OBJECTIVES: The COLEP trial in Bangladesh showed a 57% reduction in leprosy incidence among contacts of newly diagnosed patients in the first 2 years after chemoprophylaxis with single dose rifampicin (SDR). We assessed the impact of this intervention after 6 years and identified characteristics of the leprosy index patients predicting the effectiveness of this intervention. DESIGN: The cohort of 1037 patients and their 28 092 contacts that participated in the randomisedplacebo controlled field trial with single dose rifampicin was followed for 6 years. The leprosy status of contacts was established at 2, 4 and 6 years after the intervention. We assessed the association between characteristics of the index leprosy patients and the development of clinical leprosy among their contacts using logistic regression. RESULTS: The protective effect of SDR was seen only in the first 2 years, with no additional effect after 4 and 6 years. However, the total impact of the intervention was still statistically significant (P = 0.025) after 6 years and no excess cases were observed in the SDR arm at a later stage. The intervention prevented leprosy in contacts that actually received SDR, but did not offer protection to members of the same contact group who did not take chemoprophylaxis. The intervention was most effective in contact groups of female index patients, an enhanced effect was also observed in contact groups of patients belonging to a cluster of two or more leprosy patients at intake as well. CONCLUSION: These easy to recognise patient characteristics indicate a possible enhanced risk of transmission of Mycobacterium leprae to contacts in the vicinity of patients and are useful for deciding about preventive measures, such as early detection or chemoprophylaxis.
RCT Entities:
OBJECTIVES: The COLEP trial in Bangladesh showed a 57% reduction in leprosy incidence among contacts of newly diagnosed patients in the first 2 years after chemoprophylaxis with single dose rifampicin (SDR). We assessed the impact of this intervention after 6 years and identified characteristics of the leprosy index patients predicting the effectiveness of this intervention. DESIGN: The cohort of 1037 patients and their 28 092 contacts that participated in the randomised placebo controlled field trial with single dose rifampicin was followed for 6 years. The leprosy status of contacts was established at 2, 4 and 6 years after the intervention. We assessed the association between characteristics of the index leprosypatients and the development of clinical leprosy among their contacts using logistic regression. RESULTS: The protective effect of SDR was seen only in the first 2 years, with no additional effect after 4 and 6 years. However, the total impact of the intervention was still statistically significant (P = 0.025) after 6 years and no excess cases were observed in the SDR arm at a later stage. The intervention prevented leprosy in contacts that actually received SDR, but did not offer protection to members of the same contact group who did not take chemoprophylaxis. The intervention was most effective in contact groups of female index patients, an enhanced effect was also observed in contact groups of patients belonging to a cluster of two or more leprosypatients at intake as well. CONCLUSION: These easy to recognise patient characteristics indicate a possible enhanced risk of transmission of Mycobacterium leprae to contacts in the vicinity of patients and are useful for deciding about preventive measures, such as early detection or chemoprophylaxis.
Authors: Grace L Davis; Nashone A Ray; Ramanuj Lahiri; Thomas P Gillis; James L Krahenbuhl; Diana L Williams; Linda B Adams Journal: PLoS Negl Trop Dis Date: 2013-08-22
Authors: Tanja Barth-Jaeggi; Peter Steinmann; Liesbeth Mieras; Wim van Brakel; Jan Hendrik Richardus; Anuj Tiwari; Martin Bratschi; Arielle Cavaliero; Bart Vander Plaetse; Fareed Mirza; Ann Aerts Journal: BMJ Open Date: 2016-11-17 Impact factor: 2.692
Authors: Renate A Richardus; Konrad van der Zwet; Anouk van Hooij; Louis Wilson; Linda Oskam; Roel Faber; Susan J F van den Eeden; David Pahan; Khorshed Alam; Jan Hendrik Richardus; Annemieke Geluk Journal: PLoS Negl Trop Dis Date: 2017-12-11
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Authors: Becky L Rivoire; Nathan A Groathouse; Stephen TerLouw; Kapil Dev Neupane; Chaman Ranjit; Bishwa Raj Sapkota; Saraswoti Khadge; Chhatra B Kunwar; Chatra B Kunwar; Murdo Macdonald; Rachel Hawksworth; Min B Thapa; Deanna A Hagge; Melinda Tibbals; Carol Smith; Tina Dube; Dewei She; Mark Wolff; Eric Zhou; Mamodikoe Makhene; Robin Mason; Christine Sizemore; Patrick J Brennan Journal: PLoS Negl Trop Dis Date: 2014-05-29