmission than the income or schooling level of people. This is not to disparage the prime importance of improving living standards among people who have desperately low incomes and little or no schooling. It is merely to keep alive the legitimate hope and expectation of people in endemic areas that astute use of anti-microbials can achieve in more places what it demonstrably achieved in some places. There is no need to condemn people to anti-microbial neglect on the basis that they (or their descendants) will one day be well-schooled and have sufficient income.

 

Unprotected anergic LL patients can shed millions of viable HD bacilli per day or even per nose blow (6) Unprotected genomically susceptible hosts (genomically anergic LL patients with [re]infection or armadillos) are the key sources of concentrated viable bacilli. Anti-microbials are capable of protecting anergic LL patients against (re)infection in endemic areas. Armadillos and armadillo-contaminated soil can be avoided. 

Rapid declines in the incidence rate of even MB HD were demonstrated in Karigiri (India), Uele (DR Congo) and Weifang/Shandong (China) all at a time of relatively low incomes (1-3). It is one thing to look for the victims of the HD bacilli, in order to prevent irreversible nerve damage. Would it be a bad idea to ask where the HD bacilli came from in the first place, and to shut down the sources of concentrated viable bacilli? India wisely favours reverse contact tracing, where the source index case is sought to be identified and treated. When done well, that is likely to have greater epidemiological impact than waiting for people to become infected before intervening. It is also less stigmatising than stereotyping all HD patients, including those who shed zero bacilli, as being dangerous to contacts.

 

Withdrawing anti-microbial protection from LL patients in endemic areas after only 24 months of MDT is known to increase the risk of recurrence/reinfection from 1.27/100 patient-years of follow-up in the group treated till smear negativity, to 4.29/100 patient-years in the fixed 24 months MDT group (p<0.01) (7). Withdrawing MDT after only 12 months also increases the risk of painful ENL neuritis by 600% during months 13 to 24 after the start of MDT (8). One solution is fully supervised post-MDT chemoprophylaxis for LL patients, with multiple drugs (eg. ROM - rifampicin or rifapentine + ofloxacin or moxifloxacin + minocycline ). The more affordable alternative is simply to prolong MDT. 

 

Are we really determined to sit on our hands until income and schooling levels improve generally? Are we really determined to exclude anergic LL patients in endemic areas from anti-microbial protection once they complete 12 doses of rifampicin? Must they suffer bouts of excruciating ENL neuritis before they are re-admitted to anti-microbial protection? Would it be a bad idea to reduce the incidence rate of MB HD rapidly, as was achieved in several well-documented projects? (1-3)

Joel Almeida

 

References

 

1.      Norman G, Bhushanam JDRS, Samuel P. Trends in leprosy over 50 years in Gudiyatham Taluk, Vellore, Tamil Nadu. Ind J Lepr 2006. 78(2): 167-185. reviewed and analysed further in: 1a. Almeida J. Karigiri, India: How transmission rapidly was reduced in a low-income population.  LML 29 Oct 2020

2.     Tonglet R, Pattyn SR, Nsansi BN et al. The reduction of the leprosy endemicity in northeastern Zaire 1975/1989 J.Eur J Epidemiol. 1990 Dec;6(4):404-6 reviewed in: 2a. Almeida J. Reducing transmission in poor hyperendemic areas - evidence from Uele (DRC). LML 29 Nov 2019

3.      Li HY, Weng XM, Li T et al. Long-Term Effect of Leprosy Control in Two Prefectures of China, 1955-1993. Int J Lepr Other Mycobact Dis. 1995 Jun;63(2):213-221. reviewed & analysed further in: 3a. Almeida J. What really happened in Shandong? LML 16 Nov 2019

 

4.      Chen X, Shui T-J (2021) The state of the leprosy epidemic in Yunnan, China 2011–2020: A spatial and spatiotemporal analysis, highlighting areas for intervention. PLoS Negl Trop Dis 15(10): e0009783. https://doi.org/10.1371/journal.pntd.0009783

 

5.      Teixeira CSS, Pescarini JM, Alves FJO. Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil. JAMA Dermatol. 2020;156(6):640-648. doi:10.1001/jamadermatol.2020.0653

 

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

 

7.       Girdhar BK, Girdhar A, Kumar A. Relapses in multibacillary leprosy: effect of length of therapy. Lepr Rev. 2000 Jun;71(2):144-53

 

8.       Balagon MV, Gelber RH, Abalos RM, Cellona RV. Reactions following completion of 1 and 2 year multidrug therapy (MDT). Am J Trop Med Hyg 2010;83:637–44. Analysed further in 8a. Almeida J, LML 24 Mar 2023

 

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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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Fw: Ref.: (LML) VIEWPOINT: “Interruption of transmission”: A challenge

 

Leprosy Mailing List – November 14,  2023

 

Ref.:  (LML) VIEWPOINT: "Interruption of transmission": A challenge

From:  Paul EM Fine, London, UK

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Dear colleagues,

Dr. Fine gave a 30-minute keynote speech on "interruption of transmission" at The Bergen International Conference on Hansen's Disease held in Norway June 21–22, 2023, during which he used slides to share data and explain his thoughts in further detail. A video recording of his speech can be accessed at https://youtu.be/uF70pMt3Vqw?feature=shared&t=4094.

Leprosy Bulletin 117PDF

We asked permission from Dr. Takahiro NANRI, Executive Director Sasakawa Health Foundation and from Dr. Paul Fine, Professor of Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine to reprint the summary of his presentation at the Bergen International Conference on Hansen's Disease, Norway, June 2023 and permission graciously granted.

Dr. Fine is an expert in communicable diseases and their transmission. Every newcomer to the field of leprosy and leprosy control should read as a start his: "Leprosy: the epidemiology of a slow bacterium" and for example his: "The BCG Story: Lessons from the Past and Implications for the Future".

