New and Hot
environmental, and behavioural risk factors for
leprosy in North-east Brazil: results of a
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
declares leprosy 'eliminated'
Padma, TV. Nature Medicine
29 March 2006
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
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.
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.