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Single-Dose Rifapentine Reduces Leprosy Transmission In Household Contacts

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Leprosy, or Hansen’s disease, is a chronic infection caused by Mycobacterium leprae that primarily affects the skin and peripheral nerves. It spreads through prolonged and repeated close contact with an infected individual over months, mainly through droplets from the nose and mouth. Household contacts of leprosy patients face the highest risk of contracting the disease.  

As per The New England Journal Of Medicine, a recent trial conducted in China has shown promising results in reducing the transmission of leprosy among household contacts. The trial involved administering a single dose of the antibiotic rifapentine to close connections of individuals with leprosy.

The findings, published in the New England Journal of Medicine, indicate that this post-exposure prophylaxis (PEP) approach using rifapentine was more effective than the current standard antibiotic, rifampin.  

The trial included three groups: one received rifapentine, another received rifampin, and a control group received no treatment. Over four years, among the 7,000 household contacts studied in 207 clusters, there were only 24 new cases of leprosy.

The incidence rate in the rifapentine group was significantly lower at 0.09% (two cases) compared to 0.33% (nine patients) in the rifampin group and 0.55% (13 points) in the control group. Statistical analysis indicated a 92% lower incidence in the rifapentine group compared to the control group.  

The trial results have been well-received by experts in the field. Jan Hendrik Richardus, a professor emeritus of infectious diseases and public health, noted that this study confirmed the usefulness of PEP. However, he highlighted that rifapentine is more expensive than rifampin, potentially limiting its adoption in resource-constrained countries and public health programs. 

Leprosy has been treatable for decades, particularly since the introduction of multidrug therapy in the 1980s. However, strategies like PEP are crucial in reducing leprosy cases globally, as around 200,000 cases are reported yearly, primarily in Southeast Asia. The use of prophylactic antibiotics needs to be carefully managed to prevent antibacterial resistance.  

The trial also revealed two significant findings. First, the protective effect of rifapentine persisted over four years, whereas previous studies showed that rifampin’s benefits lasted only two years.

Second, the trial demonstrated that PEP can be effective even in countries with low leprosy rates, like China, suggesting its potential application in other parts of the world. David Scollard, former director of the National Hansen’s Disease Program, emphasized the potential of protecting close contacts as a game changer in leprosy prevention.  

In conclusion, the trial conducted in China provides compelling evidence that administering a single dose of rifapentine as post-exposure prophylaxis to household contacts of leprosy patients can significantly reduce the incidence of new infections. The results support implementing PEP strategies globally, although cost and antibacterial resistance considerations need to be addressed. 

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