 

Pieter AM Schreuder

Editor LML

 

VIEWPOINT: "Interruption of transmission": A challenge

There has been much discussion of global targets for leprosy control ever since the initial declaration in 1991 to "eliminate" the disease "as a public health problem," defined as reduction of prevalence below 1 case per 10,000 population. The current (2021–2030) global leprosy strategy, entitled "Towards Zero Leprosy," states that WHO has "reset the target for leprosy elimination, defined as no new autochthonous cases as a result of interruption of transmission." On close inspection, it is not entirely clear what this means. Autochthonous cases are implicitly defined as "non-foreign" despite the fact that a foreigner may contract M. leprae infection in their new home and become an autochthonous but foreign-born case. And the phrase "interruption of transmission" is also problematic – as we have no good assay for M. leprae infection, we cannot directly measure what is to be interrupted! Instead we measure clinical disease, which is not itself transmitted; it only occurs in some individuals and even then only some years after infection.

Semantics aside, there are major questions to be addressed in association with these ambitious goals, in particular the effectiveness of different control approaches, be they a new vaccine, different modes of chemoprophylaxis, or different policies for case finding and treatment. We have long recognized that leprosy is associated with poverty but have little idea what feature of improved living standards is inimical to the infection. Does infection transmission not occur in better economic conditions, as in contemporary Europe, despite the presence of considerable numbers of apparently infectious immigrant cases? Or do some individuals become infected but not develop clinical disease under such conditions? In order to study this we need an assay which can recognize paucibacillary infections with M. leprae, a challenge which has stymied researchers for many years. Recent advances in immunology might provide a solution to this but few scientists are working on the problem.  

The role of the armadillo in the Americas emerges as a major – and embarrassingly neglected – question. Zoonotic leprosy has been confirmed repeatedly in the United States, but its contribution to leprosy in Latin America remains totally unknown. It is now possible to address this issue rigorously by sequencing M. leprae in armadillos and in human cases. The presence of this reservoir indicates that zero leprosy is not a feasible global goal. Should this not be acknowledged?

There is an implication of finality in much of the target language – in the words elimination, interruption, and zero leprosy. This implication may be considered useful as an advocacy tool, but the optimistic prediction of no more leprosy may discourage some young scientists from taking up leprosy as a career and contribute to the loss in expertise needed at this stage in the global effort against the disease. Perhaps it might be better to have a simpler and more conservative target: for example, just to continually reduce the actual incidence of clinical leprosy and the number of disabled patients in every endemic population. (The word actual in this sentence is crucial for emphasizing the need to maintain surveillance as some of the recent apparent declines in disease are attributable to reduced attention and failure to recognize or report cases.) Leprosy organizations would do well to consider the long term implications of this endeavor – how to preserve leprosy expertise, which will be needed far into the future, indefinitely at least in the Americas, and how to transition leprosy programs and resources as the disease declines to very low levels to address other related public health problems.

Further reading

To read more about armadillos as a large natural reservoir of M. leprae, Dr. Fine recommends starting with Gayathriy Balamayooran, Maria Pena, Rahul Sharma, Richard W Truman, "The armadillo as an animal model and reservoir host for Mycobacterium leprae," Clinics in Dermatology 33, no. 1 (2015): 108–115, https://doi.org/10.1016/j.clindermatol.2014.07.001.

 

 

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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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Fw: Ref.: (LML) Frequency of HD transmission or infection or disease

 

 
Leprosy Mailing List – November 12,  2023

 

Ref.:  (LML) Frequency of HD transmission or infection or disease

From:  Joel Almeida, Mumbai, India

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Dear Pieter & colleagues,

What is the frequency of HD (leprosy) transmission or infection or disease in endemic areas? These reports might be of interest..

Transmission indicated by Lymphocyte changes (1) 

 

This is one of the earliest reports and still an intriguing one. While only 1 out of 12 personnel at an HD research centre not directly working with HD patients showed relevant lymphocyte transformation suggesting exposure to HD bacilli, 15 out of 17 workers (88%) at an HD outpatient clinic there did so. This does not necessarily indicate disease nor presence or replication of bacilli in the subjects, nor even carriage of bacilli. It suggests merely exposure to HD bacilli consistent with transmission of bacilli. None of any expatriate study subjects showed such indications of exposure/transmission until they had lived in an endemic area for over 2 months. However, after living in an endemic area for over a year, more than 50% of those in contact with HD patients showed such evidence of exposure/transmission. This is consistent with subsequent serology findings elsewhere among contacts using antigens specific to M. leprae. Therefore, it appears that transmission of bacilli sufficient to induce distinctive host responses has been affecting tens of millions of people in endemic areas. These tens of millions are missing from our statistics, and have escaped any stigma or deformity because they are apparently inhospitable hosts for the bacilli. With increasingly sensitive tests more and more of these tens of millions can potentially be depicted as a problem, with the accompanying risk of stigma (but with near-zero risk of progressive disease, deformity or onward transmission). 

 

Transmission indicated by physical signs

 

The less frequently and more inexpertly a population is surveyed in endemic areas, the fewer self-healing cases are detected and the less frequent does transmission appear to be. Even in Karigiri (India), where contacts of HD patients were periodically monitored by reasonably competent paramedical workers/supervisors backed by highly experienced physicians, the detected incidence rate among contacts was inversely related to the frequency of monitoring. (2)  It appears that self-healing patients escape inclusion in statistics of HD while evading diagnosis, deformity and stigma. The true incidence rate of HD for academic purposes, including ALL who develop any physical signs of infection regardless of self-healing, is probably several times higher than reported in statistics. Most of those remaining undetected in reasonably well-run programmes are self-healing cases. Sufficiently sensitive tests can unmask such self-healing persons. Even simply examining the population more frequently and expertly can help unmask self-healing cases. For example, in Tamil Nadu (India) the Leprosy Elimination Campaigns greatly boosted case detection by discovering patients with a single lesion who formed as much as 80% or more of all newly detected cases.(3) Single lesion cases are more likely than other cases to self-heal without sequelae. Hopefully most of the self-healing cases so discovered escaped the worst impacts of stigma. Without LEC campaigns nobody would have known they had HD. On the other hand, the LEC campaigns very likely helped discover progressive cases who otherwise would have developed irreversible nerve damage and deformity before diagnosis. In Agra (4) expert teams doing house to house surveys found 16,400/million persons to have previously undetected signs of HD. This was remarkably more than the 900/million such persons discovered by Leprosy Elimination Campaigns done only a couple of years earlier.

