The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study.

BACKGROUND: The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. METHODOLOGY: The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. PRINCIPAL FINDINGS: In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. CONCLUSIONS: The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.

The interrelationship between meteorological parameters and leptospirosis incidence in Hambantota district, Sri Lanka 2008-2017 and practical implications.

BACKGROUND: Leptospirosis is a bacterial zoonosis. Leptospirosis incidence (LI) in Sri Lanka is high. Infected animals pass leptospires to the environment with their urine. Leprospires' survival in the environment to infect a new host depends on meteorological factors. El Nino Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD) modulate the weather in Sri Lanka. OBJECTIVES: The determination of interrelationship between the LI in the Hambantota District, and local meteorological parameters, ENSO and IOD. METHODS: We acquired notified leptospirosis cases in the Hambantota District and population data. We calculated weekly leptospirosis incidences for 2008 to 2017.Weather data from two weather stations was obtained, averaged and converted into weekly data. We plotted time series graphs and observed the correlation between seven aggregated weather parameters and LI. We estimated cross-correlations between those weather parameters and LI. As our principal analysis we determined correlation between LI and seven local weather parameters, Nino 3.4, Nino4 and Dipole Mode Index (DMI) indices using wavelet analysis. RESULTS: Our wavelet analysis results showed troughs of minimum, maximum, mean temperatures, soil temperature, the evaporation rate, the duration of sunshine were followed by peaks in LI and peaks of rainfall followed by peaks of LI, all after lag periods. Our time series graphs and cross-correlation determination results are generally in agreement with these results. However there was no significant correlation between rainfall and LI in the cross-correlation analysis. There were peaks of LI following both peaks and troughs of DMI. There was no clear correlation between both Nino indices and LI. DISCUSSION: This may be the first long-term study demonstrating soil temperature, evaporation rate and IOD are correlating with LI. The correlation pattern of LI with temperature parameters differs from similar past studies and we explain the reasons. We propose ways to control high LI we observed after periods of weather favorable for transmission of leptospirosis.

The long-term impact of the leprosy post-exposure prophylaxis (LPEP) program on leprosy incidence: a modelling study

The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of SDR to eligible contacts of newly diagnosed leprosy patients in states or districts of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. This study investigated the long-term impact of the LPEP program on the leprosy new case detection rate (NCDR). Our results show that LPEP could reduce the NCDR beyond the impact of the routine leprosy control programme and that many new cases could be prevented. The benefit of LPEP increases gradually over time. LPEP could accelerate the time of reaching predicted NCDR levels of 2040 under routine program by up to six years. Furthermore, we highlighted how the impact varies between countries due to differences in the number of contacts per index patient screened and differences in leprosy epidemiology and national control programme. Generally, including both household contacts and neighbours (> 20 contacts per index patient) would yield the highest impact.

Prevalence and Correlates of Leprosy in a High-Risk Community Setting in Sri Lanka.

Leprosy is caused by the Mycobacterium leprae bacillus. Pockets of high endemicity remain in a number of countries including Sri Lanka, in spite of the fact that elimination has been achieved at the national level. In 2012, in a village in the Puttlam district, dermatologists reported an increase in individuals with leprosy. This village had been established in the 1990s for people displaced from Northern Sri Lanka during a civil war. A comprehensive household survey was conducted by district health officials from June to July 2012, and all household members present during the survey period were examined for leprosy lesions. Patients with suspected leprosy were referred to a dermatology clinic for clinical or pathological confirmation. The prevalence of leprosy was high (511 per 10 000 population). Household contact with another patient with leprosy increased the risk of leprosy (odds ratio = 6.69; P < .001). Continued vigilance is needed to keep leprosy at bay in high-risk communities.

Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital--a three year retrospective study.

