Effectiveness of rifampicin chemoprophylaxis in preventing leprosy in patient contacts: a systematic review of quantitative and qualitative evidence

Ferreira, Silvana Margarida Benevides; Yonekura, Tatiana; Ignotti, Eliane; Oliveira, Larissa Bertacchini de; Takahashi, Juliana; Soares, Cássia Baldini

doi:10.11124/jbisrir-2016-003301

Cited by 24 publications

(17 citation statements)

References 37 publications

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“…Contact tracing and geographic information systems studies reveal a concentration of new patients among household and social contacts, either children or adults, of previous patients highlighting the importance of developing differentiated actions for surveillance of this group 19 – 21 . Simulation studies 22 and systematic reviews 23 suggest that the control of leprosy could be achieved faster through household contact tracing associated with new interventions such as chemo or immunoprophylactic approaches 17 , 18 , 24 . Indeed, immunoprophylaxis and contact surveillance has an impact on outcome 17 , 24 .…”

Section: Introductionmentioning

confidence: 99%

Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients

Hacker

Sales

Duppré

et al. 2021

Sci Rep

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Reduction in incidence has been associated with the introduction of novel approaches, like chemo/immune-prophylaxis. Incidence determined through follow-up cohort studies can evaluate the implementation of these innovative policies towards control and prevention. We have assessed the incidence in our contacts cohort over past 33 years, considering the effect of demographic and clinical variables. Survival analysis was used to estimate the risk of leprosy. A total of 9024 contacts were evaluated, of which 192 developed leprosy, resulting in an overall incidence of 1.4/1000 person-years. The multivariate analysis showed that the major risk factors were (i) contact from MB index cases and (ii) consanguinity (iii) intra household contact. Lower risk was detected for contacts with BCG scar who were revaccinated. There was a significant decrease in accumulated risk between the 2011–2019 period compared with 1987, probably linked to the improvement in laboratory tools to monitor contacts, thereby providing early diagnosis of contacts at intake and reduction of transmission. Our findings suggest that a combination of contact surveillance and tracing, adequate neurodermatological examination, and availability of molecular tools is highly effective in supporting early diagnosis, while a second dose of the BCG vaccination can exert extra protection.

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Section: Introductionmentioning

confidence: 99%

Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients

Hacker

Sales

Duppré

et al. 2021

Sci Rep

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“…Two additional systematic reviews of quantitative and qualitative data and a meta-analysis in 2017 and 2018 confirmed the effectiveness of SDR as PEP and the general acceptance of the approach. 142,143 Preventive chemotherapy has become part of leprosy control. This is needed, since the incidence has been more or less stable at around 210,000 in the past 10 years.…”

Section: Chemoprophylaxismentioning

confidence: 99%

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

Schoenmakers

Mieras

Budiawan³

et al. 2020

RRTM

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Objective: Annually, over 200,000 people are diagnosed with leprosy, also called Hansen's disease. This number has been relatively stable over the past years. Progress has been made in the fields of chemoprophylaxis and immunoprophylaxis to prevent leprosy, with a primary focus on close contacts of patients. In this descriptive meta-analysis, we summarize the evidence and identify knowledge gaps regarding post-exposure prophylaxis against leprosy. Methods: A systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted by searching the medical scientific databases Cochrane, Embase, Pubmed/MEDLINE, Research Gate, Scopus and Web of Science on Jan. 22, 2020, using a combination of synonyms for index terms in four languages: "leprosy" and "population" or "contacts" and "prevention" or "prophylaxis." Subsequently, Infolep.org and Google Scholar were searched and the "snowball method" was used to retrieve other potentially relevant literature. The found articles were screened for eligibility using predetermined inclusion and exclusion criteria. Results: After deduplication, 1,515 articles were screened, and 125 articles were included in this descriptive meta-analysis. Immunoprophylaxis by bacillus Calmette-Guérin (BCG) vaccination is known to provide protection against leprosy. The protection it offers is higher in household contacts of leprosy patients compared with the general population and is seen to decline over time. Contact follow-up screening is important in the first period after BCG administration, as a substantial number of new leprosy patients presents three months postvaccination. Evidence for the benefit of re-vaccination is conflicting. The World Health Organization (WHO) included BCG in its Guidelines for the Diagnosis, Treatment and Prevention of Leprosy by stating that BCG at birth should be maintained in at least all leprosy high-burden regions. Literature shows that several vaccination interventions with other immunoprophylactic agents demonstrate similar or slightly less efficacy in leprosy risk reduction compared with BCG. However, most of these studies do not exclusively focus on post-exposure prophylaxis. Two vaccines are considered future candidates for leprosy prophylaxis: Mycobacterium indicus pranii (MiP) and LepVax. For chemoprophylaxis, trials were performed with dapsone/acedapsone, rifampicin, and ROM, a combination of rifampicin, ofloxacin, and minocycline. Single-dose rifampicin is favored as post-exposure prophylaxis, abbreviated as SDR-PEP. It demonstrated a protective effect of 57% in the first two years after administration to contacts of leprosy patients. It is inexpensive, and adverse events are rare. The risk of SDR-PEP inducing rifampicin resistance is considered negligible, but continuous monitoring in accordance with WHO policies should be encouraged. The integration of contact screening and SDR-PEP administration into different leprosy control programs was found to be feasible and well accep...

