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Hasker E, Assoumani Y, Randrianantoandro A, Ramboarina S, Braet SM, Cauchoix B, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Attoumani N, Grillone SH, Ronse M, Peeters Grietens K, Rakoto-Andrianarivelo M, Harinjatovo H, Supply P, Snijders R, Hoof C, Tsoumanis A, Suffys P, Rasamoelina T, Corstjens P, Ortuno-Gutierrez N, Geluk A, Cambau E, de Jong BC. Post-exposure prophylaxis in leprosy (PEOPLE): a cluster randomised trial. Lancet Glob Health 2024; 12:e1017-e1026. [PMID: 38762282 DOI: 10.1016/s2214-109x(24)00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) using single-dose rifampicin reduces progression from infection with Mycobacterium leprae to leprosy disease. We compared effectiveness of different administration modalities, using a higher (20 mg/kg) dose of rifampicin-single double-dose rifampicin (SDDR)-PEP. METHODS We did a cluster randomised study in 16 villages in Madagascar and 48 villages in Comoros. Villages were randomly assigned to four study arms and inhabitants were screened once a year for leprosy, for 4 consecutive years. All permanent residents (no age restriction) were eligible to participate and all identified patients with leprosy were treated with multidrug therapy (SDDR-PEP was provided to asymptomatic contacts aged ≥2 years). Arm 1 was the comparator arm, in which no PEP was provided. In arm 2, SDDR-PEP was provided to household contacts of patients with leprosy, whereas arm 3 extended SDDR-PEP to anyone living within 100 m. In arm 4, SDDR-PEP was offered to household contacts and to anyone living within 100 m and testing positive to anti-phenolic glycolipid-I. The main outcome was the incidence rate ratio (IRR) of leprosy between the comparator arm and each of the intervention arms. We also assessed the individual protective effect of SDDR-PEP and explored spatial associations. This trial is registered with ClinicalTrials.gov, NCT03662022, and is completed. FINDINGS Between Jan 11, 2019, and Jan 16, 2023, we enrolled 109 436 individuals, of whom 95 762 had evaluable follow-up data. Our primary analysis showed a non-significant reduction in leprosy incidence in arm 2 (IRR 0·95), arm 3 (IRR 0·80), and arm 4 (IRR 0·58). After controlling for baseline prevalence, the reduction in arm 3 became stronger and significant (IRR 0·56, p=0·0030). At an individual level SDDR-PEP was also protective with an IRR of 0·55 (p=0·0050). Risk of leprosy was two to four times higher for those living within 75 m of an index patient at baseline. INTERPRETATION SDDR-PEP appears to protect against leprosy but less than anticipated. Strong spatial associations were observed within 75 m of index patients. Targeted door-to-door screening around index patients complemented by a blanket SDDR-PEP approach will probably have a substantial effect on transmission. FUNDING European and Developing Countries Clinical Trials Partnership. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Zahara Salim
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Mohammed Amidy
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Nissad Attoumani
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Philip Supply
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017, Center for Infection and Immunity of Lille, Lille, France
| | | | | | | | - Philip Suffys
- Oswaldo Cruz Institute, Fiocruz, Laboratory of Molecular Biology Applied to Mycobacteria, Rio de Janeiro, Brazil
| | | | | | | | | | - Emmanuelle Cambau
- Inserm, IAME, Université Paris Cité, UMR 1137, Paris, France; AP-HP, Hôpital Bichat, Service de Mycobacteriologie Specialisee et de Reference, Paris, France
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Prakoeswa FRS, Haningtyas N, Dewi LM, Handoko EJ, Azenta MT, Ilyas MF. The role of CXCL10 as a biomarker for immunological response among patients with leprosy: a systematic literature review. PeerJ 2024; 12:e17170. [PMID: 38590701 PMCID: PMC11000641 DOI: 10.7717/peerj.17170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Involvement of a chemokine known as C-X-C motif chemokine ligand 10 or CXCL10 in the immunopathology of leprosy has emerged as a possible immunological marker for leprosy diagnosis and needed to be investigate further. The purpose of this systematic review is to assess CXCL10's potential utility as a leprosy diagnostic tool and evaluation of therapy. Methods This systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. A thorough search was carried out to find relevant studies only in English and limited in humans published up until September 2023 using PubMed, Scopus, Science Direct, and Wiley Online Library database with keywords based on medical subject headings (MeSH) and no exclusion criteria. The Newcastle-Ottawa Scale (NOS) was utilized for quality assessment, while the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was utilized for assessing the risk of bias. Additionally, a narrative synthesis was conducted to provide a comprehensive review of the results. Results We collected a total of 115 studies using defined keywords and 82 studies were eliminated after titles and abstracts were screened. We assessed the eligibility of the remaining 26 reports in full text and excluded four studies due to inappropriate study design and two studies with incomplete outcome data. There were twenty included studies in total with total of 2.525 samples. The included studies received NOS quality evaluation scores ranging from 6 to 8. The majority of items in the risk bias assessment, using RoBANS, across all included studies yielded low scores. However, certain items related to the selection of participants and confounding variables showed variations. Most of studies indicate that CXCL10 may be a helpful immunological marker for leprosy diagnosis, particularly in leprosy reactions as stated in seven studies. The results are better when paired with other immunological markers. Its effectiveness in field-friendly diagnostic tools makes it one of the potential biomarkers used in diagnosing leprosy patients. Additionally, CXCL10 may be utilized to assess the efficacy of multidrug therapy (MDT) in leprosy patients as stated in three studies. Conclusion The results presented in this systematic review supports the importance of CXCL10 in leprosy diagnosis, particularly in leprosy responses and in tracking the efficacy of MDT therapy. Using CXCL10 in clinical settings might help with leprosy early diagnosis. Yet the findings are heterogenous, thus more investigation is required to determine the roles of CXCL10 in leprosy while taking into account for additional confounding variables.
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Affiliation(s)
- Flora Ramona Sigit Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
- Department of Dermatology and Venereology, PKU Muhammadiyah Surakarta Hospital, Surakarta, Central Java, Indonesia
| | - Nabila Haningtyas
- Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
| | - Listiana Masyita Dewi
- Department of Microbiology, Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
| | | | - Moch. Tabriz Azenta
- Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Central Java, Indonesia
| | - Muhana Fawwazy Ilyas
- Department of Neurology, Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
- Department of Anatomy and Embryology, Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia
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Hinders DC, Taal AT, Lisam S, da Rocha AM, Banstola NL, Bhandari P, Saha A, Kishore J, Fernandes VO, Chowdhury AS, van 't Noordende AT, Mieras L, Richardus JH, van Brakel WH. The PEP++ study protocol: a cluster-randomised controlled trial on the effectiveness of an enhanced regimen of post-exposure prophylaxis for close contacts of persons affected by leprosy to prevent disease transmission. BMC Infect Dis 2024; 24:226. [PMID: 38378497 PMCID: PMC10877766 DOI: 10.1186/s12879-024-09125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. METHODS The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 - 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 - 600 mg) and clarithromycin (150 - 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox' proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. DISCUSSION Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. TRIAL REGISTRATION NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060.
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Affiliation(s)
| | | | | | | | | | | | | | - Jugal Kishore
- Vardhman Mahavir Medical College/Safdarjung Hospital, Delhi, India
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Li X, Ma Y, Li G, Jin G, Xu L, Li Y, Wei P, Zhang L. Leprosy: treatment, prevention, immune response and gene function. Front Immunol 2024; 15:1298749. [PMID: 38440733 PMCID: PMC10909994 DOI: 10.3389/fimmu.2024.1298749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Since the leprosy cases have fallen dramatically, the incidence of leprosy has remained stable over the past years, indicating that multidrug therapy seems unable to eradicate leprosy. More seriously, the emergence of rifampicin-resistant strains also affects the effectiveness of treatment. Immunoprophylaxis was mainly carried out through vaccination with the BCG but also included vaccines such as LepVax and MiP. Meanwhile, it is well known that the infection and pathogenesis largely depend on the host's genetic background and immunity, with the onset of the disease being genetically regulated. The immune process heavily influences the clinical course of the disease. However, the impact of immune processes and genetic regulation of leprosy on pathogenesis and immunological levels is largely unknown. Therefore, we summarize the latest research progress in leprosy treatment, prevention, immunity and gene function. The comprehensive research in these areas will help elucidate the pathogenesis of leprosy and provide a basis for developing leprosy elimination strategies.
