Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme.
- Richardus JH Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands. Electronic address: j.richardus@erasmusmc.nl.
- Tiwari A Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
- Barth-Jaeggi T Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
- Arif MA NLR, New Delhi, India.
- Banstola NL NLR, Kathmandu, Nepal.
- Baskota R Ministry of Health and Population of Nepal, Kathmandu, Nepal.
- Blaney D Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Blok DJ Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
- Bonenberger M FAIRMED, Bern, Switzerland.
- Budiawan T NLR, Jakarta, Indonesia.
- Cavaliero A Novartis Foundation, Basel, Switzerland.
- Gani Z Novartis Foundation, Basel, Switzerland.
- Greter H Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
- Ignotti E Universidade do Estado de Mato Grosso, Cáceres, Brazil.
- Kamara DV National Tuberculosis and Leprosy Programme, Dodoma, Tanzania.
- Kasang C German Leprosy and Tuberculosis Relief Association, Würzburg, Germany.
- Manglani PR NLR, New Delhi, India.
- Mieras L NLR, Amsterdam, Netherlands.
- Njako BF German Leprosy and Tuberculosis Relief Association, Dar es Salaam, Tanzania.
- Pakasi T Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia.
- Pandey BD Ministry of Health and Population of Nepal, Kathmandu, Nepal.
- Saunderson P American Leprosy Missions, Greenville, SC, USA.
- Singh R German Leprosy and Tuberculosis Relief Association, New Delhi, India.
- Smith WCS University of Aberdeen, Aberdeen, UK.
- Stäheli R FAIRMED, Bern, Switzerland.
- Suriyarachchi ND FAIRMED, Colombo, Sri Lanka.
- Tin Maung A American Leprosy Missions, Yangon, Myanmar.
- Shwe T American Leprosy Missions, Yangon, Myanmar.
- van Berkel J NLR, Amsterdam, Netherlands.
- van Brakel WH NLR, Amsterdam, Netherlands.
- Vander Plaetse B FAIRMED, Bern, Switzerland.
- Virmond M Instituto Lauro de Souza Lima & UNINOVE, Bauru, Brazil.
- Wijesinghe MSD Anti-Leprosy Campaign, Colombo, Sri Lanka.
- Aerts A Novartis Foundation, Basel, Switzerland.
- Steinmann P Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
- 2020-11-01
Published in:
- The Lancet. Global health. - 2020
English
BACKGROUND
Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities.
METHODS
The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates.
FINDINGS
Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported.
INTERPRETATION
Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established.
FUNDING
Novartis Foundation.
Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities.
METHODS
The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates.
FINDINGS
Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported.
INTERPRETATION
Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established.
FUNDING
Novartis Foundation.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1016/S2214-109X(20)30396-X
- PMID 33129378
- Persistent URL
- https://sonar.ch/global/documents/123882
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