And an opportunity for you to tell us what you'd like to hear more about
The Leprosy Mission's teams attended the 21st International Leprosy Congress in big numbers last November.
With over 100 staff in Hyderabad and more than 50 presentations, there was a lot to take in from TLM, even before you got to the many other excellent contributions from other teams at ILC.
In the coming pages, we will share a few highlights from TLM's contributions to the conference.
Take a read through these abstracts and at the end, take the opportunity to vote on which abstracts you might like to hear more about.
In future editions of the TLM Research Magazine we will write about the projects you vote on today.
Photo credit: Tom Bradley
Mohd Nadeem, Vinay Kumar Pathak, Itu Singh, RP Turankar, Madhvi Ahuja, Rahul Sharma, U. Sengupta
Introduction: Household contacts (HHCs) of leprosy patients have a higher risk of contracting leprosy in endemic areas of leprosy. Early diagnosis and treatment of leprosy is the most effective way to break the chain of transmission of the disease. Multiplex PCR (MPCR) is a more efficient detection tool that utilises more than one gene specific to M.leprae.
Objective: The present study was aimed to detect M.leprae DNA in nasal swabs in HHCs of paucibacillary (PB) and multibacillary (MB) patients by using MPCR.
Material and Method: HHCs (n = 90) of leprosy patients were recruited out of which nasal swab samples of HHCs of PB patients (n = 32) and HHCs of MB patients (n = 58) were collected from different hospitals of The Leprosy Mission. The bacterial indexes (BI) of PB patients were negative while BI of MB patients ranged from 3+ to 6+. DNA was extracted from all samples using lysis method. MPCR was done utilising three gene targets RLEP, 16SrRNA and sodA specific for M.leprae. The amplified products were analysed by electrophoresis on 4% agarose gel.
Results: It was observed that 34.37% (11/ 32) household contacts of PB patients were positive for M.leprae DNA by MPCR. Similarly in household contacts of MB patients, 51.72% (30/ 58) were positive by MPCR.
Conclusion: Household contacts of leprosy patients are the risk population that has to be screened for early detection of the disease. Multiplex PCR appears to be an efficient tool which can be used for surveillance of HHCs.
Subhojit Goswami
Introduction: Socio-economic risk markers for leprosy—poverty, food insecurity, crowded living conditions, lack of proper sanitary conditions—need to be seen in the context of climate change, which threatens to push more people into poverty, elevate risk of frequent pandemics, and disrupt health systems. Worryingly, most of the endemic states (Bihar, Chhattisgarh, Odisha) are highly vulnerable to climate change, more so because the existing health systems are not resilient to address competing health priorities. COVID-19 is an example. In the given situation, India is wedged between two pressing needs: addressing social determinants of health and strengthening and integrating health systems to serve people affected by leprosy effectively.
Objective: The WHO Global Leprosy Strategy 2021-2030 considers ‘zero infection and disease’ as one of the long-term goals, for which barriers have been identified largely through the lens of clinical and service delivery aspects. Another dimension that is not explored much is the layered challenges that climate change poses before us. The findings of the study, which will draw from stakeholders from diverse disciplines, will feed into the national and sub-national strategies that organisations are developing to support the National Leprosy Eradication Program.
Methodology: During the study, the team will look through peer-reviewed research papers, government reports, reports from health and policy think tanks, and media reports. They will also have one-on-one interviews (both offline and online) with doctors, researchers, leprosy-focused organisations (to understand their interventions) and duty bearers in different tiers of governance.
Conclusion: With reports flagging concerns over climate anomalies reversing the gains in health systems, this study will help in building systems and policies that are resilient, inclusive, and effective in achieving zero leprosy.
Anouk van Hooij, Marufa Khatun, Santosh Soren, Elisa Tjon Kon Fat, Danielle de Jong, Els M. Verhard, Johan Chandra Roy, Khorshed Alam, Abu Sufian Chowdhury, Jan Hendrik Richardus, Paul Corstjens and Annemieke Geluk.
Introduction: Mycobacterium leprae is still actively transmitted in endemic areas reflected by the fairly stable number of new leprosy cases detected each year. Recognizing the signs and symptoms of leprosy is challenging, especially at an early stage. Improved diagnostic tools, based on sensitive and specific biomarkers, that facilitate diagnosis of leprosy are therefore urgently needed. Since the manifestation of leprosy disease as multi- or paucibacillary is determined by host immunity, unravelling this response will facilitate the search for biomarkers.
