The World Health Organization field leprosy classification is based on the number of skin lesions: paucibacillary leprosy (1–5 skin lesions), and multibacillary leprosy (more than 5 skin lesions). Worldwide, about 250,000 new cases of leprosy are reported each year, and about 2 million people have leprosy-related disabilities.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent leprosy? What are the effects of treatments for leprosy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 20 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: chemoprophylaxis with single-dose rifampicin, Bacillus Calmette–Guerin (BCG) plus killed Mycobacterium leprae vaccine, BCG vaccine, ICRC vaccine, multidrug treatment, multiple-dose treatment, Mycobacterium w vaccine, and single-dose treatment.
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, primarily affecting the peripheral nerves and skin.
The WHO field leprosy classification is based on the number of skin lesions: paucibacillary leprosy (1–5 skin lesions), and multibacillary leprosy (more than 5 skin lesions).Worldwide, about 250,000 new cases of leprosy are reported each year, and about 2 million people have leprosy-related disabilities.
Chemoprophylaxis given to contacts of index cases is moderately effective in preventing leprosy.
Chemoprophylaxis with single-dose rifampicin reduces the incidence of leprosy in contacts of new cases, although the effect is only seen in the first 2 years.
Vaccination is the most efficient method of preventing the contraction of leprosy.
Vaccination with Bacillus Calmette–Guerin (BCG) vaccine, either alone or in combination with killed M leprae
, reduces the incidence of leprosy. BCG and BCG plus killed M leprae seem to be as effective as each other at reducing the incidence of leprosy.
ICRC vaccine prevents leprosy and produces few adverse effects, although its formulation is unclear and we only found evidence in one geographical area.
Mycobacterium w vaccine reduces the incidence of leprosy compared with placebo.
Leprosy is generally treated with multidrug programmes.
Despite sparse good RCT or cohort study evidence, there is consensus that multidrug treatment (rifampicin plus clofazimine plus dapsone) is highly effective for treating multibacillary leprosy. Placebo-controlled trials of multidrug treatment would now be considered unethical.
Multidrug treatment with rifampicin plus dapsone is believed to improve skin lesions, nerve impairment, and relapse rates in people with paucibacillary leprosy, despite a lack of good evidence.
Multiple-dose treatments with rifampicin monthly plus dapsone daily for 6 months are more effective than single-dose treatments with rifampicin plus minocycline plus ofloxacin for treating people with single skin lesions (although both achieve high cure rates).