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Affiliation(s)
- Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yun Ma
- Chronic Infectious Disease Control Section, Nantong Center for Disease Control and Prevention, Nantong, China
| | - Guoli Li
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Li Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Lianhua Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Batista G, Dioussé P, Diagne PM, Cissé M, Tamba IT, Diop F, Diop F, Fall L, Sakho D, Bammo M, Guèye N, Kasang C, Ortuño-Gutiérrez N, Zoubi LH, Diop MM. Feasibility of post-exposure-prophylaxis with single-dose rifampicin and identification of high prevalent clusters in villages' hyperendemic for leprosy in Senegal. PLoS Negl Trop Dis 2024; 18:e0011755. [PMID: 38300955 PMCID: PMC10863860 DOI: 10.1371/journal.pntd.0011755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/13/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Senegal is a leprosy low-endemic country with nine villages known to be hyperendemic with a leprosy incidence rate above 1,000 per million inhabitants. We aim to implement a door-to-door screening strategy associated with the administration of a single-dose-rifampicin (SDR) as post-exposure prophylaxis (PEP) to household and social contacts in these villages and to identify spatial clustering and assess the risk of leprosy in population according to the physical distance to the nearest index-case. METHODS From October/2020 to February/2022 active door-to-door screening for leprosy was conducted in nine villages. Using an open-source application, we recorded screening results, demographic and geographic coordinate's data. Using Poisson model we analysed clustering and estimated risk of contracting leprosy in contacts according to the distance to the nearest new leprosy patient. RESULTS In nine villages, among 9086 contacts listed, we examined 7115. Among 6554 eligible contacts, 97.8% took SDR. We found 39(0.64%) new leprosy cases among 6,124 examined in six villages. Among new cases, 21(53.8%) were children, 10(25.6%) were multibacillary and 05(12.8%) had grade 2 disability. The prevalent risk ratio and 95% confidence intervale(95%CI) adjusted by village were 4.2(95%CI 1.7-10.1), 0.97(95%CI 0.2-4.4), 0.87(95%CI 0.2-25), 0.89(95%CI 0.3-2.6) and 0.70(95%CI 0.2-2.5) for the contacts living in the same household of an index case, 1-25m, 26-50m, 51-75m and 76-100m compared to those living at more than 100m respectively. We identified nine high prevalent clusters including 27/39(69%) of new cases in 490/7,850(6%) inhabitants, with relative risks of 46.6(p-value = 0.01), and 7.3, 42.8, 8.2, 12.5, 11.4, 23.5, 22.3, and 14.6 (non-significant p-values). CONCLUSIONS Our strategy has proved the feasibility of active screening for leprosy in contacts and the introduction of PEP for leprosy under programmatic conditions. Only individuals living in the same household as the leprosy patient had a significant risk of contracting leprosy. We documented nine clusters of leprosy that could benefit from tailored control activities while optimizing resources.
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Affiliation(s)
| | - Pauline Dioussé
- Unité de Formation et Recherche en Santé, Université de Thiès, Sénégal
| | - Papa Mamadou Diagne
- Association Sénégalaise de lutte contre la lèpre et les MTN (ASCL/MTN), Dakar, Sénégal
| | - Mahamat Cissé
- Association allemande de lutte contre la lèpre et la tuberculose–DAHW Sénégal
| | | | - Fatou Diop
- Centre hospitalier régional de Kaolack, Sénégal
| | - Fanta Diop
- Centre hospitalier régional de Louga, Sénégal
| | - Lahla Fall
- Centre hospitalier de l’ordre de Malte–CHOM Dakar, Sénégal
| | - Diama Sakho
- Centre hospitalier régional de Ziguinchor, Sénégal
| | | | | | - Christa Kasang
- DAHW German Leprosy and Tuberculosis Relief Association, Germany
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Hidajat D, Risantari IGAF, Affarah WS. New cases of childhood leprosy in two male siblings in low endemic province: an iceberg phenomenon? Dermatol Reports 2023; 15:9706. [PMID: 38196899 PMCID: PMC10774850 DOI: 10.4081/dr.2023.9706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/03/2023] [Indexed: 01/11/2024] Open
Abstract
Children are the leprosy population most at risk; multibacillary infections are common. We reported pediatric cases with WHO-multibacillary lepromatous type morbus Hansen. We discovered several hypopigmented patches on the right upper arm, anesthesia-filled claw hands, and infiltrates in the ears in one 17- year-old child. In the other case (13-year-old), we discovered reduced sensory sensitivity in nearly every area of the body, infiltrates on the ear, and numerous irregular hypopigmented plaques on the belly, lumbar, and gluteus. Both patients had positive acidfast bacteria. After three months of treatment, multibacillary leprosy patients began to show improvement. Low socioeconomic and environmental conditions, as well as a history of intimate contact with leprosy patients, have been identified as risk factors.
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Affiliation(s)
- Dedianto Hidajat
- Department of Dermatology and Venereology, West Nusa Tenggara General Hospital, Lombok
| | | | - Wahyu Sulistya Affarah
- Department of Public Health, Faculty of Medicine, University of Mataram, Lombok, Indonesia
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Pham NT, Alves J, Sargison FA, Cullum R, Wildenhain J, Fenical W, Butler MS, Mead DA, Duggan BM, Fitzgerald JR, La Clair JJ, Auer M. Nanoscaled Discovery of a Shunt Rifamycin from Salinispora arenicola Using a Three-Color GFP-Tagged Staphylococcus aureus Macrophage Infection Assay. ACS Infect Dis 2023; 9:1499-1507. [PMID: 37433130 PMCID: PMC10425972 DOI: 10.1021/acsinfecdis.3c00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 07/13/2023]
Abstract
Antimicrobial resistance has emerged as a global public health threat, and development of novel therapeutics for treating infections caused by multi-drug resistant bacteria is urgent. Staphylococcus aureus is a major human and animal pathogen, responsible for high levels of morbidity and mortality worldwide. The intracellular survival of S. aureus in macrophages contributes to immune evasion, dissemination, and resilience to antibiotic treatment. Here, we present a confocal fluorescence imaging assay for monitoring macrophage infection by green fluorescent protein (GFP)-tagged S. aureus as a front-line tool to identify antibiotic leads. The assay was employed in combination with nanoscaled chemical analyses to facilitate the discovery of a new, active rifamycin analogue. Our findings indicate a promising new approach for the identification of antimicrobial compounds with macrophage intracellular activity. The antibiotic identified here may represent a useful addition to our armory in tackling the silent pandemic of antimicrobial resistance.
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Affiliation(s)
- Nhan T. Pham
- School
of Biological Sciences, The University of
Edinburgh, The King’s Buildings, Edinburgh EH9 3BF, U.K.
| | - Joana Alves
- The
Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, U.K.
| | - Fiona A. Sargison
- The
Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, U.K.
| | - Reiko Cullum
- Center
for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California at San Diego, La Jolla, California 92093-0204, United
States
| | - Jan Wildenhain
- Exscientia
Oxford Science Park, The Schrödinger Building, Oxford Science Park, Oxford OX4 4GE, U.K.
| | - William Fenical
- Center
for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California at San Diego, La Jolla, California 92093-0204, United
States
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Mark S. Butler
- Xenobe Research Institute, P. O. Box 3052, San Diego, California 92163, United States
| | - David A. Mead
- Terra
Bioforge
Inc., 3220 Deming Way
Suite 100, Middleton, Wisconsin 53562, United States
| | - Brendan M. Duggan
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - J. Ross Fitzgerald
- The
Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, U.K.
| | - James J. La Clair
- Xenobe Research Institute, P. O. Box 3052, San Diego, California 92163, United States
- Department
of Chemistry and Biochemistry, University
of California at San Diego, La
Jolla, California 92093-0358, United States
| | - Manfred Auer
- School
of Biological Sciences, The University of
Edinburgh, The King’s Buildings, Edinburgh EH9 3BF, U.K.
- Xenobe Research Institute, P. O. Box 3052, San Diego, California 92163, United States
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Coleman M, Hill J, Timeon E, Rimon E, Bauro T, Ioteba N, Cunanan A, Douglas NM, Islam T, Tomlinson J, Campbell PO, Williman J, Priest P, Marais BJ, Britton WJ, Chambers ST. Effectiveness of population-wide screening and mass drug administration for leprosy control in Kiribati: the COMBINE protocol. BMJ Open 2023; 13:e065369. [PMID: 37385746 PMCID: PMC10314446 DOI: 10.1136/bmjopen-2022-065369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Progress towards leprosy elimination is threatened by increasing incidence in 'hot-spot' areas where more effective control strategies are urgently required. In these areas, active case finding and leprosy prevention limited to known contacts is insufficient for control. Population-wide active case-finding together with universal prevention through mass drug administration (MDA) has been shown to be effective in 'hot-spot' areas, but is logistically challenging and expensive. Combining leprosy screening and MDA with other population-wide screening activities such as for tuberculosis may increase programme efficiency. There has been limited evaluation of the feasibility and effectiveness of combined screening and MDA interventions. The COMBINE study aims to bridge this knowledge gap. METHODS AND ANALYSIS This implementation study will assess the feasibility and effectiveness of active leprosy case-finding and treatment, combined with MDA using either single-dose rifampicin or rifamycin-containing tuberculosis preventive or curative treatment, for reducing leprosy incidence in Kiribati. The leprosy programme will run over 2022-2025 in concert with population-wide tuberculosis screening-and-treatment in South Tarawa. The primary research question is to what extent the intervention reduces the annual leprosy new case detection rate (NCDR) in adults and children compared with routine screening and postexposure prophylaxis (PEP) among close contacts (baseline leprosy control activities). Comparisons will be made with (1) the preintervention NCDR separably among adults and children in South Tarawa (before-after study) and (2) the corresponding NCDRs in the rest of the country. Additionally, the postintervention prevalence of leprosy obtained from a survey of a 'hot-spot' sub-population will be compared with prevalence documented during the intervention. The intervention will be implemented in collaboration with the Kiribati National Leprosy Programme. ETHICS AND DISSEMINATION Approval has been obtained from the Kiribati Ministry of Health and Medical Services (MHMS), the University of Otago (H22/111) and the University of Sydney (2021/127) Human Research Ethics Committees. Findings will be shared with the MHMS, local communities and internationally through publication.
