Studies on social medicine and leprosy in east China.

Leprosy is a disease in which the social, economic, cultural and environmental factors play an important role in occurrence, spread, control, eradication and rehabilitation. Eliminating the unfavourable factors hindering leprosy control can make achieving the goal of basic eradication of leprosy in China before the end of this century possible. For this reason, since 1984 we have carried out systematic studies of the social aspects of leprosy in Baoying County, a former high-endemic area in Jiangsu Province of East China, where the endemicity of leprosy is nearing full control.

Determination of antibodies in dried blood from earlobes of leprosy patients by enzyme-linked immunosorbent assay--a preliminary report.

An enzyme-linked immunosorbent assay (ELISA) was used with soluble antigens of Mycobacterium leprae. All blood samples collected from the earlobes of 109 leprosy patients and 100 healthy controls (from a non-endemic area of leprosy) were absorbed with M. vaccae, BCG, cardiolipin, and lecithin according to the technology of the FLA-ABS test before being tested in the ELISA. The results (at a 1:200 blood dilution) showed that antibody activity gradually increased from TT to LL (mean OD values: TT = 0.43, BT = 0.62, BB = 0.72, BL = 0.84, LL = 0.89), and the rates of positive reactions were 100% in all classifications of patients except TT (66.6%). Antibody activity in the controls was less pronounced than in leprosy patients, their mean OD value being only 0.15. We suggest that the ELISA is highly sensitive and specific for the determination of anti-M. leprae antibodies, and is useful for clinical serodiagnosis and for the study of subclinical infections in leprosy.

Evaluation of fluorescent leprosy antibody absorption test versus enzyme-linked immunosorbent assay with phenolic glycolipid 1 and their use in immuno-epidemiological studies on leprosy.

We systematically conducted comparative studies on the validity, reliability and practicality of FLA-ABS.T/PGI-ELISA in large samples. Namely, 284 leprosy patients, 20 tuberculosis patients, 172 normal controls (from nonendemic area of leprosy), 425 leprosy household contacts (HC) and 2573 random samples from the general population (RS) were involved. The results indicated that FLA-ABS.T/PGI-ELISA are highly sensitive and specific for detecting antibodies against M. leprae. Their Youden's indexes (YI) are greater than 90%, and the positive predicative and negative values are 90%. The test results agreed with immuno-epidemiological studies: 1. The positive rates using FLA-ABS.T/PGI-ELISA increased gradually from TT to LL leprosy patients (in HC, the positive rates of PGI-ELISA were much higher in contacts of multibacillary patients than in contacts of paucibacillary patients); 2. The positive rates detected by FLA-ABS.T were identical to those of PGI-ELISA both in HC and in RS; 3. Among RS, the positive rates detected by FLA-ABS. T/PGI-ELISA were similar in each district and were in concordance with the general prevalence rates. Thus, both FLA-ABS.T and PGI-ELISA are useful tests in diagnosing leprosy and detecting subclinical infection with M. leprae. However, because the PGI-ELISA is simple, it will be more practical than FLA-ABS.T in the future. The authors emphasize that the methodology of obtaining dried blood from ear lobes is important for the immuno-epidemiological study of leprosy on a large scale.