The potential for vaccination in leprosy elimination: new tools for targeted interventions

Duthie, Malcolm S.; Saunderson, Paul; Reed, Steven G.

doi:10.1590/s0074-02762012000900027

Cited by 18 publications

(17 citation statements)

References 48 publications

(37 reference statements)

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“…It is possible that the combination of medication and BCG vaccine may facilitate elimination of M . leprae in the host (by increasing TNF-α and IL12 levels and activating macrophages), decrease relapse rates and shorten the positivity of the bacilloscopy [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Monitoring of Mycobacterium leprae Transmission in Household Contacts of Patients with Hansen's Disease in Colombia

2017

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Leprosy in Colombia is in a stage of post elimination—since 1997, prevalence of the disease is less than 1/10000. However, the incidence of leprosy has remained stable, with 400–500 new cases reported annually, with MB leprosy representing 70% of these case and 10% having grade 2 disability. Thus, leprosy transmission is still occurring, and household contacts (HHCs) of leprosy patients are a population at high risk of contracting and suffering from the effects of the disease during their lifetime. We performed a cross-sectional study with the aim of evaluating leprosy transmission within Family Groups (FGs) from four Colombian departments: Antioquia, Bolívar, Córdoba and Sucre. This study included 159 FGs formed by 543 HHCs; 45 FGs were monitored twice, first in 2003 and again in 2012. Migration, forced displacement by violence, loss of contact with the health center and the lack of an agreement to participate in the second monitoring were the primary reasons not all FGs were tested a second time. In each HHC, a clinical examination was performed, epidemiological data recorded, the bacillary index determined, DNA was isolated for M. leprae detection by nested PCR and IgM anti-phenolic glycolipid-I (PGL-I) titers were inspected. Further, DNA from M. leprae isolates were typed and compared among FGs. Twenty-two (4.1%) of the 543 HHCs had IgM anti-PGL-I positive antibody titers, indicating infection. Nasal swabs (NS) taken from 113 HHCs were tested by RLEP PCR; 18 (16%) were positive for M. leprae DNA and two new leprosy cases were detected among the HHCs. Of the confirmed HHCs with leprosy, it was possible to genotype the bacterial strains from both the index case and their HHCs. We found that the genotype of these two strains agreed at 9 markers, showing the individuals to be infected by the same strain, indicating familiar transmission. HHCs of leprosy patients not only are a high-risk population for M. leprae infection, they can act as M. leprae carriers and therefore serve as sources for transmission and infection. Our results confirm familiar leprosy transmission and suggest that follow-up of HHCs is a good strategy for early diagnosis of leprosy and to monitor its transmission.

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Section: Introductionmentioning

confidence: 99%

Evaluation and Monitoring of Mycobacterium leprae Transmission in Household Contacts of Patients with Hansen's Disease in Colombia

2017

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“…Übertragung nach BCG-Impfung und Therapie: In Lepra-endemischen Regionen hat die BCG-Impfung zu einer niedrigeren Bakterienbürde (bacillary load) bei Kontaktpersonen geführt, somit die Übertragungsrate gesenkt und zusätzlich möglicherweise die Therapieeffizienz verbessert [99,122,124]. Nach heutigem Wissen kann der Therapieerfolg durch BCG-Impfung nur bei Kindern verbessert werden [124,125,129]. Die Stimulierung durch die BCG-Impfung beeinflusst das multibazilläre Stadium der Lepra stärker als das paucibazilläre [129].…”

Section: Prävention Der M Lepraeunclassified

“…Nach heutigem Wissen kann der Therapieerfolg durch BCG-Impfung nur bei Kindern verbessert werden [124,125,129]. Die Stimulierung durch die BCG-Impfung beeinflusst das multibazilläre Stadium der Lepra stärker als das paucibazilläre [129]. Als Tripeltherapie-Unterstützung konnte bei Patienten mit Lepra im Stadium BL oder LL nach BCG-Impfung die Zerstörung der motorischen Nervenfunktion wesentlich vermindert werden, während die Bildung von Lepromin-Antikörpern, Bakterienbelastung und Granulom-Bildung durch die zusätzliche BCG-Impfung nicht beeinflusst wurden [130].…”

