Chemoprophylaxis to Control Leprosy and the Perspective of Its Implementation in Brazil: A Primer for Non-Epidemiologists

Abstract

The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.

Zika Fetal Neuropathogenesis: Etiology of a Viral Syndrome

“…Epidemiological assessment of potential confounding risk factors for Zika congenital syndrome—including preceding immunologically cross-reactive arboviral infection [ 7 , 18 , 19 ]—and potential thalidomide sharing by patients being treated for leprosy [ 27 – 30 ] remains to be completed. To underscore the point, leprosy is now endemic throughout much of Brazil, including Pernambuco [ 235 ], and postexposure prophylaxis of exposed individuals has been advocated [ 236 , 237 ]. The possibility of intrauterine exposure to pyriproxifen-containing insecticides (in northeastern Brazil) with subsequent teratogenesis because of activation of retinoid X receptors has been repeatedly raised [ 26 ], and resolution of this controversy may require an appropriately powered epidemiological exposure study.…”

<p>The State of Affairs in Post-Exposure Leprosy Prevention: A Descriptive Meta-Analysis on Immuno- and Chemo-Prophylaxis</p>

“…Da Cunha et al recommended that if SDR-PEP was implemented in Brazil, it should start on a small scale, generating new evidence from the Brazilian context. 147 …”

“…Da Cunha et al recommended that if SDR-PEP was implemented in Brazil, it should start on a small scale, generating new evidence from the Brazilian context. 147 Several post-exposure chemoprophylactic studies against leprosy are ongoing. The PEP4LEP project in Ethiopia, Tanzania, and Mozambique compares the feasibility of a health center-based contact approach to acommunity skin camp-based approach regarding integrated skin screening and SDR-PEP administration (Schoenmakers et al, under publication).…”

Zika Fetal Neuropathogenesis: Etiology of a Viral Syndrome

“…Epidemiological assessment of potential confounding risk factors for Zika fetal syndrome, including preceding immunologically cross-reactive arboviral infection and potential thalidomide sharing by patients being treated for leprosy, remains to be completed (12, 193). To underscore the point, leprosy is now endemic throughout much of Brazil including Pernambuco (194), and post exposure prophylaxis of exposed individuals has been advocated (195, 196).…”