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Affiliation(s)
- Mikaela Coleman
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy Hill
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
| | - Eretii Timeon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Erei Rimon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Temea Bauro
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Nabura Ioteba
- Pasifika Futures Ltd, Christchurch, New Zealand
- Pacific Leprosy Foundation, Christchurch, New Zealand
| | - Arturo Cunanan
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Health, Culion Sanatorium and General Hospital, Culion, Philippines
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tauhid Islam
- Division of Programmes for Disease Control, Manila, Philippines
| | | | - Patrick O Campbell
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Jonathan Williman
- Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand
| | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Warwick J Britton
- Tuberculosis Research Program, The Centenary Institute at the University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Stephen T Chambers
- Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Wang L, Wang H, Yan L, Yu M, Yang J, Li J, Li J, Ning Y, Jiang H, Shi Y, Zhang W, Xiong L, Liu J, Kuang Y, Wang H, He J, Wang D, Li B, Liu Y, Shui T, Wang Y, Chen H, Sha X, Long H, Yu X, Shen C, Shen J, Yang X, Gu H, Zhang G, Wang B. Single-Dose Rifapentine in Household Contacts of Patients with Leprosy. N Engl J Med 2023; 388:1843-1852. [PMID: 37195940 DOI: 10.1056/nejmoa2205487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Previous studies have suggested that a single dose of rifampin has protective effects against leprosy in close contacts of patients with the disease. Rifapentine was shown to have greater bactericidal activity against Mycobacterium leprae than rifampin in murine models of leprosy, but data regarding its effectiveness in preventing leprosy are lacking. METHODS We conducted a cluster-randomized, controlled trial to investigate whether single-dose rifapentine is effective in preventing leprosy in household contacts of patients with leprosy. The clusters (counties or districts in Southwest China) were assigned to one of three trial groups: single-dose rifapentine, single-dose rifampin, or control (no intervention). The primary outcome was the 4-year cumulative incidence of leprosy among household contacts. RESULTS A total of 207 clusters comprising 7450 household contacts underwent randomization; 68 clusters (2331 household contacts) were assigned to the rifapentine group, 71 (2760) to the rifampin group, and 68 (2359) to the control group. A total of 24 new cases of leprosy occurred over the 4-year follow-up, for a cumulative incidence of 0.09% (95% confidence interval [CI], 0.02 to 0.34) with rifapentine (2 cases), 0.33% (95% CI, 0.17 to 0.63) with rifampin (9 cases), and 0.55% (95% CI, 0.32 to 0.95) with no intervention (13 cases). In an intention-to-treat analysis, the cumulative incidence in the rifapentine group was 84% lower than that in the control group (cumulative incidence ratio, 0.16; multiplicity-adjusted 95% CI, 0.03 to 0.87; P = 0.02); the cumulative incidence did not differ significantly between the rifampin group and the control group (cumulative incidence ratio, 0.59; multiplicity-adjusted 95% CI, 0.22 to 1.57; P = 0.23). In a per-protocol analysis, the cumulative incidence was 0.05% with rifapentine, 0.19% with rifampin, and 0.63% with no intervention. No severe adverse events were observed. CONCLUSIONS The incidence of leprosy among household contacts over 4 years was lower with single-dose rifapentine than with no intervention. (Funded by the Ministry of Health of China and the Chinese Academy of Medical Sciences; Chinese Clinical Trial Registry number, ChiCTR-IPR-15007075.).
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Affiliation(s)
- Le Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hongsheng Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Liangbin Yan
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Meiwen Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jinlan Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Junhua Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yong Ning
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Haiqin Jiang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Shi
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Wenyue Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Li Xiong
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jie Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yanfei Kuang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hao Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun He
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - De Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Bin Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yangying Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Tiejun Shui
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Huan Chen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaowei Sha
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Long
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaojin Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Chong Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jianping Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xueyuan Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Gu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Guocheng Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Baoxi Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
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Martoreli JF, Ramos ACV, Berra TZ, do Nascimento MC, Tavares RBV, Moura HSD, de Mello DF, Alves JD, Arcêncio RA. Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230006. [PMID: 36629618 PMCID: PMC9838240 DOI: 10.1590/1980-549720230006.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. METHODS Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. RESULTS 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. CONCLUSION In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels.
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Affiliation(s)
- José Francisco Martoreli
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Antônio Carlos Vieira Ramos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Thaís Zamboni Berra
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | | | - Reginaldo Bazon Vaz Tavares
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Heriederson Sávio Dias Moura
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Débora Falleiros de Mello
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | | | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
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11
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Martoreli Júnior JF, Ramos ACV, Berra TZ, Nascimento MCD, Tavares RBV, Moura HSD, Mello DFD, Alves JD, Arcêncio RA. Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. Methods Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. Results 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. Conclusion In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels
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Sugawara-Mikami M, Tanigawa K, Kawashima A, Kiriya M, Nakamura Y, Fujiwara Y, Suzuki K. Pathogenicity and virulence of Mycobacterium leprae. Virulence 2022; 13:1985-2011. [PMID: 36326715 PMCID: PMC9635560 DOI: 10.1080/21505594.2022.2141987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae (M. leprae) and M. lepromatosis, an obligate intracellular organism, and over 200,000 new cases occur every year. M. leprae parasitizes histiocytes (skin macrophages) and Schwann cells in the peripheral nerves. Although leprosy can be treated by multidrug therapy, some patients relapse or have a prolonged clinical course and/or experience leprosy reaction. These varying outcomes depend on host factors such as immune responses against bacterial components that determine a range of symptoms. To understand these host responses, knowledge of the mechanisms by which M. leprae parasitizes host cells is important. This article describes the characteristics of leprosy through bacteriology, genetics, epidemiology, immunology, animal models, routes of infection, and clinical findings. It also discusses recent diagnostic methods, treatment, and measures according to the World Health Organization (WHO), including prevention. Recently, the antibacterial activities of anti-hyperlipidaemia agents against other pathogens, such as M. tuberculosis and Staphylococcus aureus have been investigated. Our laboratory has been focused on the metabolism of lipids which constitute the cell wall of M. leprae. Our findings may be useful for the development of future treatments.
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Affiliation(s)
- Mariko Sugawara-Mikami
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan.,West Yokohama Sugawara Dermatology Clinic, Yokohama, Japan
| | - Kazunari Tanigawa
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Akira Kawashima
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuhiro Nakamura
- Department of Molecular Pharmaceutics, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Yoko Fujiwara
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Chen W, Lin W, Yu N, Zhang L, Wu Z, Chen Y, Li Z, Gong F, Li N, Chen X, He X, Wu Y, Zeng X, Yueh Y, Xu R, Ji G. Activation of Dynamin-Related Protein 1 and Induction of Mitochondrial Apoptosis by Exosome-Rifampicin Nanoparticles Exerts Anti-Osteosarcoma Effect. Int J Nanomedicine 2022; 17:5431-5446. [PMID: 36426375 PMCID: PMC9680970 DOI: 10.2147/ijn.s379917] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/12/2022] [Indexed: 09/07/2023] Open
Abstract
PURPOSE To investigate induction of cell death in Osteosarcoma (OS) using the anti-tuberculosis drug, rifampicin, loaded into exosomes. PATIENTS AND METHODS BMSC-exosomes were isolated by ultracentrifugation and loaded ultrasonically with rifampicin. Nanoparticle exosome-rifampicin (EXO-RIF) was added to the OS cell-lines, 143B and MG63, in vitro, to observe the growth inhibitory effect. In vivo experiments were conducted by injecting fluorescently labeled EXO-RIF through the tail vein of 143B cell xenograft nude mice and tracking distribution. Therapeutic and toxic side-effects were analyzed systemically. RESULTS Sonication resulted in encapsulation of rifampicin into exosomes. Exosome treatment accelerated the entry of rifampicin into OS cells and enhanced the actions of rifampicin in inhibiting OS proliferation, migration and invasion. Cell cycle arrest at the G2/M phase was observed. Dynamin-related protein 1 (Drp1) was activated by EXO-RIF and caused mitochondrial lysis and apoptosis. Exosome treatment targeted rifampicin to the site of OS, causing OS apoptosis and improving mouse survival in vivo. CONCLUSION The potent Drp1 agonist, rifampicin, induced OS apoptosis and exosome loading, improving OS targeting and mouse survival rates. EXO-RIF is a promising strategy for the treatment of diverse malignancies.
