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Background The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. Methods We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. Results Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. Discussion This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.

IL-12 and IL-18 synergistically induce the production of IFN-gamma by resting and activated T cells. To evaluate whether this induction was affected in HIV-1-infected patients, PBMC or isolated CD4 T cells were cultured with IL-12 plus IL-18, anti-CD3 plus anti-CD28, or PHA for 72 h. Cell samples were labeled daily to assess the levels of IL-12 receptor beta1 (IL-12Rbeta1), IL-12Rbeta2, and IL-18Ralpha. Culture supernatants were analyzed for the presence of Th1- and Th2-related cytokines by ELISA or cytometric bead array and analyzed by flow cytometry. A twofold increase in the percentage of CD4-resting T cells expressing IL-12Rbeta1 and IL-18Ralpha from HIV-1-infected patients was observed when compared with cells from HIV-1-negative donors. Higher IL-12Rbeta1 and IL-18Ralpha expression correlated (r=0.87; P<0.007) to increased production of IFN-gamma by isolated CD4 T cells in the presence of IL-12 and IL-18. Moreover, exogenous IL-12 and IL-18 induced the up-regulation of IL-12Rbeta2 to twice higher in CD4 T cells from HIV-1-positive individuals compared with controls. Conversely, upon activation with anti-CD3 and anti-CD28 antibodies, only 25% of the CD4+ T cells from HIV-1 patients showed an increase in the IL-12beta2 when compared with 50% in healthy controls. Furthermore, the percentage of IL-12Rbeta1-positive cells correlated inversely with the CD4 nadir of patients, suggesting that deregulation of the IL-12 and IL-18 pathways may play a role in the immunopathogenesis of HIV-1 infection.

The Coronavirus disease (COVID-19) has affected the health and the economies of the whole world since early 2020, with particular repercussions for the most vulnerable populations, including people affected by leprosy. Following the World Health Organisation (WHO) declaration of the outbreak as a Public Health Emergency of International Concern (PHEIC), 1 the Indian Prime Minister imposed a nationwide lockdown and movement restrictions in March 2020. In the leprosy context, these restrictions have negatively affected access to quality healthcare services, including case detection activities. These challenges, together with some specific recommendations have been documented elsewhere. 2-4 However, the impact of COVID-19 on new case detection has not yet been quantified.

Individual studies reported high levels of depression and anxiety among people affected with leprosy and lymphatic filariasis (LF), but they are often too small for a reliable comparison of prevalence mental ill health or its risk. The current study explores prevalence and risk factors of depression and anxiety within a large programme of a non-governmental organisation in India. Methods: In a cross-sectional survey, we administered face-to-face Washington Group extended questions for Mental Health among leprosy and LF beneficiaries entering Lepra's programmes in Bihar, Andhra Pradesh, Odisha and Madhya Pradesh (N = 3706). Data were also gathered on risk factors widely reported in the literature, such as gender, age, caste, income, occupation, exclusion, disability and marital status. Results: Around 50% of people affected with leprosy or LF reported experiences of depression and anxiety. Disability was found to be the main contributing factor for depression and anxiety, with exclusion, income, gender and age having a lower effect. Conclusion:The study confirms that mental ill health is a significant burden associated with leprosy and LF and that the mental health care needs of this population should be streamlined into the existing health and social services, and tailored according to disability status, age, marital status gender, income levels and taking into account experiences of discrimination. Current momentum for joint efforts to address skin NTDs presents a window of opportunity.