Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

Jan hendrik Richardus; Anuj Tiwari; T Barth-Jaeggi; MA Arif; NL Banstola; R Baskota; D Blaney; David Blok; M Bonenberger; T Budiawan; A Cavaliero; Z Gani; H Greter; E Ignotti; DV Kamara; C Kasang; PR Manglani; L Mieras; BF Njako; T Pakasi; BD Pandey; P Saunderson; R Singh; WCS Smith; R Staheli; ND Suriyarachchi; A Tin Maung; T Shwe; J Berkel; WH van Brakel; B Vander Plaetse; M Virmond; MSD Wijesinghe; A Aerts; P Steinmann

doi:10.1016/s2214-109x(20)30396-x

Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

Jan hendrik Richardus, Anuj Tiwari, T Barth-Jaeggi, MA Arif, NL Banstola, R Baskota, D Blaney, David Blok, M Bonenberger, T Budiawan, A Cavaliero, Z Gani, H Greter, E Ignotti, DV Kamara, C Kasang, PR Manglani, L Mieras, BF Njako, T PakasiBD Pandey, P Saunderson, R Singh, WCS Smith, R Staheli, ND Suriyarachchi, A Tin Maung, T Shwe, J Berkel, WH van Brakel, B Vander Plaetse, M Virmond, MSD Wijesinghe, A Aerts, P Steinmann

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Abstract

Background: Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods: The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings: Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation: Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established. Funding: Novartis Foundation.

Original language	English
Pages (from-to)	e81-e90
Journal	The Lancet Global Health
Volume	9
Issue number	1
DOIs	https://doi.org/10.1016/s2214-109x(20)30396-x
Publication status	Published - Jan 2021

Bibliographical note

Funding Information:
We first thank the individuals affected by leprosy, their family members, and all others who participated in the LPEP programme. Their contribution has been essential to the success of the study. Secondly, we acknowledge the efforts of all current and past staff of the participating organisations and institutions who contributed to the implementation of the LPEP programme in the field countries. Without their dedication, this work would not have been possible. India: Ministry of Health & Family Welfare, Government of India; Dadra and Nagar Haveli Health Services; Health and Family Welfare Department, Government of Gujarat; NLR, New Delhi, NLR Foundation, New Delhi; German Leprosy and Tuberculosis Relief Association, New Delhi. Nepal: Ministry of Health and Population of Nepal, Kathmandu; Leprosy Control Division, District Health Office/Provincial Health Office, Nepal; NLR, Nepal; The Leprosy Mission, Nepal; Nepal Leprosy Fellowship; Nepal National Social Welfare Association; National Federation of the Disabled Nepal. Indonesia: Ministry of Health of the Republic of Indonesia, Jakarta; East Java Provincial Health Office, Surabaya; Sumenep District Health Office and Health Centers; NLR, Jakarta. Sri Lanka: Anti-Leprosy Campaign, Colombo; FAIRMED, Colombo. Myanmar: Department of Health, Nay Pyi Taw; Department of Medical Research, Yangon; American Leprosy Missions, Yangon. Tanzania: National Tuberculosis and Leprosy Programme, Dodoma; German Leprosy and Tuberculosis Relief Association, Dar es Salaam. Brazil: Ministério da Saúde, Brasilia; Universidade do Estado de Mato Grosso, Cáceres; Instituto Lauro de Souza Lima & UNINOVE, Bauru.

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© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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Richardus, J. H., Tiwari, A., Barth-Jaeggi, T., Arif, MA., Banstola, NL., Baskota, R., Blaney, D., Blok, D., Bonenberger, M., Budiawan, T., Cavaliero, A., Gani, Z., Greter, H., Ignotti, E., Kamara, DV., Kasang, C., Manglani, PR., Mieras, L., Njako, BF., ... Steinmann, P. (2021). Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme. The Lancet Global Health, 9(1), e81-e90. https://doi.org/10.1016/s2214-109x(20)30396-x