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Affiliation(s)
- Wenkai Chen
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Wenping Lin
- Department of Spine Surgery, Shenzhen Pingle Orthopedic Hospital, Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Shenzhen, People’s Republic of China
| | - Naichun Yu
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Linlin Zhang
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Zuoxing Wu
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Yongjie Chen
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Zongguang Li
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Fengqing Gong
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Na Li
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Xiaohui Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Xu He
- Department of Spine Surgery, Shenzhen Pingle Orthopedic Hospital, Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Shenzhen, People’s Republic of China
| | - Yue Wu
- Department of Pathology, Zhongshan Hospital, Xiamen University, Xiamen, People’s Republic of China
| | - Xiangchen Zeng
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Yuting Yueh
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Ren Xu
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-Constructed by the Province and Ministry, Guangxi Medical University, Nanning, People’s Republic of China
| | - Guangrong Ji
- Department of Orthopedic Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, Xiamen Key Laboratory of Regeneration Medicine, Organ Transplantation Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
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ter Ellen F, Tielens K, Fenenga C, Mieras L, Schoenmakers A, Arif MA, Veldhuijzen N, Peters R, Ignotti E, Kasang C, Quao B, Steinmann P, Banstola NL, Oraga J, Budiawan T. Implementation approaches for leprosy prevention with single-dose rifampicin: A support tool for decision making. PLoS Negl Trop Dis 2022; 16:e0010792. [PMID: 36251696 PMCID: PMC9612816 DOI: 10.1371/journal.pntd.0010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/27/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. Methodology The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool’s usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. Principal findings Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. Conclusion An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP. The chance of contacts of leprosy patients developing leprosy can be reduced by providing a single dose of rifampicin. The implementation of this type of post-exposure prophylaxis can be done in various ways. This study led to the development of the SDR-PEP decision support tool to select the most suitable approach. It was developed in two phases; first, a tool was drafted based on a literature review and expert interviews, this was followed by phase 2 in which interviews and a focus group discussion with intended users of the tool were held. Five SDR-PEP implementation approaches that have been developed so far were identified. Apart from the characteristics of these approaches, the tool lists five basic requirements for the successful implementation of any approach, and criteria that help to select the best approach in a given context. A flowchart supports the selection process. The study found that the tool can also be used for lobby and advocacy, to clarify SDR-PEP implementation and the choice for an approach, and in training on SDR-PEP implementation. Information about costs and cost-effectiveness of the approaches is limited. Further research will help to continue to improve the tool.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Benedict Quao
- National Leprosy Control Programme, Ghana Health Service, Accra, Ghana
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, University of Basel, Basel, Switzerland
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Barbosa CC, Bezerra GSN, Xavier AT, de Albuquerque MDFPM, do Bonfim CV, de Medeiros ZM, de Souza WV. Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12155. [PMID: 36231457 PMCID: PMC9566694 DOI: 10.3390/ijerph191912155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Leprosy is a public health problem in South American, African and Oceanian countries. National programs need to be evaluated, and the survival analysis model can aid in the construction of new indicators. The aim of this study was to assess the period of time until the outcomes of interest for patients with or exposed to leprosy by means of survival analysis surveys. This review researched articles using the databases of PubMed, Science Direct, Scopus, Scielo and BVS published in English and Portuguese. Twenty-eight articles from Brazil, India, Bangladesh, the Philippines and Indonesia were included. The Kaplan-Meier method, which derives the log-rank test, and Cox's proportional hazards regression, which obtains the hazard ratio, were applied. The mean follow-up until the following outcomes were: (I) leprosy (2.3 years) in the population who were exposed to it, (II) relapse (5.9 years), (III) clinical manifestations before, during and after treatment-nerve function impairment (5.2 years), leprosy reactions (4.9 years) and physical disability (8.3 years) in the population of patients with leprosy. Therefore, the use of survival analysis will enable the evaluation of national leprosy programs and assist in the decision-making process to face public health problems.
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Affiliation(s)
- Celivane Cavalcanti Barbosa
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Amanda Tavares Xavier
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Cristine Vieira do Bonfim
- Postgraduate Program in Public Health, Federal University of Pernambuco, Recife 50670-901, Brazil
- Social Research Division, Joaquim Nabuco Foundation, Ministry of Education, Recife 52171-010, Brazil
| | - Zulma Maria de Medeiros
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | - Wayner Vieira de Souza
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
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Ortuño-Gutiérrez N, Shih PW, Wagh A, Mugudalabetta S, Pandey B, de Jong BC, Richardus JH, Hasker E. Less is more: Developing an approach for assessing clustering at the lower administrative boundaries that increases the yield of active screening for leprosy in Bihar, India. PLoS Negl Trop Dis 2022; 16:e0010764. [PMID: 36095018 PMCID: PMC9499219 DOI: 10.1371/journal.pntd.0010764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background In India, leprosy clusters at hamlet level but detailed information is lacking. We aim to identify high-incidence hamlets to be targeted for active screening and post-exposure prophylaxis. Methodology We paid home visits to a cohort of leprosy patients registered between April 1st, 2020, and March 31st, 2022. Patients were interviewed and household members were screened for leprosy. We used an open-source app(ODK) to collect data on patients’ mobility, screening results of household members, and geographic coordinates of their households. Clustering was analysed with Kulldorff’s spatial scan statistic(SaTScan). Outlines of hamlets and population estimates were obtained through an open-source high-resolution population density map(https://data.humdata.org), using kernel density estimation in QGIS, an open-source software. Results We enrolled 169 patients and screened 1,044 household contacts in Bisfi and Benipatti blocks of Bihar. Median number of years of residing in the village was 17, interquartile range(IQR)12-30. There were 11 new leprosy cases among 658 household contacts examined(167 per 10,000), of which seven had paucibacillary leprosy, one was a child under 14 years, and none had visible disabilities. We identified 739 hamlets with a total population of 802,788(median 163, IQR 65–774). There were five high incidence clusters including 12% of the population and 46%(78/169) of the leprosy cases. One highly significant cluster with a relative risk (RR) of 4.7(p<0.0001) included 32 hamlets and 27 cases in 33,609 population. A second highly significant cluster included 32 hamlets and 24 cases in 33,809 population with a RR of 4.1(p<0.001). The third highly significant cluster included 16 hamlets and 17 cases in 19,659 population with a RR of 4.8(p<0.001). High-risk clusters still need to be screened door-to-door. Conclusions We found a high yield of active household contact screening. Our tools for identifying high-incidence hamlets appear effective. Focusing labour-intensive interventions such as door-to-door screening on such hamlets could increase efficiency. India is the highest-burden country in the world where leprosy is known to cluster in hamlets. As no geographical data about hamlets is available, we develop a system to outline them using a high-resolution population density map. Then, using the household coordinates of 169 new leprosy cases enrolled in two hyperendemic blocks of Bihar, we screened household contacts and assessed clustering at hamlet level. The patients interviewed had lived in their current villages for a median of seventeen years at the moment of the survey. We found 11 new cases among 658 contacts examined equivalent to 16.7 per 1,000 population. There were three statistically significant clusters among five at the hamlet level and three including 78 cases in 98,623 population. Our results can be used to guide targeted and more efficient active case finding and post-exposure prophylaxis.
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Affiliation(s)
| | - Pin-Wei Shih
- University Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Bijoy Pandey
- State Leprosy Eradication Programme, Bihar, India
| | | | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
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Dharmawan Y, Fuady A, Korfage IJ, Richardus JH. Delayed detection of leprosy cases: A systematic review of healthcare-related factors. PLoS Negl Trop Dis 2022; 16:e0010756. [PMID: 36067195 PMCID: PMC9481154 DOI: 10.1371/journal.pntd.0010756] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/16/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. Methods PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. Conclusions Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services. New leprosy patients diagnosed with visible physical deformities represent a significant disease burden that also poses an important public health challenge. The physical deformities often result from long delays in case detection. Greater insight into the healthcare factors that contribute to such delays will support the development of effective prevention programs. We therefore reviewed all studies on the healthcare factors related to case-detection delay that had been published between January 1, 2000, and January 31, 2021. Twenty studies were included in our analysis. We found that misdiagnosis was a core healthcare factor related to delays. Other common factors included inappropriate health services, a high number of consultations before diagnosis; and a lack of referral centers, healthcare personnel, and case-detection methods. Detection delay was further influenced by geographical circumstances, financial and logistic issues, and health-service organization and management including the level of the decentralization of healthcare programs. Because delays in leprosy case detection are due mainly to misdiagnosis, we recommend to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.
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Affiliation(s)
- Yudhy Dharmawan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
- * E-mail: ,
| | - Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Investigating drug resistance of Mycobacterium leprae in the Comoros: an observational deep-sequencing study. THE LANCET MICROBE 2022; 3:e693-e700. [DOI: 10.1016/s2666-5247(22)00117-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
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Lima FR, de Paula NA, Simões MMR, Manso GMDC, Albertino GS, Felisbino GC, Antunes VMG, Perecin FAMC, Westin AT, Lugão HB, Frade MAC. Bacilloscopy and polymerase chain reaction of slit-skin smears and anti-phenolic glycolipid-I serology for Hansen’s disease diagnosis. Front Med (Lausanne) 2022; 9:972244. [PMID: 36035405 PMCID: PMC9399463 DOI: 10.3389/fmed.2022.972244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
The bacilloscopy of the slit-skin smear (SSS) is the exclusive laboratory test associated with dermato-neurological evaluation for Hansen’s disease (HD) diagnosis; however, it is negative in the majority of PB or primary neural forms. Thus, a PCR technique involving different sequences and target genes has been performed with an aim to increase the sensitivity and specificity of M. leprae identification, especially in patients with low bacillary loads. Additionally, serological assays based on antibody response reflect infection levels and indicate that this could be a simpler, less invasive technique for estimating M. leprae exposure. Serological tests and PCR have been shown to be more sensitive and accurate than the SSS. Our study aimed to measure accuracy and performance among the SSS and PCR of dermal scrapings stored on filter paper and APGL-I serology for diagnosis in HD. A cross-sectional study analyzing the medical records (n = 345) of an HD outpatient-dermatology clinic from 2014 to 2021 was conducted. Accuracy performance parameters, correlation, and concordance were used to assess the value among the SSS, PCR, and APGL-I exams in HD. The SSS presented 24.5% sensitivity, 100% specificity, 37.4% accuracy, and the lowest negative predictive value (21.5%). The PCR assay had 41, 100, and 51% sensitivity, specificity, and accuracy, respectively. PCR and APGL-I serology increased the detection of HD cases by 16 and 20.6%, respectively. PCR was positive in 51.3% of patients when the SSS was negative. The SSS obtained moderate concordance with PCR [k-value: 0.43 (CI: 0.33–0.55)] and APGL-I [k-value: 0.41 (CI: 0.31–0.53)]. A moderate positive correlation was found between the APGL-I index and the bacillary index (r = 0.53; P < 0.0001). Thus, the use of the SSS is a low sensitivity and accuracy method due to its low performance in HD detection. The use of PCR and serological tests allows for a more sensitive and accurate diagnosis of patients.
