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Morocco sees 16% annual decline in leprosy cases attributed to rifampicin
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Leprosy cases in Morocco declined by 16% annually from 2012 to 2017 after the implementation of single-dose rifampicin chemoprophylaxis, researchers found.
Writing in PLoS Neglected Tropical Diseases, Ibtissam Khoudri, MD, directorate of epidemiology and disease control and manager of the National Leprosy Control for Morocco's Ministry of Health, noted that in 1981, antibacterial multidrug therapy was introduced worldwide, leading to a reduction in leprosy cases from 5.4 million in the early 1980s to 210,758 in 2015.
“Despite this progress, leprosy control actions based on a secondary detection strategy cannot lead to leprosy elimination nor suppress the source of infection. Additional control intervention toward high-risk groups is then needed to interrupt transmission,” Khoudri and colleagues wrote. “Household contacts of leprosy cases are considered the main source of infection.”
In 2012, Morocco implemented single-dose rifampicin chemoprophylaxis nationwide in the hope of lowering the incidence of leprosy in contacts of patients diagnosed with the disease, Khoudri and colleagues noted. For their study, they conducted a time series study to demonstrate the trends of leprosy detection from 2000 to 2017, taking into account the implementation of nationwide chemoprophylaxis. They collected data on patients with leprosy, including leprosy incidence per 100,000 habitants, age, gender, origin, regions, grade of disabilities and clinical forms.
According to study findings, between 2000 and 2017, there were 801 new leprosy cases recorded. From 2000 to 2012, the leprosy detection rate decreased by 4% annually, compared with a 16% yearly decrease between 2012 and 2017.
The annual percentage change for 2012 to 2017 was –16.83% (95% CI, –29.2 to –2.3), compared with a –4.68% (95% CI, –7.3 to –2) annual percentage change during 2000 to 2012. Moreover, Khoudri and colleagues observed a significant break in 2012, the same year that the single-dose rifampicin chemoprophylaxis was implemented.
A stratified analysis also demonstrated decreased detection in leprosy cases, but the finding was not significant, the researchers said. However, after 2012, a rapid decrease in cases occurred in men, children, multi-bacillary cases, people with grade 0 to 1 disabilities, rural and urban areas and 10 specific regions.
Khoudri and colleagues suggested that the implementation of single-dose rifampicin chemoprophylaxis contributed to the decline in the detection of leprosy cases.
“This time series demonstrated a drop in case detection by 16% per year since [single-dose rifampicin chemoprophylaxis] implementation. This fact can allow us generating a hypothesis about a possible influence of [single-dose rifampicin chemoprophylaxis] on accelerating the reduction of leprosy detection in Morocco,” they concluded. “An interrupted time series analysis is needed to confirm this hypothesis.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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