Summary In recent years a number of field trials have been carried out to assess the efficacy of rifampicin chemoprophylaxis for the prevention of leprosy in contacts of leprosy patients. Results from these trials are now being analysed and published. The aim of this one-day workshop was to review current evidence and discuss potential future courses of action with regard to the use of chemoprophylaxis to prevent leprosy.
During the morning session the current evidence for the contribution that chemoprophylaxis may make to leprosy prevention was presented, both the results from trials (abstracts in section 1) and the outcome of modelling (abstract in section 2); in addition presentations were given on different aspects of the use of antibiotics for chemoprophylaxis (abstracts in section 3).
The afternoon was devoted to discussions, a summary of which is presented in section 4 of this report. The conclusions and recommendations are given in section 5.
1. Results of chemoprophylactic trials so far
Close contacts of leprosy patients are at an increased risk of developing clinical leprosy. A meta analysis showed that chemoprophylaxis with oral dapsone or intramuscular acedapsone gave around 60% protection against leprosy. This protective effect of chemoprophylaxis on the incidence of leprosy gradually waned off after the end of the chemoprophylactic regimen. The Number Needed to Treat was low in trials of household contacts. Results of non-randomized trials were very similar to those of randomized controlled trials. (1) The main disadvantage of (ace)dapsone is that it had to be administered over a long period of time.
MIRIAM BAKKER--RESULTS OF THE CHEMOPROPHYLACTIC STUDY PERFORMED ON 5 ISLANDS IN INDONESIA AFTER 69 MONTHS OF FOLLOW-UP
In 2000 a controlled chemoprophylactic intervention study started on five Indonesian islands highly endemic for leprosy. The population (4739) was actively screened for leprosy before the intervention (87% of population examined, 85 new leprosy patients detected) and subsequently once yearly for 6 years. All patients were treated with standard MDT directly after diagnosis. No chemoprophylaxis was given on one island (control group). Chemoprophylaxis was given only to household and neighbour contacts of leprosy patients on one other island ('contact' group) and to all eligible persons on three smaller islands ('blanket' group). The prophylactic regimen consisted of two doses of 600 mg rifampicin for adults and 300 mg for children (5-14 years) with 3 months between doses (90% of those eligible for chemoprophylaxis took at least one dose under supervision of the research team). The study was not randomised, not placebo-controlled and not blinded. The total cohort consisted of 3,963 persons (1251 in control, 1632 in contact and 1080 in blanket group), initially free of leprosy.
After 3 years follow-up the cumulative leprosy incidence was significantly lower in the blanket group compared with the control group (P = 0.031). No difference was found between the contact and the control groups. Blanket treatment was 75% effective and the number needed to treat (NNT) to prevent a single case of leprosy was 127.
After 6 years follow-up the difference in cumulative incidence (CI)...
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