New and Hot

Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

Kerr-Pontes., et al. Int J Epidemiol. 2006 Apr 27

This interesting study suggests that lower socio-economic status (defined by less education), bathing in a body of open water, and lack of changing bedding were all risk factors in those who contracted leprosy in Brazil. Considering that 80% of leprosy cases in the American continent occur in Brazil, this report suggests the need for specific targeting of poverty to end leprosy. The report also notes that having had the tuberculosis vaccine, the BCG, appears to provide a protective effect against leprosy.

With scores still infected, India declares leprosy 'eliminated'

Padma, TV. Nature Medicine 29 March 2006

Although India reached an important milestone in December 2005 by achieving a leprosy prevalence rate of 0.95 per 10,000 (below the target for disease elimination set by the WHO), this news report is critical of the announcement that India had “eliminated” leprosy. The report notes that several states have already stopped active surveillance, and that the multi-drug therapy conducted in some states was a haphazard affair with completion of a 6 to 12 month regimen as the only endpoint for treatment (i.e. patients were listed as “cured” by virtue of completing their medication schedule).

The role of BCG in prevention of leprosy: a meta-analysis.

Setia MS, et al. Lancet Infect Dis. 2006 Mar;6(3):162-70.

A meta-analysis of 26 studies (7 experimental, 19 observational) reveals that the tuberculosis BCG vaccine provides a protective effect of 25% in experimental studies, and 61% in observational studies. The article suggests that re-vaccination with the BCG vaccine may prove to be an important way to control leprosy in heavily endemic areas.

Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy.

Rao, PS., et al. Lepr Rev. 2006 Mar;77(1):25-33

It is currently unclear how long steroid treatment should be provided to those who develop leprosy reactions during the course of treatment. This study, conducted in India, looked at two variables: the length of treatment (12 vs. 20 weeks) and the dose of treatment (high vs. low steroid administration). The study concluded that a longer course of treatment was superior in preventing the need for more steroids, although it did not matter if the patient was initially given high or low doses of the steroid.

Treatment of leprosy: science or politics?

Naafs, B. Trop Med Int Health. 2006 Mar;11(3):268-78.

This scathing article is critical of World Health Organization efforts to eliminate and eradicate leprosy. The author notes that the WHO helps “eliminate” leprosy by virtue of changing its case definitions and treatment regimens, and provides a convincing argument that the WHO’s over-simplification of leprosy treatment could be detrimental in the fight against leprosy. The article discusses the controversial WHO recommendation to lower the length of treatment for all leprosy patients to 6 months in 2002, which resulted in significant outcry by public health communities. The author finds significant fault with the WHO case definition of leprosy, recommended treatment length and appropriate steroid use for leprosy reactions—all in all, an excellent contrast to the bright and happy picture usually seen in most public health textbooks.