LPEP - Surveillance to Evaluate the Approach and Impact of Leprosy Post-Exposure Prophylaxis

Leprosy is an infectious disease caused by Mycobacterium leprae. After an incubation period that can last years, the disease mainly affects peripheral nerves and the skin. If untreated, it may lead to loss of sensation and result in serious disabilities. The reported number of new leprosy patients has barely changed in recent years (around 200,000 new cases per year). There are no biomedical screening tests to diagnose infection or leprosy disease but treatment with a standard regimen of donated antibiotics is universally available. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50–60% reduction of the risk of developing leprosy over the following 2 years.

To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data.

The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: Brazil, Cambodia, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. From 2015/6 to 2018/9, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented.

The results will be widely disseminated, with a focus on the Global Leprosy Program of the World Health Organization (WHO) and the national leprosy control programmes of endemic countries. Complementary studies are also conducted to support the findings of the main study.

Richardus J.H, Mieras L, Saunderson P, Ignotti E, Virmond M, Arif M.A, Pandey B.D, Cavaliero A, Steinmann P. Leprosy post-exposure prophylaxis risks not adequately assessed - Author's reply. Lancet Glob Health. 2021;9(4):e402-e403. DOI: 10.1016/S2214-109X(21)00047-4

Richardus J.H, Tiwari A, Barth-Jaeggi T, Arif M.A, Banstola N.L, Baskota R, Blaney D, Blok D.J, Bonenberger M, Budiawan T, Cavaliero A, Gani Z, Greter H, Ignotti E, Kamara D.V, Kasang C, Manglani P.R, Mieras L, Njako B.F, Pakasi T, Pandey B.D, Saunderson P, Singh R, Smith W.C.S, Staheli R, Suriyarachchi N.D, Tin Maung A, Shwe T, van Berkel J, van Brakel W.H, Vander Plaetse B, Virmond M, Wijesinghe M.S.D, Aerts A, Steinmann P. Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme. Lancet Glob Health. 2021;9(1):e81-e90. DOI: 10.1016/S2214-109X(20)30396-X

Blok D.J, Steinmann P, Tiwari A, Barth-Jaeggi T, Arif M.A, Banstola N.L, Baskota R, Blaney D, Bonenberger M, Budiawan T, Cavaliero A, Gani Z, Greter H, Ignotti E, Kamara D.V, Kasang C, Manglani P.R, Mieras L, Njako B.F, Pakasi T, Saha U.R, Saunderson P, Smith W.C.S, Staheli R, Suriyarachchi N.D, Tin Maung A, Shwe T, van Berkel J, van Brakel W.H, Vander Plaetse B, Virmond M, Wijesinghe M.S.D, Aerts A, Richardus J.H. The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: a modelling study. PLoS Negl Trop Dis. 2021;15(3):e0009279. DOI: 10.1371/journal.pntd.0009279

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