Prabu Rajkumar, Manickam Ponnaiah, Mahalingam Vannapatty Nallamuthu, Jayasree Padma, Selvaraj Vadivoo, Mehendale Sanjay Madhav
Lepr Rev. 2015 Dec;86(4):345-55.
To estimate the incidence of relapse among leprosy patients released after completing multi-drug therapy (MDT) during 2005-2010 under India's National Leprosy Eradication Programme in South India.
We conducted a retrospective cohort study of leprosy patients who were released from treatment (RFT) with MDT during April 2005 and March 2010 in four purposely selected districts from South India. We clinically examined them for signs of relapse, persistence and deformity. We collected slit skin smears from those reporting signs of relapse or persistence. We computed relapse rate per 1000 person years by dividing the number of relapses by person years of follow-up and 95% confidence intervals (CI) for rates.
We tracked 3791 RFT patients and examined 58% of them. The examined and those who were not examined were similar in terms of leprosy type, year of completing MDT and gender. We identified 58 relapses (relapse rate 6.1 per 1000 person years) among the examined. Majority of these relapses occurred within 3 years post-MDT. Eighteen (31%) of the relapsed patients had deformity.
While low level of relapse indicates effectiveness of MDT, the burden of deformity is of concern. For maximizing treatment effectiveness and minimizing transmission, we recommend educating leprosy patients at treatment completion for self-monitoring of signs of relapse and advising them to visit nearby public health facilities or Community health workers for immediate evaluation and intervention.
评估在印度国家麻风病消除计划下，2005 - 2010年期间印度南部完成多药联合化疗（MDT）后治愈出院的麻风病患者的复发率。
我们对2005年4月至2010年3月期间在印度南部四个特意挑选的地区接受MDT治疗后治愈出院的麻风病患者进行了一项回顾性队列研究。我们对他们进行临床检查，以查看是否有复发、病情持续和畸形的迹象。我们从那些报告有复发或病情持续迹象的患者身上采集了皮肤涂片。我们通过将复发人数除以随访人年数来计算每1000人年的复发率以及复发率的95%置信区间（CI）。
我们追踪了3791名治愈出院患者，并对其中58%的患者进行了检查。接受检查的患者与未接受检查的患者在麻风病类型、完成MDT的年份和性别方面相似。在接受检查的患者中，我们发现了58例复发（复发率为每1000人年6.1例）。这些复发大多发生在完成MDT后的3年内。18名（31%）复发患者有畸形。
虽然低复发率表明MDT有效，但畸形负担令人担忧。为了使治疗效果最大化并减少传播风险，我们建议在麻风病患者完成治疗时对其进行教育，使其能够自我监测复发迹象，并建议他们前往附近的公共卫生设施或社区卫生工作者处进行即时评估和干预。
