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Richardus, R.A. (2020)

Preventing Leprosy: Epidemiological and immunological aspects of chemo- and immunoprophylaxis in leprosy patients’ contacts

Doctoral Thesis
Leprosy is an infectious disease caused by Mycobacterium leprae. The global number of new leprosy patients has remained constant over the past decennium, indicating that transmission is ongoing. People living in the same household as untreated leprosy cases have the highest risk of infection. Therefore, it is essential that leprosy control strategy is focused on this risk group. Immunoprophylaxis (vaccination) and
chemoprophylaxis (medication) can be used to prevent the spread of leprosy among contacts of leprosy patients, each giving a protective effect of around 60%. In the COLEP trial, an additional additive
protective effect of SDR (80%) in contacts that had received BCG vaccination in the past was found. To assess the efficacy of a combined strategy, the MALTALEP study was initiated, a cluster randomized controlled trial in the northwest of Bangladesh between 2012 and 2018, in which around 15,000 contacts of
newly diagnosed leprosy patients received either BCG...Show moreLeprosy is an infectious disease caused by Mycobacterium leprae. The global number of new leprosy patients has remained constant over the past decennium, indicating that transmission is ongoing. People living in the same household as untreated leprosy cases have the highest risk of infection. Therefore, it is essential that leprosy control strategy is focused on this risk group. Immunoprophylaxis (vaccination) and
chemoprophylaxis (medication) can be used to prevent the spread of leprosy among contacts of leprosy patients, each giving a protective effect of around 60%. In the COLEP trial, an additional additive
protective effect of SDR (80%) in contacts that had received BCG vaccination in the past was found. To assess the efficacy of a combined strategy, the MALTALEP study was initiated, a cluster randomized controlled trial in the northwest of Bangladesh between 2012 and 2018, in which around 15,000 contacts of
newly diagnosed leprosy patients received either BCG alone, or BCG plus SDR. The primary outcome
was the development of leprosy within two years. SDR reduced the number of new PB leprosy cases amongst contacts that had been vaccinated with BCG with 42% (non-significant). However, a large proportion of the new leprosy patients (33.6%) arose between vaccination and SDR. Show less
biomarkers profiles
adverse events BCG vaccine
rifampicin
prevention
prophylaxis
leprosy
M. leprae
phenolic glycolipid-I (PGL-I)
household contacts
All authors
Richardus, R.A.
Supervisor
Geluk, A.
Committee
Numans, M.E.; Jager, M.J.; Steyerberg, E.J.; Vlas, S.J. de; Jong, B. de; Dissel, J.T. de
Qualification
Doctor (dr.)
Awarding Institution
Leiden University of Medical Center [LUMC], Leiden University
Date
2020-02-04
ISBN (print)
9789463806640

Funding

Sponsorship
This work is supported by the Order of Malta-Grants-for-Leprosy-Research (MALTALEP), the Q.M. Gastmann-Wichers Foundation, the Netherlands Leprosy Relief Foundation (NLR; ILEP#: 702.02.73) and the Leprosy Research Initiative (LRI; ILEP#: 703.15.07) both together with the Turing Foundation.