 

Indian national sample survey

Sample surveys are generally not influenced by financial incentives to either under-report or over-report cases, nor to mis-assess or misreport the degree of deformity at diagnosis. The national sample survey carried out in India in or around 2011 seems particularly useful.(5) It was undertaken in response to a petition to members of the Upper House (Rajya Sabha) of the Indian Parliament initiated by an association of persons affected by HD. This is a good example of effective action by persons who experience(d) HD. At the behest of the parliamentarians, expert teams reliably examined a stratified random sample of the entire Indian population for previously undetected signs of HD. No more than 3660 persons per million population were newly detected to have accumulated signs of HD. No more than around 380,000 Indians in total were estimated by this sample survey to have previously undetected signs of HD. Around 70% of these were in rural populations. Implied claims that millions of Indians have hidden signs of HD are inconsistent with this reasonably reliable sample survey. The Supreme Court of India ordered that such sample surveys be repeated at intervals, which is a useful aid in getting such reliable surveys done. Without such surveys, financial incentives can (unintentionally) distort reported statistics especially when it comes to the frequency of visible deformity or the proportion of child cases among newly detected patients. In the absence of repeated school surveys, most self-healing cases among children escape detection and the child proportion among new cases falls regardless of the underlying epidemiology.

 

Reliable estimation of trends and magnitude

 

The total number of HD cases detected per year can be varied at will. To reduce detection, simply reduce efforts to detect. To increase the number detected, use more sensitive methods and deploy them more frequently. To boost the child proportion, do frequent school surveys. To reduce the child proportion, stop school surveys. It is possible in this way to show that the magnitude of the HD problem is ten to twenty times lesser or greater than previously imagined. It all depends on what one wishes to show.

 

Whatever else we do, we can count on the newly detected MB cases to reveal the underlying epidemiological situation because they rarely self-heal. To know the trend of HD in an endemic area and the magnitude of the problem, newly detected MB offer a reliable indicator albeit with some time lag. A multi-year moving average of the newly detected MB cases helps to smooth out artefacts in case-finding (e.g. due to COVID). 

 

Can we impact transmission?

 

None of this affects the fundamental problem in stopping transmission: the failure to protect genetically anergic LL (lepromatous) patients against (re)infection in endemic areas. In otherwise well-run programmes, this is the fundamental flaw that can maintain transmission indefinitely. By contrast, it is easy to reduce the incidence rate of MB (multibacillary) HD by up to 20%/year, as shown by projects in endemic areas that inadvertently or otherwise protected LL patients against reinfection (6-8). 40%/year decline in HD is available from periodic mass multi-drug admin in hot spots together with expert skin camps to detect missed LL patients and give them prolonged antimicrobial protection. (9,10) 

 

Given all this, are we in favour of condoning single drug use for contacts of largely non-infectious patients, that too without competently ruling out LL HD in the contacts?  Brazil has rejected SDR-PEP/LPEP. This seems wise because SDR-PEP/LPEP was both ineffective (as shown in Tocantins and other Brazilian states, and in well-implemented projects in Bima / Sampang / Sumenep - Indonesia and elsewhere) plus harmful through the inevitable selection of drug-resistant mutants in missed LL patients as well possibly increasing the risk of MB HD in patients with prior exposure to mycobacteria. (11)

 

We know how to do reliable sample surveys. We know how to achieve 16 to 20% annual decline in the incidence rate of MB HD, or even 40%/year in hot spots. Success is within reach if we protect LL patients against reinfection in endemic areas. As more and more endemic areas protect LL patients, we can look forward to an accelerating decline in new MB HD cases. As we exploit available interventions to the fullest, we can keep improving interventions in the light of new knowledge and technology.

The future is bright, as the heavy clouds of anti-microbial neglect are lifted from the backs of LL patients in endemic areas and they again can walk tall as every human being deserves to. 

 

Joel Almeida

 

 

References

 

1.      Godal T, Negassi K. Subclinical infection in leprosy. BMJ 1973; 3: 557-559

 

2      Jesudasan K, Bradley D, Smith PG, Christian M. The effect of intervals between surveys on the estimation of incidence rates of leprosy. Lepr Rev (1984) 55, 353-359

 

3.      WHO  1997 Action Program for Elimination of Leprosy.. Status Report

 

4.      Kumar A, Girdhar A, Girdhar BK. Prevalence of leprosy in Agra District (UP) from 2001 to 2003. Int J Lepr 2005. 73(2): 115-121

 

5.     Katoch K, Aggarwal A, Yadav VS, Pandey A. National sample survey to assess the new case disease burden of leprosy in India. Indian Journal of Medical Research, 2017; 146(5): 585-605.

