Specific antibodies can be used as a surrogate marker for bacterial load in leprosy. Tests to detect antibodies can be used for (i) the classification of patients for treatment purposes [most multibacillary (MB) patients are seropositive, most pauci-bacillary (PB) patients are not], (ii) the prediction of an increased risk of relapse and (iii) the identification of contacts having an increased risk of developing leprosy. With the advent of fast, robust and easy to perform serological tests such as lateral flow, agglutination and card tests, the application of serology in the field for these purposes becomes a feasible prospect. We hereby present an overview of the current knowledge and new developments in this area and discuss the strengths, limitations and possible applications of antibody detection in leprosy research and control.

The immune response in reversal reaction, (RR) and in erythema nodosum leprosum (ENL) is characterized in vitro by an enhancement in lymphocyte blast transformation against M. leprae. As thalidomide is an effective treatment for ENL, this study assessed the effect of this drug on these phenomena. Mononuclear cells from patients attending the clinic at ALERT and from healthy staff were cultured for 5 days with integral M. leprae (IMl), or a modified Dharmendra antigen (Dhar), or PPD from M. tuberculosis. In one set of cultures, thalidomide was added once at the initiation of the culture; in the other set thalidomide was added a second time (2×), 18 h prior to harvesting the cells. The mononuclear cells, in the absence of thalidomide, from healthy staff, borderline tuberculoid patients (BT) and BT patients in RR (BT/RR) incorporated [³H]-thymidine best when cultured with PPD > Dhar > M. leprae. The cells from patients with ENL did not respond well to the M. leprae antigens. Thalidomide (2×) enhanced proliferation to Dhar in the BTRR group (Wilcoxon signed rank test, P < 0.05). No significant changes occurred for the other groups. Comparing PPD-stimulated cells treated with thalidomide once to those treated with thalidomide twice, thalidomide (2×) suppressed incorporation of [H³]-thymidine by the PPD-stimulated (P < 0.05) as well as IMl-stimulated (P < 0.05) cells in the healthy staff group. In the Dhar-stimulated cells from the healthy staff thalidomide significantly suppressed TNF-𝛼 (P < 0.05). A mixed effect was seen within and between the other groups, but there was a trend for thalidomide to suppress TNF-𝛼 induced by the M. leprae, Dhar and PPD antigens.

With the decline in prevalence of leprosy, social and economic rehabilitation (SER) has become a major priority in leprosy control programme in Shandong Province. In the preparative phase of an SER programme, a province-wide survey was conducted with a semi-structured questionnaire in order to provide policy makers and programme managers with some basic information on the disability, and social and economic situation of the people affected by leprosy. This paper presents the results of a study in the people affected by leprosy living in the communities.

In the late phase of the leprosy control programme in Shandong Province, People’s Republic of China, there are a few old and disabled ex-patients living in 54 leprosy villages/leprosaria. The small, and declining number of patients makes the running of these leprosy villages/leprosaria uneconomic. In this paper, we review the history and the role of leprosy villages/leprosaria in the care of leprosy patients and the control programme in Shandong province. We then analyse the present situation of the 643 people still living in these leprosy villages/leprosaria, using information collected from a questionnaire-based survey. Finally, we offer some suggestions and recommendations for policy makers and leprosy control managers, in order to improve the present situation and make better use of existing resources.

The objective of this study is to assess whether the case-finding method is a determinant for diagnostic characteristics and treatment outcome of newly diagnosed leprosy patients in Northern Mozambique. This is a retrospective cohort study of 3202 patients on the differences between entrance characteristics and treatment outcome in self-reporting patients and patients detected during a leprosy elimination campaign (LEC) in 1999 in Northern Mozambique. As a consequence of LEC activities, 3 times more patients were found compared with the same period 1 year earlier. After the LEC, case detection remained higher in the years 2000–2002 compared with the years preceding the LEC. More young (<15 years) paucibacillary (PB) cases were diagnosed during LEC activities with, surprisingly, equal percentage of disability grades. No gender imbalance was found in diagnosed LEC patients contrary to self-reporting patient groups. Comparing patients detected during a LEC in 1999 with the passive group of 1998 and 1999 showed a slight but statistically significant better treatment result for the passive group. The classification of leprosy (in favour of PB) and age (in favour of older age groups) were also determinants for favourable treatment outcomes. Volunteers had a significantly better result of treatment compared with trained nurses and regardless of detection method. LEC proved to be a useful addition to the National Leprosy and Tuberculosis Programme in Northern Mozambique. As a result, many new cases were diagnosed and put on treatment and their treatment results were very satisfactory. LEC had a lasting impact on case finding. Volunteers make a valuable contribution to leprosy control in Mozambique because they have consistently better treatment results compared with nurses.