利福平单剂量预防麻风暴露后感染（LPEP）：一项国际可行性计划。

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

机构信息

Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.

出版信息

Lancet Glob Health. 2021 Jan;9(1):e81-e90. doi: 10.1016/S2214-109X(20)30396-X. Epub 2020 Oct 29.

DOI:10.1016/S2214-109X(20)30396-X

PMID:33129378

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.

摘要

背景

为了减少麻风病例并遏制麻风分枝杆菌的传播，需要创新的方法来控制麻风病。早期病例发现、接触者筛查和化学预防是最有前途的工具。我们旨在就将接触者追踪和单剂量利福平（SDR）管理纳入常规麻风病控制活动的可行性生成证据。

方法

麻风病接触后预防（LPEP）计划是一项国际性、多中心可行性研究，在巴西、印度、印度尼西亚、缅甸、尼泊尔、斯里兰卡和坦桑尼亚的麻风病控制项目中实施。LPEP 探讨了结合三种关键干预措施的可行性：系统追踪新诊断为麻风病的个体的接触者；对追踪到的接触者进行麻风病筛查；以及向符合条件的接触者提供 SDR。结果根据接触者的追踪、筛查和 SDR 管理率进行评估。

结果

在 2015 年 1 月 1 日至 2019 年 8 月 1 日期间，LPEP 共纳入 9170 例索引患者，并列出了 179769 名接触者，其中 174782 名（97.2%）成功追踪和筛查。在接受筛查的接触者中，有 22854 人（13.1%）因健康原因和年龄等主要原因被排除在 SDR 之外。在排除的接触者中，有 810 人被确认为新患者（每 10000 名筛查接触者中有 46 例）。在符合条件的筛查接触者中，有 1182 人（0.7%）拒绝预防性服用 SDR。总体而言，SDR 已用于 151928 名（86.9%）接受筛查的接触者。未报告严重不良事件。