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Affiliation(s)
- Filipe Rocha Lima
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Natália Aparecida de Paula
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Mateus Mendonça Ramos Simões
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Gabriel Martins da Costa Manso
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Gustavo Sartori Albertino
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Giovani Cesar Felisbino
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Vanderson Mayron Granemann Antunes
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Fernanda André Martins Cruz Perecin
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Andrezza Telles Westin
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Helena Barbosa Lugão
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Marco Andrey Cipriani Frade
- Healing and Hansen’s Disease Laboratory, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Dermatology Division, Department of Internal Medicine, National Referral Center for Sanitary Dermatology and Hansen’s Disease, Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- *Correspondence: Marco Andrey Cipriani Frade,
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Thangaraju P, Velmurugan H, N K, Venkatesan S. Time to Be Vigilant In Contacts of Leprosy for Possible Single Dose Rifampicin. JAAD Case Rep 2022; 29:100-101. [PMID: 36212896 PMCID: PMC9527492 DOI: 10.1016/j.jdcr.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Coleman M, Hill J, Timeon E, Tonganibeia A, Eromanga B, Islam T, Trauer JM, Chambers ST, Christensen A, Fox GJ, Marks GB, Britton WJ, Marais BJ. Population-wide active case finding and prevention for tuberculosis and leprosy elimination in Kiribati: the PEARL study protocol. BMJ Open 2022; 12:e055295. [PMID: 35414551 PMCID: PMC9006843 DOI: 10.1136/bmjopen-2021-055295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Population-wide interventions offer a pathway to tuberculosis (TB) and leprosy elimination, but 'real-world' implementation in a high-burden setting using a combined approach has not been demonstrated. This implementation study aims to demonstrate the feasibility and evaluate the effect of population-wide screening, treatment and prevention on TB and leprosy incidence rates, as well as TB transmission. METHODS AND ANALYSIS A non-randomised 'screen-and-treat' intervention conducted in the Pacific atoll of South Tarawa, Kiribati. Households are enumerated and all residents ≥3 years, as well as children <3 years with recent household exposure to TB or leprosy, invited for screening. Participants are screened using tuberculin skin testing, signs and symptoms of TB or leprosy, digital chest X-ray with computer-aided detection and sputum testing (Xpert MTB/RIF Ultra). Those diagnosed with disease are referred to the National TB and Leprosy Programme for management. Participants with TB infection are offered TB preventive treatment and those without TB disease or infection, or leprosy, are offered leprosy prophylaxis. The primary study outcome is the difference in the annual TB case notification rate before and after the intervention; a similar outcome is included for leprosy. The effect on TB transmission will be measured by comparing the estimated annual risk of TB infection in primary school children before and after the intervention, as a co-primary outcome used for power calculations. Comparison of TB and leprosy case notification rates in South Tarawa (the intervention group) and the rest of Kiribati (the control group) before, during and after the intervention is a secondary outcome. ETHICS AND DISSEMINATION Approval was obtained from the University of Sydney Human Research Ethics Committee (project no. 2021/127) and the Kiribati Ministry of Health and Medical Services (MHMS). Findings will be shared with the MHMS and local communities, published in peer-reviewed journals and presented at international conferences.
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Affiliation(s)
- Mikaela Coleman
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, Centenary Institute Medical Research Foundation, Newtown, New South Wales, Australia
| | - Jeremy Hill
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tuberculosis Research Program, Centenary Institute Medical Research Foundation, Newtown, New South Wales, Australia
| | - Eretii Timeon
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Alfred Tonganibeia
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Baraniko Eromanga
- Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | - Tauhid Islam
- Division of Programmes for Disease Control, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - James M Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen T Chambers
- The Pacific Leprosy Foundation, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Greg J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Warwick J Britton
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- The Centenary Institute at the University of Sydney, Camperdown, New South Wales, Australia
| | - Ben J Marais
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the most recent evidences concerning mycobacterial skin infections, limiting the period of literature research to 2020--2021. RECENT FINDINGS Mycobacterial skin infections include a heterogeneous group of cutaneous diseases.Cutaneous tuberculosis is usually the result of hematogenous dissemination or spread from underlying foci and it must be distinguished from tuberculids, resulting from the immunological reaction to Mycobacterium tuberculosis antigens. Leprosy prevalence was drastically reduced after introduction of multidrug therapy in the 1980 s, but cases are still reported due to underdiagnosis, and animal and environmental reservoirs. Recent advances concentrate in the diagnostic field. Specific guidelines for the treatment of nontuberculous mycobacteria skin infections are missing and surgical procedures may be required. Prognosis is better as compared to nontuberculous mycobacteria lung disease. Rapid laboratory-confirmed diagnosis of Buruli ulcer may be achieved by the IS2404 PCR. Among new drugs, telacebec is promising in terms of potency, shorter duration and tolerability in animal studies. A clinical trial in humans is planned. SUMMARY Mycobacterial cutaneous lesions are nonpathognomonic and clinical suspicion must be confirmed by culture or molecular detection. Long-course multidrug treatment is required based on susceptibility tests. Surgical intervention may also be required. Rehabilitation and psychosocial support reduce long-term physical and mental consequences mostly in Buruli ulcer and leprosy.
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Prevalence, incidence, and reported global distribution of noma: a systematic literature review. THE LANCET INFECTIOUS DISEASES 2022; 22:e221-e230. [DOI: 10.1016/s1473-3099(21)00698-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
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Machado LMG, Dos Santos ES, Cavaliero A, Steinmann P, Ignotti E. Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil. Infect Dis Poverty 2022; 11:21. [PMID: 35193684 PMCID: PMC8862266 DOI: 10.1186/s40249-022-00943-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/02/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin. METHODS Leprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016-2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes. RESULTS Overall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01). CONCLUSIONS The disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.
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Affiliation(s)
- Lúbia Maieles Gomes Machado
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Emerson Soares Dos Santos
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Department of Geography, Post-Graduation Program of Geography, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,School of Health Sciences, Post-Graduation Program in Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
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Taal AT, Blok DJ, Handito A, Wibowo S, Sumarsono, Wardana A, Pontororing G, Sari DF, van Brakel WH, Richardus JH, Prakoeswa CRS. Determining target populations for leprosy prophylactic interventions: a hotspot analysis in Indonesia. BMC Infect Dis 2022; 22:131. [PMID: 35130867 PMCID: PMC8822733 DOI: 10.1186/s12879-022-07103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Leprosy incidence remained at around 200,000 new cases globally for the last decade. Current strategies to reduce the number of new patients include early detection and providing post-exposure prophylaxis (PEP) to at-risk populations. Because leprosy is distributed unevenly, it is crucial to identify high-risk clusters of leprosy cases for targeting interventions. Geographic Information Systems (GIS) methodology can be used to optimize leprosy control activities by identifying clustering of leprosy cases and determining optimal target populations for PEP. Methods The geolocations of leprosy cases registered from 2014 to 2018 in Pasuruan and Pamekasan (Indonesia) were collected and tested for spatial autocorrelation with the Moran’s I statistic. We did a hotspot analysis using the Heatmap tool of QGIS to identify clusters of leprosy cases in both areas. Fifteen cluster settings were compared, varying the heatmap radius (i.e., 500 m, 1000 m, 1500 m, 2000 m, or 2500 m) and the density of clustering (low, moderate, and high). For each cluster setting, we calculated the number of cases in clusters, the size of the cluster (km2), and the total population targeted for PEP under various strategies. Results The distribution of cases was more focused in Pasuruan (Moran’s I = 0.44) than in Pamekasan (0.27). The proportion of total cases within identified clusters increased with heatmap radius and ranged from 3% to almost 100% in both areas. The proportion of the population in clusters targeted for PEP decreased with heatmap radius from > 100% to 5% in high and from 88 to 3% in moderate and low density clusters. We have developed an example of a practical guideline to determine optimal cluster settings based on a given PEP strategy, distribution of cases, resources available, and proportion of population targeted for PEP. Conclusion Policy and operational decisions related to leprosy control programs can be guided by a hotspot analysis which aid in identifying high-risk clusters and estimating the number of people targeted for prophylactic interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07103-0.
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Affiliation(s)
- A T Taal
- NLR, Amsterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - D J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Handito
- Department of Infectious Disease, Leprosy Control Programme, Ministry of Health, Jakarta, Indonesia
| | - S Wibowo
- East Java Provincial Health Office, Surabaya, Indonesia
| | - Sumarsono
- East Java Provincial Health Office, Surabaya, Indonesia
| | | | | | - D F Sari
- NLR Indonesia, Jakarta, Indonesia
| | | | - J H Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C R S Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Barbieri RR, Xu Y, Setian L, Souza-Santos PT, Trivedi A, Cristofono J, Bhering R, White K, Sales AM, Miller G, Nery JAC, Sharman M, Bumann R, Zhang S, Goldust M, Sarno EN, Mirza F, Cavaliero A, Timmer S, Bonfiglioli E, Smith C, Scollard D, Navarini AA, Aerts A, Ferres JL, Moraes MO. Reimagining leprosy elimination with AI analysis of a combination of skin lesion images with demographic and clinical data. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:100192. [PMID: 36776278 PMCID: PMC9903738 DOI: 10.1016/j.lana.2022.100192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Leprosy is an infectious disease that mostly affects underserved populations. Although it has been largely eliminated, still about 200'000 new patients are diagnosed annually. In the absence of a diagnostic test, clinical diagnosis is often delayed, potentially leading to irreversible neurological damage and its resulting stigma, as well as continued transmission. Accelerating diagnosis could significantly contribute to advancing global leprosy elimination. Digital and Artificial Intelligence (AI) driven technology has shown potential to augment health workers abilities in making faster and more accurate diagnosis, especially when using images such as in the fields of dermatology or ophthalmology. That made us start the quest for an AI-driven diagnosis assistant for leprosy, based on skin images. Methods Here we describe the accuracy of an AI-enabled image-based diagnosis assistant for leprosy, called AI4Leprosy, based on a combination of skin images and clinical data, collected following a standardized process. In a Brazilian leprosy national referral center, 222 patients with leprosy or other dermatological conditions were included, and the 1229 collected skin images and 585 sets of metadata are stored in an open-source dataset for other researchers to exploit. Findings We used this dataset to test whether a CNN-based AI algorithm could contribute to leprosy diagnosis and employed three AI models, testing images and metadata both independently and in combination. AI modeling indicated that the most important clinical signs are thermal sensitivity loss, nodules and papules, feet paresthesia, number of lesions and gender, but also scaling surface and pruritus that were negatively associated with leprosy. Using elastic-net logistic regression provided a high classification accuracy (90%) and an area under curve (AUC) of 96.46% for leprosy diagnosis. Interpretation Future validation of these models is underway, gathering larger datasets from populations of different skin types and collecting images with smartphone cameras to mimic real world settings. We hope that the results of our research will lead to clinical solutions that help accelerate global leprosy elimination. Funding This study was partially funded by Novartis Foundation and Microsoft (in-kind contribution).
