title: CHEMOPROPHYLAXIS TO CONTROL LEPROSY AND THE PERSPECTIVE OF ITS IMPLEMENTATION IN BRAZIL: A PRIMER FOR NON-EPIDEMIOLOGISTS.
abstract: The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.
authors.affiliation: Departamento de Medicina Social, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil, cunhatmt@gmail.com, barretovitor@hotmail.com.
authors.forename: Sergio Souza da
authors.initials: SS
authors.lastname: Cunha
authors.affiliation: Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil, albierrenbach@yahoo.com.br.
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Bierrenbach
authors.affiliation: Departamento de Medicina Social, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, PE, Brasil, cunhatmt@gmail.com, barretovitor@hotmail.com.
authors.forename: Vitor Hugo Lima
authors.initials: VH
authors.lastname: Barreto
mesh_terms: D001938:Brazil / Q000453:epidemiology; D019317:Evidence-Based Medicine / Q000592:standards; D005192:Family Health; D006284:Health Plan Implementation / Q000592:standards*; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use*; D007918:Leprosy / Q000188:drug therapy* / Q000517:prevention & control*; D009313:National Health Programs; D061366:Numbers Needed To Treat / Q000592:standards; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D007917:Leprostatic Agents