 

6.     Norman G, Bhushanam JDRS, Samuel P. Trends in leprosy over 50 years in Gudiyatham Taluk, Vellore, Tamil Nadu. Ind J Lepr 2006. 78(2): 167-185. reviewed and analysed further in: 1a. Almeida J. Karigiri, India: How transmission rapidly was reduced in a low-income population.  LML 29 Oct 2020

 

7.     Tonglet R, Pattyn SR, Nsansi BN et al. The reduction of the leprosy endemicity in northeastern Zaire 1975/1989 J.Eur J Epidemiol. 1990 Dec;6(4):404-6 reviewed in: 2a. Almeida J. Reducing transmission in poor hyperendemic areas - evidence from Uele (DRC). LML 29 Nov 2019

8.      Li HY, Weng XM, Li T et al. Long-Term Effect of Leprosy Control in Two Prefectures of China, 1955-1993. Int J Lepr Other Mycobact Dis. 1995 Jun;63(2):213-221. reviewed & analysed further in: 3a. Almeida J. What really happened in Shandong? LML 16 Nov 2019

 

9.     WORKSHOP ON THE PREVENTION OF LEPROSY, POHNPEI, FEDERATED STATES OF MICRONESIA. 25-27 MAY 1999 sponsored by the Sasakawa Memorial Health Foundation Tokyo, Japan and the Western Pacific Regional Office of the World Health Organization. Int J Lepr, 67 (4) (SUPPLEMENT)

 10.     Diletto C, Blanc L, Levy L. Leprosy chemoprophylaxis in Micronesia. Lepr Rev. 2000;71(Suppl):S21–3.

 

11.       Richardus R, Alam K, Kundu K et al. Effectiveness of single-dose rifampicin after BCG vaccination to prevent leprosy in close contacts of patients with newly diagnosed leprosy: A cluster randomized controlled trial.  International Journal of Infectious Diseases 88 (2019) 65–72

 

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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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Fw: Ref.: (LML) Infolep monthly overview of new publications on leprosy, November 7, 2023.

 

Leprosy Mailing List – November 7,  2023

 

Ref.:  (LML) Infolep monthly overview of new publications on leprosy, November 7, 2023.

From:  Roos Geutjes & Josephine Breman-Srivastava, Amsterdam, the Netherlands

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Dear colleagues, 

An amazing achievement in the journey towards the elimination of leprosy by the year 2030 has been made: The Republic of Maldives was celebrated by the World Health Organization for achieving five consecutive years of zero child Leprosy case detection and interruption of transmission! Central to the success of the Zero Leprosy program has been the training and capacity-building of healthcare professionals. 

In the past Newsletter editions, we shared the launch of the NTD Inclusion Score Card (NISC). If you want to learn more about it; please join the exclusive NISC webinar "Unlocking Organisational Impact Through the NTD Inclusion Score Card (NISC) - Your Path to Inclusion and Participation" on the 13th of November; 13:30 - 15:00 GMT +1. Please click here to secure your spot! Additionally, there is a facilitator available free of cost between now and the end of December 2023, who can support you and your organization with the assessment. If interested, please reach out to Bernice Ejiogu (b.ejiogu@nlrinternational.org). 

We want to show appreciation to Fontilles for the publication of the Revista de Leprología, which came to an end this year after 78 years of publishing scientific work and international knowledge on leprosy in the Spanish language.

Warm regards,

Roos Geutjes & Josephine Breman-Srivastava

www.infolep.org
info@infolep.org

Practical Materials

SDR-PEP Implementation - Standard Operating Procedures (SOPs) (Guiding documents)
NLR . 2023.
 

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Sex & Gender In Health Research Resource Hub (Resource Repository)
human reproduction programme (hrp) , TDR: For research on diseases of poverty . n.d. 
 

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Pepra med lepra - siste nytt frå leprafronten (Podcast in Norwegian & English)
Pestpodden . 2023.
 

Highlighted

The geographical distribution and socioeconomic risk factors of COVID-19, tuberculosis and leprosy in Fortaleza, Brazil
Taal AT, Barreto JG, Santos de Sousa GD, et al. BMC Infectious Diseases. Springer Science and Business Media LLC. 2023; 23 (1) : 1-10.
 

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The spectrum of central nervous system manifestations in leprosy: a systematic review of published case reports and case series.
Garg R, Uniyal R, Pandey S, et al. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2023.
 

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Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: A protocol for a randomized double-blind, controlled Phase 2 trial in Indonesia (MetLep Trial)
Krismawati H, Muchtar SV, Rahardjani M, et al. Wellcome Open Research. F1000 Research Ltd. 2023.
 

Revista de Leprologia - Fontilles

On July 1, 1944, Fontilles published the first issue of the medical journal Revista de Leprología with the aim of publishing the sanatorium of Fontilles's scientific work and the most relevant international knowledge on leprosy. Over the years, it became an important reference, in the Spanish-speaking world for consultation and training on leprosy. This has been the work of Revista de Leprología during the last 78 years and with our issue 33(4) July-December 2022 the journal has come to an end.

Fontilles wishes to thank all the scientific organizations and individuals who have contributed with their publications and advice, with a special mention to the Editorial Board during all these years who have been fundamental for the success of the publication.

 

New publications

Feel free to contact us to receive full-text versions if these cannot be found through the Infolep portal.

Redesigning multi-drug therapy: Hasty or judicious?
Sagar HK, Singh Pawar H. Indian Journal of Dermatology, Venereology and Leprology. Scientific Scholar. 2023.
 

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Hansen's Disease: Still a Burden in Post Elimination Era
Praveena C, Anupama Y. G, Anushree L. S, et al. Indian Journal of Leprosy . Hind Kusht Nivaran Sangh. 2023; 95 (2) : 103-109.
 

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Time to revisit the purported link of leprosy reactions with infective triggers: An unnecessary economic burden for patients.
Muddebihal A, Sardana K, Khurana A, et al. Tropical doctor. 2023.
 

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Neuromuscular ultrasound in leprosy: A scanning protocol.
Pirola R, Visser L, Nasr-Eldin Y, et al. Journal of clinical ultrasound : JCU. 2023.
 

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Field-friendly anti-PGL-I serosurvey in children to monitor transmission in Bihar, India.
Pierneef L, Malaviya P, van Hooij A, et al. Frontiers in medicine. 2023.
 

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Ticks are unlikely to play a role in leprosy transmission in the Comoros (East Africa) as they do not harbour DNA.
Krausser L, Chauvaux E, Van Dyck-Lippens M, et al. Frontiers in medicine. 2023.
 