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Affiliation(s)
- Raquel R Barbieri
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil,Corresponding authors.
| | - Yixi Xu
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States,Corresponding authors.
| | | | - Paulo Thiago Souza-Santos
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Anusua Trivedi
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Jim Cristofono
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Ricardo Bhering
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Kevin White
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Anna M Sales
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Geralyn Miller
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - José Augusto C Nery
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Michael Sharman
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Richard Bumann
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Shun Zhang
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Mohamad Goldust
- University of Basel, Basel, Switzerland,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Euzenir N Sarno
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Sander Timmer
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | - Elena Bonfiglioli
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States
| | | | | | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Juan Lavista Ferres
- Microsoft, One Microsoft Way, One Microsoft Way, Redmond, WA, United States,Corresponding authors.
| | - Milton O Moraes
- Laboratório de Hanseníase Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil,Corresponding authors.
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Thangaraju P, Velmurugan H, Yella SST, Venkatesan S. Vigilance Needed in Treating Leprosy Patients in Accordance with WHO's AWaRe. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2022; 17:95-102. [PMID: 35864797 DOI: 10.2174/2772434417666220720111849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Leprosy is a highly stigmatized disease that can range from a minor skin lesion to life-threatening conditions such as deformities and disability. The World Health Organization (WHO) has developed a tool called "Access, Watch, and Reserve" (AWaRe) to reduce antibiotic misuse and abuse. AIM The purpose of this review is to determine whether the drugs used in the leprosy treatment regimen are complied with the AWaRe programme, in order to improve the quality of hospital antibiotic use and reduce the incidence of antimicrobial resistance (AMR). METHODS We started by looking for antibiotics that are used in the treatment and chemoprophylaxis of leprosy, as defined by the WHO's AWaRe classification. Furthermore, we look for studies on antibiotics that showed sensitivity or less resistance after antimicrobial sensitivity testing (AST) on isolates from infected leprosy ulcers, as well as their AWaRe category. RESULTS There were 32 studies found, but only 5 of them met the inclusion criteria. They consisted of four cross-sectional studies and one descriptive retrospective study. A total of 19 antibiotics were identified in 5 studies, with 9 (47.4%) antibiotics in the access category, 8 (42.1%) antibiotics in the watch group, and 2 (10.5%) antibiotics in the reserve group. CONCLUSION As per our knowledge, this is the first study to explore antibiotics in leprosy treatment, chemoprophylaxis, and complications such as ulcer compliance with the AWaRe programme. Antimicrobial resistance is on the rise, which is a global issue that continues to pose challenges to clinical practices. This review may provide physicians with an overview of the current state of drug prescribing trends in leprosy, whether in accordance with the AWaRe classification in selecting the right drug when the use of antimicrobials is indicated and may also aid in rational drug prescribing.
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Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur 492099, Chhattisgarh, India
| | - Hemasri Velmurugan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur 492099, Chhattisgarh, India
| | | | - Sajitha Venkatesan
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur 492099, Chhattisgarh, India
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Cavaliero A, Ay SS, Aerts A, Lay S, So V, Robijn J, Steinmann P. Preventing leprosy with retrospective active case finding combined with single-dose rifampicin for contacts in a low endemic setting: results of the Leprosy Post-Exposure Prophylaxis program in Cambodia. Acta Trop 2021; 224:106138. [PMID: 34562427 DOI: 10.1016/j.actatropica.2021.106138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR) reduces the risk of developing leprosy among contacts of leprosy patients. Most evidence for the feasibility of the intervention is from highly endemic settings while low-endemic areas present unique challenges including reduced awareness of the disease among the population and in the health system, and the only sporadic occurrence of cases which together make defining any type of routine process challenging. We complemented the retrospective active case finding (RACF) approach with SDR administration to eligible contacts, and piloted the intervention across 31 operational districts in Cambodia. The aim was to demonstrate the feasibility of improving early case detection and administering SDR in a low endemic setting. The intervention focused on leprosy patients diagnosed since 2011 and was implemented between October 2016 - September 2019. The "drives" approach was employed to trace contacts: a trained team systematically contacted all eligible cases in a district, traced and screened contacts, and administered SDR. A total of 555 index patients were traced by the drive team, and 10,410 contacts in their household and 5 immediate neighbor houses listed. Among these contacts, 72.0% could be screened while most others were absent on the screening day. A total of 33 new leprosy cases were diagnosed and 6189 contacts received SDR (82.6% of the screened contacts). Sixty-one contacts refused SDR administration. We conclude that integrating PEP with SDR in RACF campaigns is feasible, and that this approach is appropriate in low resource and low endemic settings. Over time, evidence on whether or not the approach reduced leprosy transmission in Cambodia, may become clear.
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29
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Randhawa A, Kapila R, Schwartz RA. Leprosy: what is new. Int J Dermatol 2021; 61:733-738. [PMID: 34826151 DOI: 10.1111/ijd.15998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Leprosy, also known as Hansen's disease, is an age-old chronic granulomatous infection characterized by prominent cutaneous and neurologic findings. Long known to be caused by Mycobacterium leprae, a new etiologic species was identified and linked in 2008, Mycobacterium lepromatosis. The BCG vaccine with highly variable efficacy may soon be replaced by the first leprosy-specific subunit vaccine LepVax, which has recently moved forward in human trials. Recent evidence supporting theories of zoonotic transmission from armadillos and the less-discussed Eurasian red squirrels has emerged. Knowledge on genetic polymorphisms that may increase leprosy susceptibility, such as the newly uncovered mitochondrial ribosomal protein S5 (MRPS5) polymorphism in the Chinese population, has provided a fresh perspective and direction. Further, we will delineate the latest information on leprosy, including the possible effects of leprosy coinfection with COVID-19, HIV, and HTLV-1, and the shift to newer leprosy therapies and treatment regimens.
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Affiliation(s)
- Avneet Randhawa
- Rutgers University New Jersey Medical School, New Jersey Medical School, Newark, NJ, USA
| | - Rajendra Kapila
- Rutgers University New Jersey Medical School, New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Rutgers University New Jersey Medical School, New Jersey Medical School, Newark, NJ, USA
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30
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Saar M, Beissner M, Gültekin F, Maman I, Herbinger KH, Bretzel G. RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test. BMC Infect Dis 2021; 21:1186. [PMID: 34823479 PMCID: PMC8620619 DOI: 10.1186/s12879-021-06882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. METHODS: Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 "must not detect RLEP" samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 "must detect RLEP" samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001-10.000 bacilli/extract), low-positive samples of MB leprosy patients (1-1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. RESULTS: Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43-27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93-100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. CONCLUSIONS: The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.
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Affiliation(s)
- Malkin Saar
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany.
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Fatih Gültekin
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Issaka Maman
- Ministère de la Santé, Institut National d'Hygiène (INH), Lomé, Togo
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Leopoldstrasse 5, 80802, Munich, Germany
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Martoreli Júnior JF, Ramos ACV, Alves JD, Crispim JDA, Alves LS, Berra TZ, Barbosa TP, da Costa FBP, Alves YM, dos Santos MS, Gomes D, Yamamura M, Pinto IC, Fuentealba-Torres MA, Nunes C, Pieri FM, Arcoverde MAM, dos Santos FL, Arcêncio RA. Inequality of gender, age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil. PLoS Negl Trop Dis 2021; 15:e0009941. [PMID: 34784350 PMCID: PMC8631739 DOI: 10.1371/journal.pntd.0009941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/30/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to investigate the epidemiological situation of leprosy
(Hansen’s Disease), in a hyperendemic metropolis in the Central-West region of
Brazil. We studied trends over eleven years, both in the detection of the
disease and in disabilities, analyzing disparities and/or differences regarding
gender and age. This is an ecological time series study conducted in Cuiabá,
capital of the state of Mato Grosso. The population consisted of patients
diagnosed with leprosy between the years 2008 and 2018. The time series of
leprosy cases was used, stratifying it according to gender (male and female),
disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar
adjustment technique was applied. For modeling the trends, the Seasonal-Trend
decomposition procedure based on Loess (STL) was used. We identified 9.739
diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59
years. Regarding detection according to gender, there was a decrease among women
and an increase in men. The study shows an increasing trend in disabilities in
both genders, which may be related to the delay in diagnosis. There was also an
increasing number of cases that were not assessed for disability at the time of
diagnosis, which denotes the quality of the services. In the 2019 report, Brazil had a detection rate of 13.23 per 100.000 inhabitants
far from the goal of less than 1 leprosy (Hansen’s Disease) case per 10,000
inhabitants describe by the World Health Organization. The present study aimed
to investigate the epidemiological situation of leprosy and its trend between
2008 and 2018 in a hyperendemic metropolis in the Central-West region of Brazil.
