Elimination of
leprosy cannot be achieved by multidrug
therapy alone, and new tools are needed to prevent
leprosy. A randomized controlled trial with
chemoprophylaxis for contacts of
leprosy patients using a single dose of
rifampicin (SDR) has shown an overall protective effect of approximately 60%, effective in the first 2 years after the intervention. When a contact who previously received bacillus Calmette-Guérin (BCG) vaccination also receives SDR, the protective effect is additive, approximating 80%.
Vaccine trials have been conducted with BCG, often in combination with Mycobacterium leprae or related Mycobacterium
vaccines as immunoprophylaxis for contacts of
leprosy patients, with BCG giving the best results. Meta-analysis shows that the protective effect of BCG vaccination is larger in observational studies than in trials, 60% versus 41%, and is higher among contacts of
leprosy patients than among the general population, 68% versus 53%. We believe that a future
leprosy control strategy should include contact management, consisting of a contact survey, at which time preventive interventions could be added, such as
chemoprophylaxis and immunoprophylaxis. Modeling studies have shown that both interventions will lower the incidence of
leprosy in the population. Implementation studies of such contact-based strategy are now called for.