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Grade of disability and perceived stigma of leprosy patients: Is there any relationship?
Dalimunthe D. A, Sinambela D. W. I, Lubis S. R. Journal of Pakistan Association of Dermatologists. 2023; 33 (4) : 1552-1556.
 

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Leprosy Neuropathy: Clinical Presentation
Noer R. R, Kurniawan S. N. Journal of Pain, Headache, and Vertigo. 2023; 4 (2) : 27-30.
 

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Histoid leprosy, an unusual variant of leprosy − review of literature
Santhanakrishnaan S, Dakshinamoorthy M. Egyptian Journal of Dermatology and Venereology. 2023; 43 (3) : 161–163.
 

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Point-of-care ultrasound of peripheral nerves in the diagnosis of Hansen's disease neuropathy
Voltan G, Filho FB, Leite MN, et al. Frontiers in Medicine. Frontiers Media SA. 2022.
 

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Health issues of the indigenous communities with special reference to the Particularly Vulnerable Tribal Groups (PVTGs) of Odisha: a review
Kanrar P, Goswami M, Roy S. Papers on Anthropology. University of Tartu. 2023; 32 (1) : 45-80.
 

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Overview of leprosy, including the diagnosis and current available treatments
Srivastav Y, Prajapati A, Jaiswal A, et al. Journal of Innovations in Applied Pharmaceutical Science (JIAPS). South Asian Academic Publications. 2023.
 

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Role of pharmacist in the management of Hansen's Disease: A scoping review
de Oliveira Duarte EC, Santiago NR, Visacri MB, et al. Exploratory Research in Clinical and Social Pharmacy. Elsevier BV. 2023.
 

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Dehabilitation among Leprosy Affected Persons and Lived Experiences: A Mixed-Method Study
Gupta A, Khapre M, Saini B, et al. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023; 95 (3) : 165-2023.
 

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Clitoria Ternatea Antioxidant Reduces Serum MDA in Leprosy Patients with Reversal Reactions
Ananda FA, Kusumaningrum N, Muniroh M, et al. Jurnal Ilmiah Kesehatan (JIKA). LPPM Akper Yapenas 21 Maros. 2023; 5 (2) : 291-301.
 

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To study the effectiveness of Methotrexate as a steroid sparing agent in Type 2 Lepra reaction
Batham M, Malviya A, Kumar V, et al. Journal of Cardiovascular Disease Research. 2023; 14 (9) : 620-624.
 

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Intra-urban differences underlying leprosy spatial distribution in central Brazil: geospatial techniques as potential tools for surveillance
Carvalho AG, Dias CLH, Blok DJ, et al. Geospatial Health. PAGEPress Publications. 2023.
 

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Lepromatous Ulcer
Rai T. Uncommon Ulcers of the Extremities. Springer Nature Singapore. 2023.
 

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Th17 Cells and Cytokines in Leprosy: Understanding the Immune Response and Polarization.
Zaniolo L, Damazo A. Revista da Sociedade Brasileira de Medicina Tropical. 2023.
 

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Immunohistochemical Characterization of M1, M2, and M4 Macrophages in Leprosy Skin Lesions
Quaresma TC, de Aguiar Valentim L, de Sousa JR, et al. Pathogens. MDPI AG. 2023; 12 (10) : 1-14.
 

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Single-nucleotide polymorphism of interleukin-10 promoter (IL-10 -819C/T) in leprosy patients with and without erythema nodosum leprosum, and household contacts
Arif SM, Massi N. Narra J. Narra T. 2023; 3 (3) : e276.
 

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Molecular Characterization in 3D Structure of MicroRNA Expressed in Leprosy
Andrade LJDO, Jesus HBD, Oliveira LMD, et al. Revista de Ciências Médicas e Biológicas. Universidade Federal da Bahia. 2023; 22 (2) : 188-196.
 

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Construction and validation of an educational video for nurses on the management of neuropathic ulcer associated with leprosy
Souza CBL, Brandão MGSA, Silva PGD, et al. ESTIMA, Brazilian Journal of Enterostomal Therapy. SOBEST Associacao Brasileira de Estomaterapia. 2023.
 

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Assessment of knowledge and awareness about leprosy among medical college students in Tripoli
Amer H, Hariba Z. Journal of Science and Technology - Awlad Ali. 2023.
 

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Discapacidad por lepra
Gascón L. C. H.. Folia Dermatológica Cubana. 2023; 17 (1) : 1-6.
 

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Conferências de saúde e a hanseníase: ditos e silenciamentos sobre a doença negligenciada e seus estigmas
Pegaiani KNA, Pinto NDS, Batiston AP, et al. Saúde e Sociedade. FapUNIFESP (SciELO). 2023; 32 (3) : 1-12.
 

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A implementação do teste anti-pgl1 no sistema único de saúde para rastreio de contactantes de hanseníase
Oliveira M. F, Costa M. de S. N. M, Fonseca A. M. M, et al. 2023: ANAIS DO IV COMA: CONGRESSO MÉDICO ACADÊMICO DA FACULDADE DE MEDICINA DE JUIZ DE FORA - UNIPAC-JF. 2023.
 

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A persistência da hanseníase no brasil: problemas na detecção precoce ou falta de interesse das políticas de saúde?
Erpen G. G, Bevilaqua J. F, Xavier P. B. Seminário de Iniciação Científica e Seminário Integrado de Ensino, Pesquisa e Extensão (SIEPE). 2023.
 

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Adesão ao tratamento de Hanseníase no município de Itumbiara - GO
Rocha LA, Vicente DAR, Da Cunha LLP, et al. Brazilian Journal of Health Review. South Florida Publishing LLC. 2023; 6 (5) : 24869-24883.
 

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Filhos e Comunicantes: a construção do problema da proximidade com osdoentes de hanseníase na legislação.
da Silva L. F. Revista Desenvolvimento Socioeconomico em debate. 2023; 9 (2) : 22-40.
 