A total of 9.739 leprosy cases were reported between 2008 and 2018. The majority
of cases were male (58.37%), with a predominant age of 15 to 59 years (87.55%).
The predominant level of education was incomplete elementary school (43.96%).
The disability grade at diagnosis showed that 40.19% had G0D and for the G2D was
8,.06%.There was a predominance in operational classification of multibacillary
cases (72.85%). While detection rate trends in females and the majority of the
age groups are decreasing, increases are seen in the detection of male patients
and patients already suffering from disabilities. Although declining trends were
presented, the metropolis is still not close to elimination showing the need
prioritize leprosy actions and to improve care for this disease.
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Affiliation(s)
- José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
- * E-mail:
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Josilene Dalia Alves
- Departament of Epidemiology, Federal University of Mato Grosso, Cuiába,
Mato Grosso, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Tatiana Pestana Barbosa
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Márcio Souza dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Dulce Gomes
- Department of Mathematics, University of Évora, Évora,
Portugal
| | - Mellina Yamamura
- Departament of Nursing, Federal University of São Carlos, São Carlos, São
Paulo, Brazil
| | - Ione Carvalho Pinto
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | | | - Carla Nunes
- Department of Public Health, New University of Lisbon, Lisbon,
Portugal
| | | | - Marcos Augusto Moraes Arcoverde
- Center for Education, Letters and Health, Western Paraná State
University, Campus Foz do Iguaçu, Foz do Iguaçu, Paraná,
Brazil
| | - Felipe Lima dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
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Singh I, Sengupta U. Drug Resistance in Mycobacterium Leprae in the Context of Zero Leprosy. Indian Dermatol Online J 2021; 12:791-795. [PMID: 34934713 PMCID: PMC8653743 DOI: 10.4103/idoj.idoj_599_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Itu Singh
- Department of Molecular Biology, Stanley Browne Laboratory, The Leprosy Mission Community Hospital – Nand Nagri, New Delhi, India
| | - Utpal Sengupta
- Department of Molecular Biology, Stanley Browne Laboratory, The Leprosy Mission Community Hospital – Nand Nagri, New Delhi, India
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BCG-induced immunity profiles in household contacts of leprosy patients differentiate between protection and disease. Vaccine 2021; 39:7230-7237. [PMID: 34688497 DOI: 10.1016/j.vaccine.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
Leprosy is an infectious disease caused by Mycobacterium leprae leading to irreversible disabilities along with social exclusion. Leprosy is a spectral disease for which the clinical outcome after M. leprae infection is determined by host factors. The spectrum spans from anti-inflammatory T helper-2 (Th2) immunity concomitant with large numbers of bacteria as well as antibodies against M. leprae antigens in multibacillary (MB) leprosy, to paucibacillary (PB) leprosy characterised by strong pro-inflammatory, Th1 as well as Th17 immunity. Despite decades of availability of adequate antibiotic treatment, transmission of M. leprae is unabated. Since individuals with close and frequent contact with untreated leprosy patients are particularly at risk to develop the disease themselves, prophylactic strategies currently focus on household contacts of newly diagnosed patients. It has been shown that BCG (re)vaccination can reduce the risk of leprosy. However, BCG immunoprophylaxis in contacts of leprosy patients has also been reported to induce PB leprosy, indicating that BCG (re)vaccination may tip the balance between protective immunity and overactivation immunity causing skin/nerve tissue damage. In order to identify who is at risk of developing PB leprosy after BCG vaccination, amongst individuals who are chronically exposed to M. leprae, we analyzed innate and adaptive immune markers in whole blood of household contacts of newly diagnosed leprosy patients in Bangladesh, some of which received BCG vaccination. As controls, individuals from the same area without known contact with leprosy patients were similarly assessed. Our data show the added effect of BCG vaccination on immune markers on top of the effect already induced by M. leprae exposure. Moreover, we identified BCG-induced markers that differentiate between protective and disease prone immunity in those contacts.
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Ogunsumi DO, Lal V, Puchner KP, van Brakel W, Schwienhorst-Stich EM, Kasang C, Chukwu J, Kreibich S, Parisi S, Richardus JH, Blok DJ. Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey. PLoS Negl Trop Dis 2021; 15:e0009769. [PMID: 34543282 PMCID: PMC8483296 DOI: 10.1371/journal.pntd.0009769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/30/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level. METHODS We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods. RESULTS The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels 'high' and 'low' were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators. CONCLUSION There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies.
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Affiliation(s)
- Dorcas O. Ogunsumi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vivek Lal
- Sasakawa-India Leprosy Foundation, New Delhi, India
| | - Karl Philipp Puchner
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Medical Faculty/Master’s Programme Global Health and Disaster Medicine, University of Athens, Greece
| | | | - Eva-Maria Schwienhorst-Stich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Faculty of Medicine, University of Würzburg, Würzburg, Germany
| | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Joseph Chukwu
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Saskia Kreibich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Sandra Parisi
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Department for General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Schoenmakers A, Hambridge T, van Wijk R, Kasang C, Richardus JH, Bobosha K, Mitano F, Mshana SE, Mamo E, Marega A, Mwageni N, Letta T, Muloliwa AM, Kamara DV, Eman AM, Raimundo L, Njako B, Mieras L. PEP4LEP study protocol: integrated skin screening and SDR-PEP administration for leprosy prevention: comparing the effectiveness and feasibility of a community-based intervention to a health centre-based intervention in Ethiopia, Mozambique and Tanzania. BMJ Open 2021; 11:e046125. [PMID: 34446483 PMCID: PMC8395349 DOI: 10.1136/bmjopen-2020-046125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER NL7294 (NTR7503).
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Affiliation(s)
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin van Wijk
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Christa Kasang
- Deutsche Lepra- und Tuberkulosehilfe e.V, Wuerzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fernando Mitano
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Ephrem Mamo
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Nelly Mwageni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Taye Letta
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | - Artur Manuel Muloliwa
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | | | | | | | - Blasdus Njako
- Deutsche Lepra- und Tuberkulosehilfe e.V. Tanzania, Dar es Salaam, United Republic of Tanzania
| | - Liesbeth Mieras
- Medical Technical Department, NLR, Amsterdam, The Netherlands
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Richardus JH. Towards zero leprosy: Dream or vision? Indian J Med Res 2021; 153:401-403. [PMID: 34380783 PMCID: PMC8354041 DOI: 10.4103/ijmr.ijmr_304_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Tawfik GM, Biala M, Yousef YM, Tiwari R, Dobs M, Lotfy CI, Farrag DA, Hue AT, Yotsu RR, Huy NT. Efficacy of chemoprophylaxis and immunoprophylaxis in leprosy prevention: a systematic review and network meta-analysis of randomized controlled trials. Clin Microbiol Infect 2021; 27:1754-1761. [PMID: 34332107 DOI: 10.1016/j.cmi.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vaccination and single-dose rifampin are the main proven effective intervention types for preventing leprosy among contacts of Mycobacterium leprae endemic areas. Currently, no high-quality evidence is available regarding the best prophylactic intervention. OBJECTIVES Our primary study aim is to detect the most effective prophylactic intervention for the prevention of leprosy. METHODS In May 2019, 12 databases were searched systematically. Updated search terms were developed in March 2020 to complete an updated search. All randomized controlled trials (RCTs) comparing the different types of chemoprophylactic and immunoprophylactic interventions in leprosy prevention were included. Our participants were contacts of patients with leprosy or people residing in leprosy endemic communities. We searched for different types of chemoprophylactic and immunoprophylactic interventions used in leprosy prevention. We used network meta-analysis and meta-analysis. Quality assessment was performed using Cochrane Risk of Bias for included RCTs, in which all included RCTs were rated to be low to moderate risk. We registered our protocol in Prospero with ID CRD42019143207. RESULTS Among 11 included studies (326 264 patients) from original and updated search terms, eight were eligible for network meta-analysis (NMA) while four were eligible for MA. Findings suggest that Bacillus Calmette-Guérin (BCG) vaccination was the most effective intervention compared to placebo (risk ratios (RRs) 0.49 (0.30, 0.80), p 0.77), followed by combined BCG vaccination and single-dose rifampicin (SDR) with similarly low values (RR 48%, p 0.77). BCG revaccination was the least effective intervention compared to placebo (RR 1.08 (0.36, 3.22), p 0.26). CONCLUSION Compared to placebo, the BCG vaccine was the most effective prophylactic intervention. The combination of BCG vaccination + SDR had nearly the same efficacy as BCG vaccination alone, while BCG revaccination was the least effective. Thus, vaccination proved to be a more effective treatment than SDR alone. A well-designed multicenter RCT is warranted to evaluate the safety of these vaccines.