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abstract = "Background: Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods: The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings: Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation: Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established. Funding: Novartis Foundation.",

author = "Richardus, {Jan hendrik} and Anuj Tiwari and T Barth-Jaeggi and MA Arif and NL Banstola and R Baskota and D Blaney and David Blok and M Bonenberger and T Budiawan and A Cavaliero and Z Gani and H Greter and E Ignotti and DV Kamara and C Kasang and PR Manglani and L Mieras and BF Njako and T Pakasi and BD Pandey and P Saunderson and R Singh and WCS Smith and R Staheli and ND Suriyarachchi and {Tin Maung}, A and T Shwe and J Berkel and {van Brakel}, WH and {Vander Plaetse}, B and M Virmond and MSD Wijesinghe and A Aerts and P Steinmann",

note = "Funding Information: We first thank the individuals affected by leprosy, their family members, and all others who participated in the LPEP programme. Their contribution has been essential to the success of the study. Secondly, we acknowledge the efforts of all current and past staff of the participating organisations and institutions who contributed to the implementation of the LPEP programme in the field countries. Without their dedication, this work would not have been possible. India: Ministry of Health & Family Welfare, Government of India; Dadra and Nagar Haveli Health Services; Health and Family Welfare Department, Government of Gujarat; NLR, New Delhi, NLR Foundation, New Delhi; German Leprosy and Tuberculosis Relief Association, New Delhi. Nepal: Ministry of Health and Population of Nepal, Kathmandu; Leprosy Control Division, District Health Office/Provincial Health Office, Nepal; NLR, Nepal; The Leprosy Mission, Nepal; Nepal Leprosy Fellowship; Nepal National Social Welfare Association; National Federation of the Disabled Nepal. Indonesia: Ministry of Health of the Republic of Indonesia, Jakarta; East Java Provincial Health Office, Surabaya; Sumenep District Health Office and Health Centers; NLR, Jakarta. Sri Lanka: Anti-Leprosy Campaign, Colombo; FAIRMED, Colombo. Myanmar: Department of Health, Nay Pyi Taw; Department of Medical Research, Yangon; American Leprosy Missions, Yangon. Tanzania: National Tuberculosis and Leprosy Programme, Dodoma; German Leprosy and Tuberculosis Relief Association, Dar es Salaam. Brazil: Minist{\'e}rio da Sa{\'u}de, Brasilia; Universidade do Estado de Mato Grosso, C{\'a}ceres; Instituto Lauro de Souza Lima & UNINOVE, Bauru. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

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month = jan,

doi = "10.1016/s2214-109x(20)30396-x",

language = "English",

volume = "9",

pages = "e81--e90",

journal = "The Lancet Global Health",

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Richardus, JH, Tiwari, A, Barth-Jaeggi, T, Arif, MA, Banstola, NL, Baskota, R, Blaney, D, Blok, D, Bonenberger, M, Budiawan, T, Cavaliero, A, Gani, Z, Greter, H, Ignotti, E, Kamara, DV, Kasang, C, Manglani, PR, Mieras, L, Njako, BF, Pakasi, T, Pandey, BD, Saunderson, P, Singh, R, Smith, WCS, Staheli, R, Suriyarachchi, ND, Tin Maung, A, Shwe, T, Berkel, J, van Brakel, WH, Vander Plaetse, B, Virmond, M, Wijesinghe, MSD, Aerts, A & Steinmann, P 2021, 'Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme', The Lancet Global Health, vol. 9, no. 1, pp. e81-e90. https://doi.org/10.1016/s2214-109x(20)30396-x

