Fürst Thomas, Cavaliero Arielle, Lay Sambath, Dayer Chrystel, Chan Saren, Smrekar Ajda, So Visal, Barth-Jaeggi Tanja, Steinmann Peter
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Imperial College London, London, United Kingdom.
Novartis Foundation, Basel, Switzerland.
Acta Trop. 2018 Apr;180:26-32. doi: 10.1016/j.actatropica.2017.12.031. Epub 2017 Dec 28.
Currently, leprosy control relies on the clinical diagnosis of leprosy and the subsequent administration of multidrug therapy (MDT). However, many health workers are not familiar with the cardinal signs of leprosy, particularly in low-endemic settings including Cambodia. In response, a new approach to early diagnosis was developed in the country, namely retrospective active case finding (RACF) through small mobile teams. In the frame of RACF, previously diagnosed leprosy patients are traced and their contacts screened through "drives". According to the available records, 984 of the 1,463 (67.3%) index patients diagnosed between 2001 and 2010 and registered in the national leprosy database were successfully traced in the period 2012-2015. Migration (8.4%), death (6.7%), operational issues (1.6%) and unidentified other issues (16.0%) were the main reasons for non-traceability. A total of 17,134 contacts of traced index patients (average: 2.2 household members and 15.2 neighbors) and another 7,469 contacts of the untraced index patients could be screened. Among them, 264 new leprosy patients were diagnosed. In the same period, 1,097 patients were diagnosed through the routine passive case detection system. No change was observed in the relation between the rate at which new patients were identified and the number of years since the diagnosis of the index patient. Similar to leprosy patients diagnosed through passive case detection, the leprosy patients detected through RACF were predominantly adult males. However, the fraction of PB leprosy patients was higher among the patients diagnosed through RACF, suggesting relatively earlier diagnosis. It appears that RACF is a feasible option and effective in detecting new leprosy patients among contacts of previously registered patients. However, a well-maintained national leprosy database is essential for successful contact tracing. Hence, passive case detection in the frame of routine leprosy surveillance is a precondition for efficient RACF as the two systems are mutually enhancing. Together, the two approaches may offer an interesting option for countries with low numbers of leprosy patients but evidence of ongoing transmission. The impact on leprosy transmission could be further increased by the administration of single dose rifampicin as post-exposure prophylaxis to eligible contacts.
目前，麻风病防治依赖于麻风病的临床诊断及随后的多药联合化疗（MDT）。然而，许多卫生工作者并不熟悉麻风病的主要体征，在包括柬埔寨在内的低流行地区尤其如此。对此，该国开发了一种新的早期诊断方法，即通过小型流动团队进行回顾性主动病例发现（RACF）。在RACF框架下，追踪之前确诊的麻风病患者，并通过“筛查行动”对其接触者进行筛查。根据现有记录，在2012 - 2015年期间，在国家麻风病数据库中登记的1463例2001年至2010年期间确诊的索引患者中有984例（67.3%）被成功追踪。迁移（8.4%）、死亡（6.7%）、操作问题（1.6%）以及不明其他问题（16.0%）是无法追踪的主要原因。总共对追踪到的索引患者的17134名接触者（平均：2.2名家庭成员和15.2名邻居）以及另外7469名未追踪到的索引患者的接触者进行了筛查。其中，诊断出264例新的麻风病患者。在同一时期，通过常规被动病例发现系统诊断出1097例患者。新患者确诊率与索引患者确诊后的年数之间的关系未观察到变化。与通过被动病例发现诊断出的麻风病患者相似，通过RACF发现的麻风病患者主要是成年男性。然而，在通过RACF诊断出的患者中，PB麻风病患者的比例更高，这表明诊断相对较早。看来RACF是一种可行的选择，并且在检测先前登记患者的接触者中的新麻风病患者方面是有效的。然而，维护良好的国家麻风病数据库对于成功的接触者追踪至关重要。因此，在常规麻风病监测框架下的被动病例发现是有效RACF的前提条件，因为这两个系统相互促进。对于麻风病患者数量少但有持续传播证据的国家而言，这两种方法结合可能提供一个有趣的选择。通过对符合条件的接触者给予单剂量利福平作为暴露后预防措施，对麻风病传播的影响可能会进一步增加。
