Abstract
BackgroundIndonesia ranking third in the world, regarding leprosy burden. Chemoprophylaxis is effective in reducing risk of developing leprosy among contacts. ‘Blanket approach’ is an operational strategy for leprosy post-exposure prophylaxis in which all members of an isolated community, high endemic for leprosy are screened and given a single dose of rifampicin (SDR) in the absence of signs and symptoms of leprosy. The objective is to assess the operational feasibility of a population-wide ‘blanket’ administration of SDR for leprosy prevention in isolated communities in a remote island.MethodsA prospective follow-up study was conducted in the year 2014, 2015 and 2016 in Lingat village of Selaru Island, Indonesia. During the first two visits, screening and SDR were provided, whereas only screening was conducted during the third visit. The demographic and clinical data were used for a descriptive analysis of the project coverage and leprosy epidemiology.ResultsDuring the first two visits, 1671 persons (88%) were screened, 1499 (79%) received SDR, and 213 (11%) were excluded based on the exclusion criteria. During the first two visits, 43 (2.6%) cases were diagnosed with leprosy with a rate of 2263 per 100,000 population. The prevalence was highest in the age groups 15–24 and 25–49 years. Total, 14 (33%) cases had MB and 29 (67%) PB leprosy. Two cases (5%) had grade 2 disability. During the third visit, 10 new leprosy cases, with no grade 2 disability, were detected out of 1481 screened persons at the rate of 484 cases per 100,000 population (n = 2065 population in 2016). Among those screened during the third visit, there was a 50% reduction of leprosy among those who had previously received SDR compared to those who had not.ConclusionWith adequate planning and some additional investment, it is feasible to implement a blanket approach of chemoprophylaxis in a remote island of Indonesia, although effort needs to be made to cover as many people as possible in the first visit. Contingency plans need to be made to actively follow this village closely in the coming years and continue leprosy elimination efforts until no new cases are found any more.
Highlights
Indonesia ranking third in the world, regarding leprosy burden
The blanket approach in Lingat Village was implemented under the Leprosy Post Exposure Prophylaxis (LPEP) programme
The objective of this paper is to assess the operational feasibility of the population-wide ‘blanket’ administration of single dose of rifampicin (SDR) for leprosy prevention in isolated communities, by documenting the implementation process and initial results of a pilot project in a remote island of Indonesia
Summary
Indonesia ranking third in the world, regarding leprosy burden. Chemoprophylaxis is effective in reducing risk of developing leprosy among contacts. The objective is to assess the operational feasibility of a population-wide ‘blanket’ administration of SDR for leprosy prevention in isolated communities in a remote island. The disease burden has reduced in the last two decades, for which multidrug therapy (MDT) is largely credited [2, 3]. This has not led to the incidence based global elimination of leprosy [4]. 136 countries report leprosy (210,758 new cases in 2015), indicating that transmission of M. leprae has not yet been interrupted [5]. Leprosy causes serious and irreversible nerve damage, which is a leading cause of disability among communicable diseases in developing countries [6]. 14,059 cases (0.25/100,000 population) were detected with grade 2 disability in 2015 [5]
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