Patient-related factors predicting the effectiveness of rifampicin chemoprophylaxis in contacts: 6 year follow up of the COLEP cohort in Bangladesh.
OBJECTIVE
The COLEP trial in Bangladesh showed a 57% reduction in leprosy incidence among contacts of newly diagnosed patients in the first 2 years after chemoprophylaxis with single dose rifampicin (SDR). We assessed the impact of this intervention after 6 years and identified characteristics of the leprosy index patients predicting the effectiveness of this intervention.


METHODS
The cohort of 1037 patients and their 28 092 contacts that participated in the randomised placebo controlled field trial with single dose rifampicin was followed for 6 years. The leprosy status of contacts was established at 2, 4 and 6 years after the intervention. We assessed the association between characteristics of the index leprosy patients and the development of clinical leprosy among their contacts using logistic regression.


RESULTS
The protective effect of SDR was seen only in the first 2 years, with no additional effect after 4 and 6 years. However, the total impact of the intervention was still statistically significant (P = 0.025) after 6 years and no excess cases were observed in the SDR arm at a later stage. The intervention prevented leprosy in contacts that actually received SDR, but did not offer protection to members of the same contact group who did not take chemoprophylaxis. The intervention was most effective in contact groups of female index patients, an enhanced effect was also observed in contact groups of patients belonging to a cluster of two or more leprosy patients at intake as well.


CONCLUSIONS
These easy to recognise patient characteristics indicate a possible enhanced risk of transmission of Mycobacterium leprae to contacts in the vicinity of patients and are useful for deciding about preventive measures, such as early detection or chemoprophylaxis.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. sgfeenstra@yahoo.com
Sabiena G
SG
Feenstra
David
D
Pahan
F Johannes
FJ
Moet
Linda
L
Oskam
Jan Hendrik
JH
Richardus
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D018890:Chemoprevention / Q000379:methods; D016358:Contact Tracing; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007918:Leprosy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000187:drug effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012293:Rifampin / Q000494:pharmacology* / Q000627:therapeutic use; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
D012293:Rifampin