Contact tracing round a leprosy index case, Eire, summer season 2024 (n = 13). Credit score: Eurosurveillance
A case report printed in Eurosurveillance on an grownup with an imported case of leprosy in Eire reveals that there are notable challenges in tackling the illness in settings the place it’s uncommon.
The affected person was considered one of 5 people with leprosy reported in Eire prior to now decade. The authors report challenges confronted within the public well being response attributable to a delayed recognition of the signs by well being care suppliers, an absence of particular Irish and European pointers, and make contact with tracing in a congregate setting.
Forward of World Leprosy Day, this case examine highlights the necessity for public well being pointers tailor-made to international locations the place the illness may be very uncommon, in addition to methods to scale back stigma associated to the illness. Leprosy is considered one of 24 uncared for tropical ailments focused for elimination by the World Well being Group (WHO) in its 2021–2030 roadmap. Although it’s unusual in Europe, it nonetheless represents a excessive burden of illness worldwide, with 182,815 circumstances reported throughout the globe.
Case overview
The case concerned an individual of their 30s who was born and raised within the Caribbean, the place leprosy is widespread. They’d moved to Eire 2 years previous to prognosis from southern Brazil, the place incidence of leprosy can be excessive. The person initially reported to a well being care supplier in late 2023 with neurological signs and lightened pores and skin lesions. The affected person was recognized after a 7-month investigation via a pores and skin biopsy. After being handled with a multi-drug remedy, they recovered from the an infection.
The contact tracing technique and danger evaluation had been primarily based on WHO pointers and coverage paperwork, as there have been no particular pointers out there in Eire. Many of the worldwide steerage on contact tracing comes from low- and middle-income international locations, as few high-income international locations have developed their very own pointers. There are appreciable inconsistencies in pointers throughout totally different international locations on contact tracing, post-exposure prophylaxis eligibility, and follow-up approaches for affected people and contacts.
Public well being response
Researchers recognized a detailed contact as any one who had been involved with the untreated preliminary case for not less than 20 hours per week, for not less than 3 months within the previous yr, primarily based on the WHO definition.
One of many particular person’s eight housemates, their companion and a work-related contact had been recognized as shut contacts beneath the WHO standards. Ten different adults had been additionally thought-about potential shut contacts. Given the stigma of the illness, the general public well being consultants dominated out intensive contact tracing of all family members, because it may have threatened the person’s livelihood and entry to housing, each of which had been reported to be precarious.
Based mostly on WHO, Western Australian and British pointers, clinicians supplied chemoprophylaxis with single-dose rifampicin to the three true shut contacts for the affected person. This therapy has been proven to supply a protecting impact in leprosy contacts the place the illness is widespread. Nevertheless, there may be some uncertainty on whether or not these outcomes additionally apply to settings the place leprosy is uncommon, with worldwide pointers being much less constant.
The incubation interval for leprosy is very variable and ranges from 2 to five years, however might be shorter or lengthen as much as 20 years or extra. Most worldwide pointers suggest an annual follow-up for shut contacts given this unusually lengthy incubation interval, with some variation on the period of follow-up. Preparations the place subsequently made with native main physicians to conduct yearly follow-ups with the three contacts for the case for at least 5 years, as beneficial by the World Well being Group.
Suggestions
The report reveals the numerous challenges in responding to leprosy in high-income international locations the place it’s uncommon. Nations ought to think about creating tailor-made methods for these settings, which ought to prioritize ongoing training of well being care professionals on the illness, in addition to sturdy measures to counter stigma and enhance entry to psychological well being for affected people.
The authors additionally suggest a extra harmonized strategy to responding to sporadic circumstances, with higher standardization throughout public well being pointers.
Extra info:
Rebecca Marshall et al. Challenges of the general public well being response to a uncommon case of non-autochthonous Mycobacterium leprae, Eire, 2024, Eurosurveillance (2025). DOI: 10.2807/1560-7917.ES.2025.30.3.2500033, www.eurosurveillance.org/conte … ES.2025.30.3.2500033
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European Centre for Illness Prevention and Management (ECDC)
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Tailor-made pointers and decreased stigma wanted to sort out leprosy, Irish case examine reveals (2025, January 23)
retrieved 24 January 2025
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