Section: Prävention Der M Lepraeunclassified

Mycobacterium leprae – der Erreger von Lepra

2016

Bundesgesundheitsbl

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Der Arbeitskreis Blut des Bundesministeriums für Gesundheit gibt als nationales Beratungsgremium Stellungnahmen zu neuartigen Erregern ab, bewertet neue Erkenntnisse zu bekannten Erregern und erarbeitet entsprechende Empfehlungen für die Fachöffentlichkeit. Diese Serie von Stellungnahmen zu einzelnen Erregern wird als Zusammenfassung des aktuellen Wissensstandes veröffentlicht, speziell unter transfusionsmedizinisch relevanten Aspek

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“…Despite these measures, however, studies in the last decades have shown that the expected decline in the new case notification rate (CNR) and possibly incidence of leprosy has not occurred [3], [10]–[14]; in some high endemic areas even an increase in leprosy notification rates is found [10], [15]–[17]. Globally, approximately 250,000 new leprosy cases are still detected each year [17].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of the Epidemiology of Leprosy in Cebu: An Eleven-Year Profile

Scheelbeek

Balagon²,

Orcullo³

et al. 2013

PLoS Negl Trop Dis

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BackgroundCebu has been one of the most leprosy endemic areas in the Philippines. Despite the high coverage rates of multiple drug therapy (MDT) and high BCG-vaccine coverage in children, leprosy control authorities believe that leprosy transmission and incidence (as evidence by continuing new case detection in both adults and children) have not declined as expected, once leprosy had been eliminated.In response to the concerns communicated by the authorities regarding ongoing leprosy transmission in Cebu, this study aims to examine the evidence for the hypothesized ongoing transmission, both in children and adults. Furthermore, it will be assessed which groups and areas are experiencing a continuing risk of leprosy infection; this can form a starting point for more targeted approaches to leprosy control.Methodology & Principal FindingsCase records from 2000–2010 were retrospectively collected from the Leonard Wood Memorial Clinic archives, and all other clinics on the island where leprosy was treated. Between 2000 and 2010, 3288 leprosy cases were detected. The overall five year case notification rate (CNR) dropped significantly from 47.35 (2001–2005) to 29.21 cases (2006–2010) per 100.000 population. Smaller CNRs were reported for children; however the decline in child-CNR over the same period was minimal. Furthermore, no increase in median age of notification in children or adults was found between 2000 and 2010. Population-adjusted clustering of leprosy cases was mainly detected in urban and peri-urban areas.Conclusions & SignificanceAlthough the overall CNR declined significantly, CNR seems to be rather static in lower risk populations and areas. Cases are mainly found in urban areas, however CNRs in these areas decline at a much faster rate than in the lower endemic rural areas. A similar situation was found when comparing adults and children: CNRs observed in children were lower than in adults, but further decline (and elimination) of these childhood CNRs was found to be difficult. Moreover, the median age of notification in children has remained stable, suggesting transmission is still on-going.It is unclear why many years of good MDT-coverage and a gradual decline in CNR have not been accompanied by evidence of reduced transmission, especially beyond a certain threshold level of case notification. We believe that a new approach to leprosy control is required to tackle transmission more directly. The most promising approach may involve chemoprophylaxis and/or immunoprophylaxis interventions, targeted at high risk (urban) areas and groups such as household contacts, followed by a different approach once decline in CNR starts to level off. Identified clusters and trends can form the starting point for implementing this approach.

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The potential for vaccination in leprosy elimination: new tools for targeted interventions

Cited by 18 publications

References 48 publications

Evaluation and Monitoring of Mycobacterium leprae Transmission in Household Contacts of Patients with Hansen's Disease in Colombia

Evaluation and Monitoring of Mycobacterium leprae Transmission in Household Contacts of Patients with Hansen's Disease in Colombia

Mycobacterium leprae – der Erreger von Lepra

A Retrospective Study of the Epidemiology of Leprosy in Cebu: An Eleven-Year Profile

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