Department of Dermatology and Venereology, AIIMS, Bhubaneswar, Odisha, India.
Department of Dermatology, Max Smart Super Specialty Hospital, New Delhi, India.
Indian J Dermatol Venereol Leprol. 2020 Mar-Apr;86(2):115-123. doi: 10.4103/ijdvl.IJDVL_326_19.
With the worldwide implementation of WHO multidrug therapy in the 1980s, the global burden of leprosy has decreased. However, the annual new case detection rate around the world has remained nearly static over the past decade with India, Brazil, and Indonesia contributing the majority of these new cases. This has been attributed to the ongoing transmission of Mycobacterium leprae from existing untreated cases and partly to the intensive new case detection programs operative in endemic areas. The WHO has called for a "global interruption of transmission of leprosy by 2020". Targeted chemoprophylaxis of contacts may help bring down the number of new cases. The single-dose rifampicin currently in use for post-exposure prophylaxis (PEP) has limitations and so newer antileprosy drugs and regimens have been trialed for chemoprophylaxis. BCG re-vaccination in combination with chemoprophylaxis for the prevention of leprosy transmission has not been very encouraging. The use of the anti-phenolic glycolipid-1 (PGL-1) antibody test to detect subclinical cases and administer targeted chemoprophylaxis was unsuccessful owing to its low sensitivity and technical difficulties in a field setup. There is a pressing need for newer multidrug chemoprophylactic regimens using second-line antileprosy drugs. The Netherlands Leprosy Relief has proposed an enhanced PEP++ regimen. A simple but highly sensitive and specific serological test to detect subclinical cases at the field level needs to be developed. Although there are a number of challenges in the large-scale implementation of strategies to halt leprosy transmission, it is important to overcome these in order to move towards a "leprosy-free world."
随着 20 世纪 80 年代世界卫生组织（WHO）多药疗法的实施，麻风病的全球负担有所减轻。然而，在过去十年中，全球新病例检出率几乎保持不变，印度、巴西和印度尼西亚贡献了大多数新病例。这归因于现有未治疗病例中麻风分枝杆菌的持续传播，部分原因是在流行地区实施的强化新病例检出方案。世界卫生组织呼吁“到 2020 年全球中断麻风病传播”。针对接触者的有针对性的化学预防可能有助于减少新病例的数量。目前用于接触后预防（PEP）的单剂量利福平有其局限性，因此已经试验了新的抗麻风病药物和方案用于化学预防。BCG 再接种联合化学预防预防麻风病传播的效果并不理想。使用抗酚糖脂-1（PGL-1）抗体检测来检测亚临床病例并进行有针对性的化学预防并不成功，这是由于其敏感性低，在现场设置中存在技术困难。迫切需要使用二线抗麻风病药物的新的多药化学预防方案。荷兰麻风救济会提出了增强的 PEP++方案。需要开发一种简单但高度敏感和特异的血清学检测方法，以便在现场水平检测亚临床病例。尽管在大规模实施阻止麻风病传播的策略方面存在许多挑战，但为了迈向“无麻风病世界”，克服这些挑战非常重要。
