**7. Chemoprophylaxis (post-exposure prophylaxis)**

Chemoprohylaxis using effective antibiotics focuses on providing protection to people at risk such as close contacts – family members, neighbors, co-workers, health care providers for lepers etc. Due to the stigma of disease the leprosy cases

**139**

**Table 1.**

*Leprosy: Prevention and Control*

for the use of rifampicin.

laxis by programs are:

*DOI: http://dx.doi.org/10.5772/intechopen.92089*

the incidence and breaking the chain of transmission.

i.Adequate management of contacts.

The limitations of this approach are:

low bacillary load.

*Rifampicin dose for chemoprophylaxis [3].*

a.The protection is approximately for only 2 years.

**8. Deformity prevention and rehabilitation**

and industry [5–7]. Early treatment helps in disability limitation.

ii.Consent of the index case to disclose his/her disease.

prevented after 1–2 years and three cases prevented after 5–6 years. Recommended dosage schedules for SDR are given in **Table 1**.

b.High bacillary load cannot be eliminated using single dose.

are found in clusters in all endemic regions, rather than being evenly dispersed over the whole area. Thus these high risk people can be identified and prophylaxis provided along with secondary prevention strategies. The process includes focused surveillance, contact tracing, early diagnosis and treatment. This helps in reducing

Chemoprophylaxis, as recommended by WHO Guideline Development Group (GDG), is done using single dose rifampicin (SDR) for contacts of leprosy patients both in adults and children of 2 years of age and above. Before starting the drug leprosy and TB disease are to be excluded. There should be no contraindications also

Other important considerations for the implementation of this chemoprophy-

An RCT found that SDR reduces risk of leprosy over 5–6 years in leprosy contacts. For every 1000 contacts treated with SDR, there were four leprosy cases

c.Specific screening test needed to distinguish between contacts with high and

**Age/weight Rifampicin single dose** Adults (≥15 years) 600 mg 10–14 years 450 mg Children 6–9 years (weight ≥ 20 kg) 300 mg Children <20 kg (≥2 years) 10–15 mg/kg

Among communicable diseases, leprosy remains a leading cause of peripheral neuropathy and disability in the world, despite extensive efforts to reduce the disease burden. It is an important aspect of leprosy control. It means the medical, surgical, social, educational, and vocational restoration as far as possible of treated patients to normal activity so that they resume their place in the home, in society

Rehabilitation: WHO has defined rehabilitation as "the combined and coordinated use of medical, social, educational and vocational measures for training and

retraining the individual to the highest possible level of functional ability."

#### *Leprosy: Prevention and Control DOI: http://dx.doi.org/10.5772/intechopen.92089*

*Public Health in Developing Countries - Challenges and Opportunities*

immune response of the individual to the vaccine.

Vietnamese trial contradicted the results [8].

tation of new emerging vaccines (**Figure 7**).

**7. Chemoprophylaxis (post-exposure prophylaxis)**

of leprosy [8].

**Figure 7.**

*Locations of leprosy vaccine testing.*

National Hansen's Disease Program and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with financial support from American Leprosy Missions, have developed this leprosy vaccine. Based on the preclinical studies, the LepVax, has progressed to Phase I clinical testing in the United States, the first stage of safety testing in human volunteers. The clinical trial is focused not only on safety but also evaluates the

c.**Indian cancer research center (ICRC) bacilli:** Another variant belonging to the *M. avium intracellulare* group, the ICRC bacilli are thought to induce lepromin conversion in lepromatous leprosy patients and in lepromin-negative

leprosy-free individuals. Its efficacy was reported to be 65.5 percent [8].

d.*M. vaccae:* The studies with this soil-dwelling mycobacterial species combined with BCG showed to provide greater protection against leprosy, but a

e.*M. Habana:* This bacilli has been reported to induce lepromin conversion when used as a live vaccine in monkeys, and protected mice against the development

Chemoprophylaxis alone provides two-year protective window while effective immunization will provide a much broader protective window. Thus many studies and research is going on to provide both chemoprophylaxis and immunization for immediate and short-term protection and longer-term protection respectively. This strategy could have better impact and distinct appeal in controlling and preventing leprosy. Such trials could also provide a gateway for the assessment and implemen-

Chemoprohylaxis using effective antibiotics focuses on providing protection to people at risk such as close contacts – family members, neighbors, co-workers, health care providers for lepers etc. Due to the stigma of disease the leprosy cases

**138**

are found in clusters in all endemic regions, rather than being evenly dispersed over the whole area. Thus these high risk people can be identified and prophylaxis provided along with secondary prevention strategies. The process includes focused surveillance, contact tracing, early diagnosis and treatment. This helps in reducing the incidence and breaking the chain of transmission.

Chemoprophylaxis, as recommended by WHO Guideline Development Group (GDG), is done using single dose rifampicin (SDR) for contacts of leprosy patients both in adults and children of 2 years of age and above. Before starting the drug leprosy and TB disease are to be excluded. There should be no contraindications also for the use of rifampicin.

Other important considerations for the implementation of this chemoprophylaxis by programs are:

i.Adequate management of contacts.

ii.Consent of the index case to disclose his/her disease.

An RCT found that SDR reduces risk of leprosy over 5–6 years in leprosy contacts. For every 1000 contacts treated with SDR, there were four leprosy cases prevented after 1–2 years and three cases prevented after 5–6 years.

Recommended dosage schedules for SDR are given in **Table 1**. The limitations of this approach are:

a.The protection is approximately for only 2 years.

b.High bacillary load cannot be eliminated using single dose.

c.Specific screening test needed to distinguish between contacts with high and low bacillary load.


**Table 1.**

*Rifampicin dose for chemoprophylaxis [3].*