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Tecnologias em saúde e prevenção de incapacidades físicas por hanseníase: revisão integrativa
Candido SCN, Almeida PD. Revista Prevenção de Infecção e Saúde. Universidade Federal do Piaui. 2023; 9 (1) : 1-14.
 

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Respuesta inmune en pacientes con diagnóstico de lepra
Darias-Domínguez C, Velázquez-Sánchez A, De Vegas-Ascanio L, et al. Revista Médica Electrónica. 2023.
 

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Qualidade de vida de pessoas com hanseníase residentes em um hospital colônia
Costa RMPG, Fernandes MA. Contribuciones a las Ciencias Sociales. South Florida Publishing LLC. 2023; 16 (9) : 15049-15063.
 

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Avaliação da import ncia de testes rápidos no diagnóstico precoce da hanseníase e seu papel na promoção da saúde pública
Sousa MCCD, SILVA MARD, VIDAL TIR, et al. Anais do IV Congresso Nacional de Inovações em Saúde. Revista Multidisciplinar em Saúde. 2023.
 

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Hanseníase e racismo estrutural: análise dos determinantes sociais de saúde no município de cascavel, paraná
Peres GL, Griep R, Gomes ECZ. Revista Ibero-Americana de Humanidades, Ciências e Educação. Revista Ibero-Americana de Humanidades, Ciencias e Educacao. 2023; 9 (9) : 4546-4559.

Overview and Current Advances in Dapsone Hypersensitivity Syndrome.
Wang Z, Zeng R, Wu Z, et al. Current allergy and asthma reports. 2023.
 

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High frequency of ofloxacin resistance patterns of M. leprae from India: An indication to revisit second line anti-leprosy treatment regimen.
Chhabra S, Narang T, Sahu S, et al. Journal of global antimicrobial resistance. 2023.
 

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The cross-cultural validation of the Beach Center Family Quality of Life Scale among persons affected by leprosy or podoconiosis in Northwest Ethiopia.
Aycheh M, Noordende A, Moges N, et al. PLoS neglected tropical diseases. 2023; 17 (10) : 1-15.
 

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Psychological Interventions in Psychodermatological Practice
Latheef ENA, Hafi BNA. Clinical Dermatology Review. Medknow. 2023; 7 (4) : 333-337.
 

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Voices From Below: The Politics of Leprosy Control in Southeastern Nigeria, 1926-1960
Kingsley Eze O. Department of History. University of Mississippi. 2023.
 

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Multiplex PCR-based RFLP assay for early identification of prevalent Mycobacterium leprae genotypes.
Dwivedi P, Sharma M, Singh P. Diagnostic microbiology and infectious disease. 2023.
 

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Use of Multidrug Therapy Regimen for Hansen Disease Patients
Nawaz S. Mycobacterial Diseases. 2023; 13 (5) : 1.
 

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Clinical profile of newly diagnosed leprosy patients with special references to deformities and disabilities
Chhakchhuak L, Chhakchhuak L, Rongpi R, et al. Asian Journal of Medical Sciences. Nepal Journals Online (JOL). 2023; 14 (9) : 158-161.
 

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Are leprosy and Hansen's disease identical?
Guo J, Dong X. Nature. 2023; 622 (7981) : 31.
 

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Vision-related quality of life among released from treatment cases of leprosy evaluated with NEI-VFQ-25: a cross-sectional study.
Irawati Y, Andayani G, Rahayu T, et al. BMC ophthalmology. 2023; 23 (1) : 1-8.
 

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Advances in the pathogenic, genetic and immunological studies of leprosy
Mi Z, Liu H, Zhang F. hLife. Elsevier BV. 2023.
 

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Analysis of vitamin E in leprosy patients
Hazlianda C. P, Dalimunthe D. A, Partogi D. Journal of Pakistan Association of Dermatologist. 2023; 33 (4) : 1238-1241.
 

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Childhood Leprosy in Postelimination Era: A Clinico-Epidemiological Prospective Observational Study from India
Joy N, Patnaik S, Nayak S, et al. Indian Dermatology Online Journal. 2023.
 

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Childhood Leprosy: A 11 Year Retrospective Study at a Tertiary Care Hospital
Chodavadia N. H, Raghavon U. N, Bhuptani N. V, et al. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023.
 

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Adverse reactions after Covid-19 vaccination in persons affected by leprosy: A scoping review
Ramasamy S, Galhotra A, Agrawal S. Journal of Family Medicine and Primary Care. Medknow. 2023; 12 (9) : 1771-1774.
 

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An evaluation protocol of 'Replicability Model' project for detection and treatment of leprosy and related disability in Chhattisgarh, India.
Darlong J, Govindasamy K, Ilozumba O, et al. PloS one. 2023; 18 (10) : 1-11.
 

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Implementation of suitable optimal control strategy through introspection of different delay induced mathematical models for leprosy: A comparative study
Ghosh S, Roy AK, Roy PK. Optimal Control Applications and Methods. Wiley. 2023.
 

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The Development of 2D Animation Media on the Self-care of Leprosy Patients for Public Health Personnel in Rajpracha Samasai Institute, Department of Disease Control, Ministry of Public Health
Buranut K, Jirachai P. International Journal of Educational Communications and Technology (IJECT). 2024; 4 (1) : 1-8.
 

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Study of Hematological Changes and Neutrophil to Lymphocytes Ratio in Type 2 Lepra Reaction Cases
Vaishnani J. B, Momin A. M, Modi P, et al. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023.
 

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Comparison of serum levels of interleukin 17 and interleukin 9 in leprosy patients with and without lepra reaction: A cross-sectional analytical study from Central India
Choudhary R, Chhabra N, Patel S. Indian Journal of Dermatology. 2023.
 

