Leprosy transmission and mucosal immunity: towards eradication?

I. A. CREE, W. CAIRNS SMITH
1998 Leprosy Review  
The declining prevalence of leprosy has not been matched by a declining incidence. Widespread adoption of mutliple drug therapy (MDT) in closely mon itored control programmes has not prevented transmission of My cobacterium leprae. Despite the rarity of lepromatous patients, most of those living in endemic areas have immunological evidence of exposure to M. leprae. This paradox could be explained if, for many such individuals, infection was transient, did not result in disease development, but
more » ... id allow the transmission of infection to other individuals. There is increasing evidence from nasal PCR studies that such sub-clinical transmission may exist and that mucosal immune responses to M. leprae may develop during resolution of initial infection. Sub-clinical infection appears to occur in clusters and may require close contact over a prolonged period for optimal transmission. Control of transmis sion may be feasible through identification and treatment of individuals within infection clusters, allowing progress towards the eradication of leprosy.
doi:10.5935/0305-7518.19980011 fatcat:qnb6u6mmnvdjrbq2bewvby4pdi