INTRODUCTION: Leptospirosis is a disease of epidemic proportions in Sri Lanka. There is paucity of data on the determinants of mortality and impact of therapy in patients with leptospirosis admitted to critical care settings in endemic territories. METHODOLOGY: This retrospective cross-sectional study was performed in patients with serologically confirmed leptospirosis admitted to the intensive care unit of the General Hospital, Kalutara from January 2011 to April 2014. Associations between socio-epidemiological, clinical and laboratory parameters and patient mortality were examined. RESULTS: Forty-five patients were included. The mean age was 49.11(SD = 16.95) and majority (92%) were male. Percentage mortality was 44.4%. Patient mortality was associated with age > 40 (p = 0.012), symptoms of uremia (p = 0.017), evidence of CNS involvement (p = 0.039), presence of oliguria (p = 0.002) and anuria (p = 0.014), presence of multi-organ dysfunction syndrome (MODS) (p < 0.001), CRP > 96 (p = 0.036), platelet count < 20,000 (p = 0.045), Potassium > 5.0 (p = 0.05), metabolic acidosis with pH < 7.2 (p = 0.03), INR > 2 (p = 0.037) and requirement of mechanical ventilation (p < 0.001). Cox regression analysis revealed MODS and potassium > 5 to be independently associated with mortality. CONCLUSIONS: A high mortality rate is noted. The presence of MODS and serum potassium concentration > 5.0 was independently associated with mortality in this retrospective study of patients with confirmed leptospirosis in a critical care setting.

Relative lack of clinical disease among household contacts of tuberculosis patients compared to leprosy households.

The incidence of clinical tuberculosis and clinical leprosy among household members of tuberculosis and leprosy patients in Sri Lanka was studied. The study period was approximately 20 years (January 1981 to December 2001) and the total number of patients and contacts were 325 and 968 for tuberculosis and 726 and 3066 for leprosy, respectively. While none of the tuberculosis patient households had more than 1 patient nor any contacts who developed clinical disease during the observation period, 20% (148/726) of the leprosy patients had more than 1 patient in the family and 0.9% (13/1403) of their contacts who were followed-up developed clinical leprosy during the observation period. Although the tuberculosis patient household contacts did not develop clinical disease, in 79% (88/112) of contacts who were tested by Western blot analysis, there was serologic evidence of Mycobacterium tuberculosis infection. These data show that in populations of comparable socio-economic, environmental and geographic locations, tuberculosis and leprosy show very different transmission patterns. In general, in tuberculosis household contacts, in spite of exposure, infection did not proceed to clinical disease. In contrast, a significant number of leprosy household contacts developed clinical leprosy. These findings have implications in the design and implementation of control programmes for these two diseases.

Processes and challenges: how the Sri Lankan health system managed the integration of leprosy services.

At the end of 1999, the Ministry of Health in Sri Lanka took the bold decision to integrate its Leprosy Services within the country's general health system. The integration was completed in February 2001 and is already starting to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventative health services needed to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities. Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. Prevalence has increased by 36% and the new case load by 41%. A few areas still need more attention, such as integrating MDT supplies within existing systems and improving the flow of information, but nonetheless the ownership of leprosy is shifting rapidly to local health services.

Prevalence of skin diseases in suburban Sri Lanka.

BACKGROUND: In Sri Lanka the only available measures of disease frequency related to skin disorders are from hospital-based clinic studies. They reflect only the patterns of clinic attendance, and the actual prevalence of skin diseases in the community is unknown. The main objective of this study was to determine the prevalence of skin diseases in a selected area. METHODS: A household survey based on health interviews and clinical examination was conducted over a period of 4 months. 418 households were selected for modified cluster sampling from predetermined areas in Piliyandala. RESULTS: There were 1806 people residing in the 418 households surveyed. 894 cases were identified, of which 34 people could not be traced for clinical examination. 33 households did not have anyone with a skin lesion. The prevalence of skin disease was 47.6%. Fungal infections, followed by dermatitis, were found to be the commonest problems. There was only one case of leprosy. Psoriasis was found to be of low prevalence. CONCLUSIONS: The overall prevalence of skin disease was high in the community that we surveyed. There were marked differences between community prevalence and hospital dermatology clinic attendance data for a number of skin diseases.