TY - JOUR

T1 - Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

AU - Richardus, Jan hendrik

AU - Tiwari, Anuj

AU - Barth-Jaeggi, T

AU - Arif, MA

AU - Banstola, NL

AU - Baskota, R

AU - Blaney, D

AU - Blok, David

AU - Bonenberger, M

AU - Budiawan, T

AU - Cavaliero, A

AU - Gani, Z

AU - Greter, H

AU - Ignotti, E

AU - Kamara, DV

AU - Kasang, C

AU - Manglani, PR

AU - Mieras, L

AU - Njako, BF

AU - Pakasi, T

AU - Pandey, BD

AU - Saunderson, P

AU - Singh, R

AU - Smith, WCS

AU - Staheli, R

AU - Suriyarachchi, ND

AU - Tin Maung, A

AU - Shwe, T

AU - Berkel, J

AU - van Brakel, WH

AU - Vander Plaetse, B

AU - Virmond, M

AU - Wijesinghe, MSD

AU - Aerts, A

AU - Steinmann, P

N1 - Funding Information: We first thank the individuals affected by leprosy, their family members, and all others who participated in the LPEP programme. Their contribution has been essential to the success of the study. Secondly, we acknowledge the efforts of all current and past staff of the participating organisations and institutions who contributed to the implementation of the LPEP programme in the field countries. Without their dedication, this work would not have been possible. India: Ministry of Health & Family Welfare, Government of India; Dadra and Nagar Haveli Health Services; Health and Family Welfare Department, Government of Gujarat; NLR, New Delhi, NLR Foundation, New Delhi; German Leprosy and Tuberculosis Relief Association, New Delhi. Nepal: Ministry of Health and Population of Nepal, Kathmandu; Leprosy Control Division, District Health Office/Provincial Health Office, Nepal; NLR, Nepal; The Leprosy Mission, Nepal; Nepal Leprosy Fellowship; Nepal National Social Welfare Association; National Federation of the Disabled Nepal. Indonesia: Ministry of Health of the Republic of Indonesia, Jakarta; East Java Provincial Health Office, Surabaya; Sumenep District Health Office and Health Centers; NLR, Jakarta. Sri Lanka: Anti-Leprosy Campaign, Colombo; FAIRMED, Colombo. Myanmar: Department of Health, Nay Pyi Taw; Department of Medical Research, Yangon; American Leprosy Missions, Yangon. Tanzania: National Tuberculosis and Leprosy Programme, Dodoma; German Leprosy and Tuberculosis Relief Association, Dar es Salaam. Brazil: Ministério da Saúde, Brasilia; Universidade do Estado de Mato Grosso, Cáceres; Instituto Lauro de Souza Lima & UNINOVE, Bauru. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2021/1

Y1 - 2021/1

N2 - Background: Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods: The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings: Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation: Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established. Funding: Novartis Foundation.

AB - Background: Innovative approaches are required for leprosy control to reduce cases and curb transmission of Mycobacterium leprae. Early case detection, contact screening, and chemoprophylaxis are the most promising tools. We aimed to generate evidence on the feasibility of integrating contact tracing and administration of single-dose rifampicin (SDR) into routine leprosy control activities. Methods: The leprosy post-exposure prophylaxis (LPEP) programme was an international, multicentre feasibility study implemented within the leprosy control programmes of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Tanzania. LPEP explored the feasibility of combining three key interventions: systematically tracing contacts of individuals newly diagnosed with leprosy; screening the traced contacts for leprosy; and administering SDR to eligible contacts. Outcomes were assessed in terms of number of contacts traced, screened, and SDR administration rates. Findings: Between Jan 1, 2015, and Aug 1, 2019, LPEP enrolled 9170 index patients and listed 179 769 contacts, of whom 174 782 (97·2%) were successfully traced and screened. Of those screened, 22 854 (13·1%) were excluded from SDR mainly because of health reasons and age. Among those excluded, 810 were confirmed as new patients (46 per 10 000 contacts screened). Among the eligible screened contacts, 1182 (0·7%) refused prophylactic treatment with SDR. Overall, SDR was administered to 151 928 (86·9%) screened contacts. No serious adverse events were reported. Interpretation: Post-exposure prophylaxis with SDR is safe; can be integrated into different leprosy control programmes with minimal additional efforts once contact tracing has been established; and is generally well accepted by index patients, their contacts, and health-care workers. The programme has also invigorated local leprosy control through the availability of a prophylactic intervention; therefore, we recommend rolling out SDR in all settings where contact tracing and screening have been established. Funding: Novartis Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85095999951&partnerID=8YFLogxK

U2 - 10.1016/s2214-109x(20)30396-x

DO - 10.1016/s2214-109x(20)30396-x

M3 - Article

SN - 2214-109X

VL - 9

SP - e81-e90

JO - The Lancet Global Health

JF - The Lancet Global Health

IS - 1

ER -

Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

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