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Do Systemic Steroids Given for Lepra Reactions Increase the Risk of Relapse after Release from Treatment?: A 10 year Retrospective Study from a Tertiary Care Centre
Nair S. P, Viswanath V. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023.
 

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HSP60 mimetic peptides from Mycobacterium leprae as new antigens for immunodiagnosis of Leprosy.
Lima M, Corrêa M, Moraes E, et al. AMB Express. 2023; 13 (1) : 120.
 

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A Literature Review: Understanding TNF and IL-1 of the Main Cause of Thorombo-occlusive in Lucio's Phenomenon
Simatupang E. G. H, Pratiwi U, Saint H. O, et al. International Journal of Health, Economics, and Social Sciences. 2023.
 

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Single Nucleotide Variants in the TLR1, TLR2 and TLR6 Genes: A Case-Control Study in a Colombian Population.
Gutierrez-Castañeda L, Acosta C, Bustos M, et al. Tropical medicine and infectious disease. 2023; 8 (10) : 1-13.
 

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Leprosy in children under fifteen years of age in the most hyperendemic municipality in Brazil
Costa RM, Menezes MS, Guimarães MSA, et al. Revista Paulista de Pediatria. FapUNIFESP (SciELO). 2024.
 

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Children's drawings as an instrument for evaluating learning in a health educational activity about leprosy
Silva D. R, Paschoal V. Del A, Nardi S. M. T. Revista Família, Ciclos de Vida e Saúde no Contexto Social. 2023.
 

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Aspectos imunológicos das reações hansenícas: uma overview
Rodrigues MLC, Drummond Júnior DG, Ungaro A, et al. CONTRIBUCIONES A LAS CIENCIAS SOCIALES. South Florida Publishing LLC. 2023; 16 (10) : 22131-22148.
 

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Hanseníase em menores de quinze anos no amazonas: aspectos clínicos e epidemiológicos e distribuição espacial
Da Silva Ribeiro UK, Dantas Almeida P. Revista Enfermagem Atual In Derme. Revista Enfermagem Atual. 2023; 97 (3) : 1-13.
 

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Protocolo de Atividade e Exercício (PAE): A efetividade do uso do instrumento para reabilitação de MMSS em pacientes com sequelas hansênicas em Belém
Carvalho AADL, Pereira AIR, Boaventura ACS, et al. CIÊNCIA MÉDICA DESCOBERTAS CIENTÍFICAS PARA UMA SAÚDE TRANSFORMADORA. Seven Editora. 2023.
 

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Evolução do grau de incapacidade física e do escore olhos, mãos e pés em casos novos de hanseníase
Bomtempo CF, Ferrari SMF, Grossi MADF, et al. Hansenologia Internationalis: hanseníase e outras doenças infecciosas. Instituto Lauro de Souza Lima. 2023.
 

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Percepção dos profissionais de saúde acerca das ações de controle da Hanseníase frente a pandemia COVID-19
Chaves AEP, Da Silva GBC, De Medeiros SM, et al. Contribuciones a las Ciencias Sociales. South Florida Publishing LLC. 2023; 16 (10) : 19065-19083.
 

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Minha cor não é essa, essa é a cor do remédio: imagem corporal de menores de 15 anos que tiveram hanseníase em Petrolina-PE e Juazeiro-BA
Araújo Vieira MC, Lima Cruz Teixeira MDG, Vieira Ribeiro K, et al. O Mundo da Saúde. Centro Universitario Sao Camilo - Sao Paulo. 2023.
 

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Atuação do farmacêutico no tratamento de hanseníase nas unidades básica
Silva CVVDSD, Andrade LGD. Revista Ibero-Americana de Humanidades, Ciências e Educação. Revista Ibero-Americana de Humanidades, Ciencias e Educacao. 2023; 9 (9) : 3847-3857.
 

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Pemberdayaan kader tangguh peduli lepra dalam pelacakan kusta
Kurniadi K, Aniharyati A, Haris A. Jurnal Pengabdian Masyarakat Multidisiplin. LPPM Universitas Abdurrab. 2023; 7 (1) : 64-71.
 

Case Reports

Autologous Subcutaneous Platelet-Rich Plasma in the Management of Non- Healing Trophic Ulcer in Leprosy
Rather S, Kour S, Aslam A. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023; 95 (3) : 221-224.
 

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Type 1 Lepra Reaction Presenting as Unilateral Perichondritis: A Case Report and Review of Literature
Adil M, Naaz S, Amin S. S, et al. Indian Journal of Leprosy. Hind Kusht Nivaran Sangh. 2023; 95 (3) : 237-240.
 

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Leprosy combined with vitiligo skin lesions.
Charlier C, Canouï E. La Revue de medecine interne. 2023.
 

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Surgery for ulnar nerve decompression and drainage of a caseous granuloma in a neural form of leprosy in children.
de Souza F, Lemos L, Rosado B, et al. Clinical case reports. 2023; 11 (10) : 1-5.
 

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Histoid Leprosy Presenting with Borderline Tuberculoid Leprosy in Type 1 reaction: An Uncommon Shift of Spectrum
Dhattarwal N, Sharma R, Divyashree R. Indian Journal of Leprosy. Hind Kusht Nivaran Sang. 2023; 95 (1) : 65-71.
 

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Type 2 reaction associated sensorineural hearing loss in a drug resistant lepromatous leprosy patient: A case report
Pawar HS, Singh I, Sagar HK. Asian Pacific Journal of Tropical Medicine. Medknow. 2023; 16 (9) : 425-427.
 

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Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case
Panigrahi R, Priyadarshini SR, Sahoo PK, et al. Cureus. Springer Science and Business Media LLC. 2023.
 

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Erythema nodosum leprosum after allergen immunotherapy as initial presentation of lepromatous leprosy treated with novel multidrug regimen.
Xie C, Stryjewska B, McNiff J, et al. JAAD case reports. 2023.

