Leprosy Eradication Project of Malta

Abstract

This is the first publication of the initial 5-year-period of the eradication programme since its introduction in the Maltese Islands in the second half of 1972. All patients were treated with a combined drug regimen, its chief components being rifampicin (RMP), prothionamide (PTH), isoniazid (INH) and diaminodiphenyl-sulfone (DDS). To simplify the therapeutic technique, PTH, INH and DDS were given as a fixed combination. Other medications, such as DDS-free regimens, were whenever possible also given as fixed combinations. Fixed combinations not only make treatment simpler, but also guarantee a more reliable acceptance of the medication and the adherence to the dosage proportions which play an important role with regard to the effectiveness. For an eradication programme the classification into the different leprosy types plays not a too important role. It was rather our goal to cure each single patient so as to eliminate him as a possible source of infection. Whether or not this goal has been reached was as far as possible related to the results of the bacteriological assessment. Of the originally recorded 210 patients 206 were included in the first part of the programme (groups I–III). By the end of 5 years, a total of 20 patients had left the programme (death or emigration) so that 186 patients remained registered per June, 1977. In 180 cases treatment has been discontinued; 6 patients are still under therapy. The relapse-free observation periods are more than 2 years in 160 patients, more than 3 years in 120 patients, and more than 4 years in 12 patients. 31 patients joined the programme when it was already under way, namely 11 patients in 1973, 9 patients in 1974, 6 patients in 1975, and 5 patients in 1976. These newly registered cases were grouped separately (group IV). 27 patients were found to be bacteriologically positive; 10 of them are meanwhile negative, 11 are still being treated. Under observation without therapy are 19. One patient died of nonspecific disease in 1976. In continuation of the programme we are aiming at (a) conclusive treatment of the rest of the patients who are still under therapy, (b) conclusive treatment of the patients according to group IV, (c) regular observation of all cases for the absence of relapses, and (d) search for new cases and inclusion of such eventually newly identified cases in the programme. Further scientific evaluation of the material, chiefly in the bacteriological, clinical, pathological and genetic field, will require lengthy investigations which we are working at. A larger quantity of well-examined and well-classified material has accumulated since the start of the programme. The material is at the disposal also of all colleagues outside Borstel Institute. Up to the present, we have collected approximately 30,000 histological slides, representing all stages of leprosy, i.e. from the period before, during and after treatment (about 5000 biopsies). The article explains the prerequisites for an eradication programme which in principle can serve as a model for si...

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