Post-exposure prophylaxis(PEP)for leprosy is administered as one single dose of rifampicin(SDR)to the contacts of newly diagnosed leprosy patients.SDR reduces the risk of developing leprosy among contacts by around 60...Post-exposure prophylaxis(PEP)for leprosy is administered as one single dose of rifampicin(SDR)to the contacts of newly diagnosed leprosy patients.SDR reduces the risk of developing leprosy among contacts by around 60%in the first 2–3 years after receiving SDR.In countries where SDR is currently being implemented under routine programme conditions in defined areas,questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M.tuberculosis strains circulating in these areas.This issue has not been addressed in scientific literature to date.To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis,a meeting was convened with tuberculosis(TB)and leprosy experts.The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of(multi)drug-resistance in M.tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy.They concluded that SDR given to contacts of leprosy patients,in the absence of symptoms of active TB,poses a negligible risk of generating resistance in M.tuberculosis in individuals and at the population level.Thus,the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M.tuberculosis.展开更多
Background Leprosy post-exposure prophylaxis(LPEP)with single dose rifampicin(SDR)can be integrated into different leprosy control program set-ups once contact tracing has been established.We analyzed the spatio-tempo...Background Leprosy post-exposure prophylaxis(LPEP)with single dose rifampicin(SDR)can be integrated into different leprosy control program set-ups once contact tracing has been established.We analyzed the spatio-temporal changes in the distribution of index cases(IC)and co-prevalent cases among contacts of leprosy patients(CP)over the course of the LPEP program in one of the four study areas in Brazil,namely the municipality of Alta Floresta,state of Mato Grosso,in the Brazilian Amazon basin.Methods Leprosy cases were mapped,and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018.Data were obtained on new leprosy cases[Notifiable diseases information system(Sinan)],contacts traced by the LPEP program,and socioeconomic variables[Brazilian Institute of Geography and Statistics(IBGE)].Kernel,SCAN,factor analysis and spatial regression were applied to analyze changes.Results Overall,the new case detection rate(NCDR)was 20/10000 inhabitants or 304 new cases,of which 55 were CP cases among the 2076 examined contacts.Changes over time were observed in the geographic distribution of cases.The highest concentration of cases was observed in the northeast of the study area,including one significant cluster(Relative risk=2.24;population 27427,P-value<0.001)in an area characterized by different indicators associated with poverty as identified through spatial regression(Coefficient 3.34,P-value=0.01).Conclusions The disease distribution was partly explained by poverty indicators.LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.展开更多
基金supported by Novartis Foundation as coordinator of the LPEP project and hosted by the Netherlands Leprosy Relief,one of the ILEP partners involved in the LPEP project.
文摘Post-exposure prophylaxis(PEP)for leprosy is administered as one single dose of rifampicin(SDR)to the contacts of newly diagnosed leprosy patients.SDR reduces the risk of developing leprosy among contacts by around 60%in the first 2–3 years after receiving SDR.In countries where SDR is currently being implemented under routine programme conditions in defined areas,questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M.tuberculosis strains circulating in these areas.This issue has not been addressed in scientific literature to date.To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis,a meeting was convened with tuberculosis(TB)and leprosy experts.The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of(multi)drug-resistance in M.tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy.They concluded that SDR given to contacts of leprosy patients,in the absence of symptoms of active TB,poses a negligible risk of generating resistance in M.tuberculosis in individuals and at the population level.Thus,the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M.tuberculosis.
文摘Background Leprosy post-exposure prophylaxis(LPEP)with single dose rifampicin(SDR)can be integrated into different leprosy control program set-ups once contact tracing has been established.We analyzed the spatio-temporal changes in the distribution of index cases(IC)and co-prevalent cases among contacts of leprosy patients(CP)over the course of the LPEP program in one of the four study areas in Brazil,namely the municipality of Alta Floresta,state of Mato Grosso,in the Brazilian Amazon basin.Methods Leprosy cases were mapped,and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018.Data were obtained on new leprosy cases[Notifiable diseases information system(Sinan)],contacts traced by the LPEP program,and socioeconomic variables[Brazilian Institute of Geography and Statistics(IBGE)].Kernel,SCAN,factor analysis and spatial regression were applied to analyze changes.Results Overall,the new case detection rate(NCDR)was 20/10000 inhabitants or 304 new cases,of which 55 were CP cases among the 2076 examined contacts.Changes over time were observed in the geographic distribution of cases.The highest concentration of cases was observed in the northeast of the study area,including one significant cluster(Relative risk=2.24;population 27427,P-value<0.001)in an area characterized by different indicators associated with poverty as identified through spatial regression(Coefficient 3.34,P-value=0.01).Conclusions The disease distribution was partly explained by poverty indicators.LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.
