Operational approaches and recommendations to interrupt transmission of Mycobacterium leprae

The Global Partnership for Zero Leprosy (GPZL) Zero Transmission Symposium (May 23-25, 2024, Bergen, Norway) brought together a diverse group of experts to discuss developments over 10 years to interrupt Mycobacterium leprae transmission, both in research and operationally. Through a well-structured and participatory agenda, research and operational approaches were discussed. The operational approaches from the symposium are described here and focus on defining optimal methods for monitoring infection transmission and prevalence using current tools; additional tools to customise implementation based on local context, such as mapping; identifying critical gaps and interventions to accelerate transmission interruption through scaled-up programmatic implementation; and expanding com-munity coverage of interventions. Recommendations were developed in diagnostics, active case detection, post-exposure prophylaxis (PEP) and treatment, antimicrobial resistance surveillance, vaccination, and social determinants of health. Recommendations in diagnostics included forming a diagnostics consortium, global initiatives (including updating WHO Guidelines) and national initiatives to optimise availability of 'point-of-care' tools, active case detection, including contact tracing, integrated programmes, and cluster-based campaigns considering strategic alignment with other disease consortia/initiatives; maximizing the use of molecular techniques and genotyping technologies; and improving epidemiological surveillance. Overall, considerable progress has been made in interrupting transmission in the last 10 years, especially at the sub-national level. Implementing symposium recommenda-tions will further accelerate interruption of M. leprae transmission.