Objective: To identify biomarkers for M. leprae infection and paucibacillary disease based on host immunity and incorporate these in lateral flow assays applicable to leprosy endemic areas.
Results: A biomarker signature was identified that jointly allowed discrimination of patients with multi- and paucibacillary leprosy. These biomarkers were successfully incorporated in a lateral flow multi-biomarker test (MBT), which demonstrated feasibility of quantitative detection of these host proteins simultaneously. The biomarker signature proved to be applicable in both high and low leprosy endemic areas. Moreover, pilot testing of fingerstick blood showed similar MBT performance in point-of-care (POC) settings as observed for plasma and serum.
Conclusion: The newly developed prototype MBT measures multiple biomarkers covering immunity against M. leprae across the leprosy spectrum. The MBT can thereby provide the basis for immunodiagnostic POC tests for leprosy with potential for other (infectious) diseases as well.
Authors: Masuma Parvin, Jiptha Boiragee, Margaret Guyan, James Pender, Heather Saranne, Surendra Nath Singh
Introduction: Early leprosy case detection is essential to achieve all four WHO Global leprosy targets for 2030. However, only 39% of new cases found in 2019-2020 were female. This leaves women vulnerable to a “triple jeopardy” of discrimination due to gender, the stigma associated with leprosy and increased disability because of late diagnosis and treatment.
Description of the case/issue: Although the majority of new cases found globally are male, evidence is that both men and women are equally likely to contract the disease. As around 200,000 new cases of leprosy are diagnosed annually but only 39% of them female, it is suggested that each year over 40,000 new female cases of leprosy may be missed!
TLM programmes in Bangladesh and Nepal working to address the imbalance, found a majority of female cases, in three of its working areas in recent years ranging from 51% to 55% of new cases.
Programmatic efforts to achieve a greater gender parity in case finding have included:
Partnership with local organisations focused on empowering women
Ensuring gender balance within the team involved in case detection
Mass awareness campaigns tailored to ensure they reach women.
Training female community health volunteers
Carrying out contact tracing activities at times when women will be available
Empowering and screening women in self- help groups
Improving gender sensitive practises when screening
Extended contact surveys
Training a higher proportion of female Government health workers including at grassroots level
Conclusion: It is not inevitable that a greater proportion of male new leprosy cases will be found. These projects have proven that a greater proportion of new female leprosy cases may be detected. Attention must be made to achieve gender parity in new case detection and to discover the thousands of female cases that have been missed over the years.
James Pender
Introduction: In the context of health and development climate change is best described as a ‘risk multiplier’, for it exacerbates the impact of other processes and factors that threaten the health and wellbeing of communities. Leprosy is no exception as climate change will influence the factors that determine leprosy prevalence as well as disrupt and alter natural cycles and processes which impact on the livelihoods and wellbeing of people affected by leprosy.
Description of the case/issue: A major factor that governs transmission of leprosy is the viability of Mycobacterium leprae outside the human body which is related to the thermal-hydrologic regime of the local climate. However, there are many additional determiners of leprosy prevalence that are themselves affected by climate change such as migration, overcrowded settlements, nutrition, poverty, secure livelihoods, hygiene and sanitation.
People affected by leprosy may additionally find that climate change impacts are reducing their access to health care, affecting the viability of their medication, slowing their wound healing, increasing their risk of secondary infection and weakening their mental health.
Furthermore, communities in which people affected by leprosy reside are invariably highly marginalised: in remote/sub-optimal locations, ethnic/religious minorities, in areas of endemic poverty, facing co-morbidities, and already excluded groups. Marginalisation makes them potentially more vulnerable to climate shocks.
Additionally, leprosy stigma and disability may reduce their adaptation options and impair effectiveness of their response to climate related disasters.
Conclusion: Although the most important factors that govern leprosy prevalence may not be directly related to climate change, leprosy transmission is likely to be indirectly affected. Climate change will also impinge on the quality of life of people affected by leprosy.
Organisations working on leprosy must therefore ensure their operations are ‘climate proofed’ and must ensure people affected by leprosy are supported to increase their resilience to climate impacts.