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Affiliation(s)
- Gehad Mohamed Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan.
| | - Marwa Biala
- Faculty of Medicine, Tripoli University, Tripoli, Libya.
| | - Yomna Mahmoud Yousef
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
| | - Ranjit Tiwari
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, 44600, Nepal.
| | - Monica Dobs
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Assuit University, Assuit, Egypt.
| | - Caroline Ibrahim Lotfy
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Pharmacy, Assuit University, Assuit, Egypt.
| | - Doha Ahmed Farrag
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Anh Tran Hue
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; School of Medicine, International University of Health and Welfare, Tochigi, Japan.
| | - Rie Roselyne Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Nguyen Tien Huy
- Online Research Club (http://onlineresearchclub.org), Nagasaki, 852-8523, Japan; Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
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Exploring clustering of leprosy in the Comoros and Madagascar: A geospatial analysis. Int J Infect Dis 2021; 108:96-101. [PMID: 33991682 DOI: 10.1016/j.ijid.2021.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To identify patterns of spatial clustering of leprosy. DESIGN We performed a baseline survey for a trial on post-exposure prophylaxis for leprosy in Comoros and Madagascar. We screened 64 villages, door-to-door, and recorded results of screening, demographic data and geographic coordinates. To identify clusters, we fitted a purely spatial Poisson model using Kulldorff's spatial scan statistic. We used a regular Poisson model to assess the risk of contracting leprosy at the individual level as a function of distance to the nearest known leprosy patient. RESULTS We identified 455 leprosy patients; 200 (44.0%) belonged to 2735 households included in a cluster. Thirty-eight percent of leprosy patients versus 10% of the total population live ≤25 m from another leprosy patient. Risk ratios for being diagnosed with leprosy were 7.3, 2.4, 1.8, 1.4 and 1.7, for those at the same household, at 1-<25 m, 25-<50 m, 50-<75 m and 75-<100 m as/from a leprosy patient, respectively, compared to those living at ≥100 m. CONCLUSIONS We documented significant clustering of leprosy beyond household level, although 56% of cases were not part of a cluster. Control measures need to be extended beyond the household, and social networks should be further explored.
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Blok DJ, Steinmann P, Tiwari A, Barth-Jaeggi T, Arif MA, Banstola NL, Baskota R, Blaney D, Bonenberger M, Budiawan T, Cavaliero A, Gani Z, Greter H, Ignotti E, Kamara DV, Kasang C, Manglani PR, Mieras L, Njako BF, Pakasi T, Saha UR, Saunderson P, Smith WCS, Stäheli R, Suriyarachchi ND, Tin Maung A, Shwe T, van Berkel J, van Brakel WH, Vander Plaetse B, Virmond M, Wijesinghe MSD, Aerts A, Richardus JH. The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study. PLoS Negl Trop Dis 2021; 15:e0009279. [PMID: 33788863 PMCID: PMC8011751 DOI: 10.1371/journal.pntd.0009279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes. The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of SDR to eligible contacts of newly diagnosed leprosy patients in states or districts of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. This study investigated the long-term impact of the LPEP program on the leprosy new case detection rate (NCDR). Our results show that LPEP could reduce the NCDR beyond the impact of the routine leprosy control programme and that many new cases could be prevented. The benefit of LPEP increases gradually over time. LPEP could accelerate the time of reaching predicted NCDR levels of 2040 under routine program by up to six years. Furthermore, we highlighted how the impact varies between countries due to differences in the number of contacts per index patient screened and differences in leprosy epidemiology and national control programme. Generally, including both household contacts and neighbours (> 20 contacts per index patient) would yield the highest impact.
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Affiliation(s)
- David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anuj Tiwari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Barth-Jaeggi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - David Blaney
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | | | - Helena Greter
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | | | | | - Blasdus F. Njako
- German Leprosy and Tuberculosis Relief Association, Dar es Salaam, Tanzania
| | - Tiara Pakasi
- Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Unnati R. Saha
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul Saunderson
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | | | | | | | | | - Tin Shwe
- American Leprosy Missions, Yangon, Myanmar
| | | | | | | | | | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Richardus JH, Mieras L, Saunderson P, Ignotti E, Virmond M, Arif MA, Pandey BD, Cavaliero A, Steinmann P. Leprosy post-exposure prophylaxis risks not adequately assessed - Author's reply. Lancet Glob Health 2021; 9:e402-e403. [PMID: 33740406 DOI: 10.1016/s2214-109x(21)00047-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | | | | | - Basu Dev Pandey
- Ministry of Health and Population of Nepal, Kathmandu, Nepal
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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Lockwood DNJ, de Barros B, Negera E, Gonçalves H, Hay RJ, Kahawita IP, Singh RK, Kumar B, Lambert SM, Pai V, Penna GO, Prescott G, de Arquer GR, Talhari S, Srikantam A, Walker SL. Leprosy post-exposure prophylaxis risks not adequately assessed. LANCET GLOBAL HEALTH 2021; 9:e400-e401. [PMID: 33740405 DOI: 10.1016/s2214-109x(21)00046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Edessa Negera
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | | | | | | | | | - Saba M Lambert
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Vivek Pai
- Bombay Leprosy Project, Mumbai, India
| | - Gerson O Penna
- Tropical Medicine Centre Universidade de Brasilia, Brasilia Federal District, Brazil; Fiocruz School of Government, Brasilia Federal District, Brazil
| | | | | | - Sinesio Talhari
- Fundacao de Dermatologia tropica e venereologia Alfredo da Matta, Manaus, Brazil
| | - Aparna Srikantam
- LEPRA Blue Peter Public Health and Research Centre, Hydedrabad, India
| | - Stephen L Walker
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Taal AT, Blok DJ, van Brakel WH, de Vlas SJ, Richardus JH. Number of people requiring post-exposure prophylaxis to end leprosy: A modeling study. PLoS Negl Trop Dis 2021; 15:e0009146. [PMID: 33630836 PMCID: PMC7906365 DOI: 10.1371/journal.pntd.0009146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Worldwide, around 210,000 new cases of leprosy are detected annually. To end leprosy, i.e. zero new leprosy cases, preventive interventions such as contact tracing and post-exposure prophylaxis (PEP) are required. This study aims to estimate the number of people requiring PEP to reduce leprosy new case detection (NCD) at national and global level by 50% and 90%. METHODOLOGY/PRINCIPAL FINDINGS The individual-based model SIMCOLEP was fitted to seven leprosy settings defined by NCD and MB proportion. Using data of all 110 countries with known leprosy patients in 2016, we assigned each country to one of these settings. We predicted the impact of administering PEP to about 25 contacts of leprosy patients on the annual NCD for 25 years and estimated the number of contacts requiring PEP per country for each year. The NCD trends show an increase in NCD in the first year (i.e. backlog cases) followed by a significant decrease thereafter. A reduction of 50% and 90% of new cases would be achieved in most countries in 5 and 22 years if 20.6 and 40.2 million people are treated with PEP over that period, respectively. For India, Brazil, and Indonesia together, a total of 32.9 million people requiring PEP to achieve a 90% reduction in 22 years. CONCLUSION/SIGNIFICANCE The leprosy problem is far greater than the 210,000 new cases reported annually. Our model estimates of the number of people requiring PEP to achieve significant reduction of new leprosy cases can be used by policymakers and program managers to develop long-term strategies to end leprosy.
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Affiliation(s)
- Anneke T. Taal
- NLR, Amsterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Leprosy post-exposure prophylaxis: innovation and precision public health. LANCET GLOBAL HEALTH 2021; 9:e8-e9. [DOI: 10.1016/s2214-109x(20)30512-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022]
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van Hooij A, Tjon Kon Fat EM, de Jong D, Khatun M, Soren S, Chowdhury AS, Chandra Roy J, Alam K, Kim JP, Richardus JH, Geluk A, Corstjens PLAM. Prototype multi-biomarker test for point-of-care leprosy diagnostics. iScience 2020; 24:102006. [PMID: 33490914 PMCID: PMC7807156 DOI: 10.1016/j.isci.2020.102006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 12/23/2020] [Indexed: 12/27/2022] Open
Abstract
To end the decade-long, obstinately stagnant number of new leprosy cases, there is an urgent need for field-applicable diagnostic tools that detect infection with Mycobacterium leprae, leprosy's etiologic agent. Since immunity against M. leprae is characterized by humoral and cellular markers, we developed a lateral flow test measuring multiple host proteins based on six previously identified biomarkers for various leprosy phenotypes. This multi-biomarker test (MBT) demonstrated feasibility of quantitative detection of six host serum proteins simultaneously, jointly allowing discrimination of patients with multibacillary and paucibacillary leprosy from control individuals in high and low leprosy endemic areas. Pilot testing of fingerstick blood showed similar MBT performance in point-of-care (POC) settings as observed for plasma and serum. Thus, this newly developed prototype MBT measures six biomarkers covering immunity against M. leprae across the leprosy spectrum. The MBT thereby provides the basis for immunodiagnostic POC tests for leprosy with potential for other (infectious) diseases as well. Prototype MBT that quantitatively detects six host-derived biomarkers is developed The immunopathological spectrum of leprosy is ideally suited to evaluate the MBT MBT discriminated patients with leprosy from controls in a high and non-endemic area Application of the MBT using low invasive fingerstick blood is technically feasible
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Affiliation(s)
- Anouk van Hooij
- Department of Infectious Diseases Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Elisa M Tjon Kon Fat
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Danielle de Jong
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Marufa Khatun
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Santosh Soren
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Abu Sufian Chowdhury
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Johan Chandra Roy
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Khorshed Alam
- Rural Health Program, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Jong-Pill Kim
- Institute for Leprosy Research, Korean Hansen Welfare Association, Gyeonggi-do, South Korea
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
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Mieras L, Singh M, Manglani P, Arif M, Banstola N, Pandey B, Budiawan T, Utami R, Wibowo T, Iswandi A, Peters R, van Brakel W. A single dose of rifampicin to prevent leprosy; quantitative analysis of impact on perception, attitudes and behaviour of persons affected, contacts and community members towards leprosy in India, Nepal and Indonesia. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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