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“…Another systematic review showed that one dose of rifampicin reduced the incidence of leprosy among contacts of leprosy patients in the first two years by 56.5% and that this intervention is socially accepted. 15 Individually, BCG vaccination and chemoprophylaxis have been shown to be effective strategies in preventing leprosy. A study, which assessed the combined effect of BCG vaccination and single dose rifampicin on leprosy prevention, showed that the protective effects provided by BCG vaccination and rifampicin, independently, were 57% and 58%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of Immunoprophylaxis and/or Chemoprophylaxis for Household Contacts of Patients with Hansen’s Disease: A Prospective, Single-Center, Mixed Methods Study

Espiridion-Calma¹,

Dofitas²,

Sison³

2020

Acta Med Philipp

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Objectives. Leprosy is an infectious disease affecting the skin and nerves caused by Mycobacterium leprae. Closer physical distance was found to increase risk transmission. Thus, targeted provision of prophylactic medications to household contacts of patients with leprosy could possibly aid in decreasing its incidence in a cost-effective manner. This study aimed to determine the attitudes towards disclosure of the diagnosis of leprosy and acceptance of immuno- and chemoprophylaxis for household contacts of patients undergoing treatment in a dermatology outpatient clinic of a tertiary hospital in the Philippines. Methods. We conducted a prospective, single-center, cross-sectional and mixed methods study at a dermatology clinic of a tertiary hospital. All diagnosed leprosy patients, household contacts of leprosy patients, and individuals with no leprosy and no known contact with a leprosy case were invited. Eligible participants who gave consent were included in the cross-sectional survey, followed by in-depth interviews of selected participants. STATA 12 was used to analyze the data. Descriptive statistics were used to summarize information. Chi-square was computed to obtain a measure of association of important variables. The field notes and the verbatim transcriptions of the interviews and narratives were filed using an analytic memo system. Results. Fifty-five participants (22 Hansen’s disease patients, 13 household contacts, and 20 individuals unaffected by and unexposed to leprosy) were enrolled. Mean age of respondents was 38 years, 60% were female, and 85% were living in an urban setting. Majority of the patients with leprosy were borderline lepromatous (45%) to lepromatous type (27%) with mean treatment duration of 13 months. Overall, the respondents were willing to disclose the diagnosis of leprosy to their household members to facilitate provision of prophylaxis. They were also generally willing to receive prophylaxis despite potential side effects, expense, incomplete protection, and the need for yearly assessment for the development of leprosy. All respondents felt hopeful about the availability of medications that can prevent the development of leprosy and its complications, with some feeling anxious and only a few being embarrassed about receiving them. Conclusions. Prophylactic medications were found to be generally acceptable despite some concerns. There is also a willingness to disclose the diagnosis of leprosy to facilitate the targeted provision of prophylaxis to household contacts.

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Effectiveness of rifampicin chemoprophylaxis in preventing leprosy in patient contacts: a systematic review of quantitative and qualitative evidence

Abstract: Chemoprophylaxis with one dose of rifampicin is found to be effective in preventing contacts of leprosy patients from contracting the disease. Also, there is indication that this strategy is socially accepted.

Cited by 24 publications

References 37 publications

Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients

Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients

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

Acceptability of Immunoprophylaxis and/or Chemoprophylaxis for Household Contacts of Patients with Hansen’s Disease: A Prospective, Single-Center, Mixed Methods Study

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