Despite the increasing coverage of the standard multidrug therapy of WHO(MDT) and
consequent rapid decline of the prevalence, leprosy continues to be a serious public
health problem in many countries in the South Asia, Latin America and some countries
in Africa. WHO estimated that there were more than 600,000 new cases in 1991 and the
number remained at the same level in 1993, even though the number of active leprosy
patients declined from 5.51 million to 3.05 million during the same period of time. These
statistics suggest that the implementation of MDT alone is not enough to stop the
transmission of the disease. The development of prophylactic measures is, therefore,
essential for the successful leprosy control and eventual elimination of the disease.
There are three measures for prevention of leprosy ; MDT, immunoprophylaxis and
chemoprophy-laxis. MDT is partially effective for reducing the source of idection. The
immunoprophylaxis is essential to inhibit the infection of leprosy bacilli, choreas
chemoprophylaxis is important for preventing already infected contacts from developing
to the clinical manifestation.
In 1991, we conducted an epidemiological survey of two endemic villages in South
Sulawesi, Indonesia, and found that more than 30% of the general inhabitants had been
infected with leprosy bacilli without direct contain with leprosy patients. Some of these
infected villagers will develop leprosy sooner or later. The only way to protect these
high risk contacts from leprosy is chemoprophylaxis. One of the important unsolved
problems in chemoprophylakis is the predictive identification of risky individuals from a
large number of infected inhabitants. We are now trying to develop techniques to solve
the problem ; and the predictive ability of new techniques are being tested by
rose-control study. The results of one such study will be reported in the presentation.
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