Adrenal Crisis in a Leprosy Patient due to Chronic Steroid Abuse: A Life-Threatening Emergency Often Overlooked!
Sinha P, Sharma J, Sharma M, et al. Journal of Marine Medical Society. 2023.
 

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Role of Ultrasonography in Peripheral Nerve Involvement in Leprosy: A Cross-sectional Study
Khan I, Alvi E, Khan MN, et al. Journal of Advances in Medicine and Medical Research. Sciencedomain International. 2023; 35 (19) : 273-278.
 

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Total knee arthroplasty for neuropathic arthropathy in a patient with leprosy.
Kii S, Sonohata M, Mawatari M. Modern rheumatology case reports. 2023.
 

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Childhood borderline lepromatous leprosy: a case report.
Hutahaean G, Susanto M, Napitupulu T, et al. The Turkish journal of pediatrics. 2023; 65 (5) : 862-867.
 

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Analysis Mycobacterium lepromatosis as the causative agent of diffuse lepromatous leprosy patient in Indonesia
Alinda MD, KARIM A, PUTRA BHK, et al. Biodiversitas Journal of Biological Diversity. UNS Solo. 2023.
 

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Claw Hand Deformity in Leprosy
Zhao GZ, Venkatesh S, Zheng L, et al. The American Journal of Medicine. Elsevier BV. 2023.
 

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Effective amelioration of the Lucio phenomenon with adjuvant tofacitinib therapy in a patient with dual infection of Mycobacterium leprae and Mycobacterium lepromatosis: a case report from India
Patel NH, Padhiyar JK, Patel KA, et al. Access Microbiology. Microbiology Society. 2023; 5 (10) : 1-9.
 

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Type 2 Leprosy Reaction Mimicking Leukocytoclastic Vasculitis in a Postpartum Patient.
Schaffenburg W, Royer M, Scorza M. The American Journal of dermatopathology. 2023.
 

News & Events

 

CPHIA 2023
November 27-30, 2023; Lusaka, Zambia.

The 3rd International Conference on Public Health in Africa (CPHIA). The theme of the conference is "Breaking Barriers: Repositioning Africa in the Global Health Architecture". The conference provides a unique African-led platform for leaders across the continent to reflect on lessons learned in health and science, and align on a way forward to creating more resilient health systems.
 

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Reaching the Last Mile Forum 2023
December 3, 2023; Dubai, United Arab Emirates.

The Reaching the Last Mile (RLM) Forum will stimulate new momentum, innovation, and investment towards solving the urgent health challenges faced by last-mile communities. Taking place within COP28's inaugural Health Day, the forum will provide a vital platform to elevate and embed health in the global climate agenda, with an emphasis on building resilient health systems that best serve vulnerable communities.

The forum will be a hybrid event, with virtual participation also available. Please note that forum attendance is by invitation only and invitations are non-transferable. To request an invitation, please email info@reachingthelastmile.com

 

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TropicalMed 2023 Best PhD Thesis Award 

TropicalMed is inviting applications for the TropicalMed 2023 Best PhD Thesis Award. The prize will be awarded to a PhD student or recently qualified PhD who produced a highly anticipated thesis with great academic potential. Application deadline is the 31 January 2024.
 

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8th Health Systems Global Symposium on Health Systems Research
November 18-22, 2024, Japan.

The 8th Global Symposium on Health Systems Research will be held in Nagasaki, Japan in 2024. The theme of  the Symposium is "Building Just and Sustainable Health Systems: Centring People and Protecting the Planet". 

 

NISC Webinar
November 13th, 2023;13:30-15:00 GMT +1; online.

A webinar that will introduce the NISC tool; its seven key domains of assessment; the NISC assessment process; and discover how the NISC can drive real change in your organisation, fostering a culture of inclusivity and accountability.
 

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The Health for All Film Festival

The 5th Health for ALL Film Festival calls for submissions from 1st of November 2023 to the 31st of January 2024. Public institutions, NGO's, communities, activists and students in public health, film schools, and other relevant domains are invited to submit their short films. The main categories are: Universal Health Coverage, Health Emergencies, and Better Health and Well-being. 
 

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Wellcome Discovery Awards

This scheme provides funding for established researchers and teams from any discipline who want to pursue bold and creative research ideas to deliver significant shifts in understanding that could improve human life, health and wellbeing.
Submission deadline is the 21 November 2023, 17:00 GMT.
 

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Career Development Awards 

This scheme provides funding for mid-career researchers from any discipline who have the potential to be international research leaders. They will develop their research capabilities, drive innovative programmes of work and deliver significant shifts in understanding that could improve human life, health and wellbeing.
Submission deadline is the 16 November 2023, 17:00 GMT.
 

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TropicalMed  2023 Young Investigator Award

TropicalMed is inviting nominations for the TropicalMed 2023 Young Investigator Award. The prize will be given to one young investigator in recognition of their excellence in the field of tropical medicine and infectious disease. 
The nomination deadline is the 30th of November, 2023.

 

Links

Info Hansen - A innovative hub for knowledge sharing about Hansen's Disease
 

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ALLF - Official website of the Association des Léprologues de Langue Française
 

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LML - Leprosy Mailing List - a free moderated email list that allows all persons interested in leprosy to share ideas, information, experiences and questions
 

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InfoNTD - Information on cross-cutting issues in Neglected Tropical Diseases (NTDs)

ILEP newsletter archive

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GPZL newsletter subscription

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WHO Goodwill Ambassador's Leprosy Bulletin

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Leprosy Review

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Leprosy Review Repository (1928-2001)

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Fontilles Revista de Leprología

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Indian Journal of Leprosy

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Hansenologia Internationalis

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HARP - database of Hansen's Disease Antimicrobial Resistance Profiles

GDPR & the Infolep newsletter

 
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Infolep will only process the data we have (names, email addresses) for the purpose of sending you the newsletter. We take your security seriously and will never share your contact details with anyone else.

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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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