Research Paper on Chemoprophylaxis & Immunoprophylaxis: Reducing Leprosy Transmission & Incidence

A systematic review of the importance of chemoprophylaxis and immunoprophylaxis in subclinical case of leprosy that can reduce the incidence and the transmission of leprosy.

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Introduction

Leprosy is a condition that is believed to be caused by Mycobacterium lapae abbreviated as m-lapae. The condition is transmitted with droplets as untreated patients contain bacillary load that are in high concentrations, and they contact with susceptible individuals. The high risk of transmission is owed to the contacts, in such case, a sick person is a risk to those surrounding them, and they are in potential of getting contact. In the recent past, there have medical development to reduce the rate of transmission, the development of Multidrug therapy has reduced transmission of leprosy in the world by 10 per cent of reported and recognizable cases. However, despite the availability and accessibility of multidrug therapy, there have been reported cases in the past ten years. This means that there is still a gap in developing the rightful process of preventing the transmission of leprosy. Chemoprophylaxis is the process of administering drugs to an individual's situation or condition to prevent an infection into an individual or preventing an infection into an individual. The drugs can also be administered to avoid further development of an infection to an already active condition in an individual. Preventing leprosy has been termed as impossible, and there is no medication available that can prevent the virus m-lapae that causes Leprosy. However, chemoprophylaxis has been found to prevent the progression of leprosy in contacts to those who have acquired m-lapae organism. Immunoprophylaxis is the prevention of a disease condition by producing an active or passive immunity that is injected to the people who at high risk of getting infected by the disease condition. In this case, the immunoprophylaxis includes designing an immunity that will prevent people surrounded by leprosy patients to get infected via contacts. Combination of immunoprophylaxis and Chemoprophylaxis can be a resourceful way of preventing the progression of leprosy from infecting more people.

Background to the Study

Evidence-Based Research Question

For the subclinical case of leprosy (P), what is the importance chemoprophylaxis and immunoprophylaxis (I) in comparison with subclinical cases of leprosy who does not use chemoprophylaxis and immunoprophylaxis (C) in reducing the incidences leprosy (O) by controlling transmission of leprosy (S)?

In this perspective, the study will explore the main changes acknowledged and recorded to populations where there is a group of leprosy patients to understand the importance of the chemoprophylaxis and immunoprophylaxis in reducing and preventing further transmission of leprosy to those who do not have the disease condition. The main objective of the study is to investigate the importance of the two preventive measures and their effectiveness in preventing leprosy in those who are not yet infected and yet they are closer to the patients having the condition.

Background

According to the world health organization, more than one hundred and fifty people in the world have leprosy majority coming from Africa and Asia continents. In the United States, over one hundred people are diagnosed with leprosy every year. However, it has been noted that Leprosy is not such contagious, one can one get infected when they get nose and mouth droplets contact from a person who is already infected with leprosy that is untreated. The world health organization has also revealed that children are more likely to be infected than adults.

Leprosy condition primarily affects the skin and the brain nerves a condition that leads to paralyzation of an individual in case it attacks the spinal cord nerves. Sometimes the disease may attack the eyes and the thin linen in the nose. The condition and the symptoms appear to an individual after 3 to 5 years after the person came into contact with a person who was infected with leprosy. The time between when the person contacted the bacteria and when symptoms start showing is known as the incubation period. The long incubation period has made it difficult for doctors and practitioners to detect and understand where the bacteria-infected a person hence a need to provide a preventive mechanism to those people who are at high risk of getting infected.

Literature Search and Strategy

This study has searched for several medical and nursing databases to get the necessary materials. The databases helped in Understanding the importance of chemoprophylaxis and immunoprophylaxis in reducing transmission of leprosy in subclinical cases. Pubmed, Cinahl were the primary databases considered for this study. Pubmed and Cinahl provide information and materials about the health issues and medication of different conditions and diseases in the United States, and the databases also include information about the National Health Institute of the United States. Online Journal for issues in Nursing and American Journal of Nursing was another database that was researched to find materials for this study.

All these studies provided reliable and informative materials for the use in this study. The materials were filtered from the last two decades to get the most accurate and updated information.

The keywords that were established in researching the databases included Leprosy, signs of leprosy, prevention of leprosy, the prevalence of leprosy, importance of preventive measures of leprosy, importance of chemoprophylaxis and immunoprophylaxis, subclinical cases of leprosy, leprosy incubation period, treatment of leprosy, methods of reducing transmission of leprosy, diagnosis of leprosy and methods of controlling leprosy.

Inclusions and Exclusions

The databases stated above in the study were screened systematically using the keywords stated above. In the databases, over three hundred articles about individual studies were found, each containing detailed information on the keywords used for the search. However, not all the materials that were found in the databases that answered the PICOS questioned stated for this study. The inclusion and exclusion criteria was based on keywords of the articles that were found in the databases. The articles that were excluded in this study had the following keywords; leprosy in children, treating of leprosy, ways of avoiding leprosy, curing leprosy, the population affected by leprosy, age and leprosy and understanding leprosy. Though these articles and studies had relevant information about leprosy their content did not try and help in solving the PICOS question of the survey.

After excluding the studies with keywords that did not address the PICOS question of the study, four articles were selected for systematic analysis for this study. The chosen studies had the following keywords, mycobacteria, antibiotics, preventing leprosy transmission, leprosy vaccine and chemoprophylaxis and immunoprophylaxis.

Evidence of the Appraisal

The first study considered for this study was conducted by Malcolm and Marivic entitled Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy in 2016. The study was investigating the effectiveness of the combination of chemoprophylaxis and immunoprophylaxis in preventing transmission of leprosy. The study was developed on understanding the available methods for treating leprosy and their effectiveness in the past to construct effective mechanisms of preventing leprosy condition.

The study found out that various chemoprophylaxis methods are effective in treating people who are at high risk of getting infected with leprosy, yet they did not exhibit and sigh or symptoms of leprosy. In the Indonesia where the study was conducted it was found that RIF treatment was effective to the community where those that did not take the drug had distinct effects from the condition in the same community. The study recorded that RIF medication was up 57 per cent preventive of the leprosy condition in households where there was regular contact with people infected with leprosy. Dapsone prophylaxis programs that were initiated to the people living with the affected population were found to be effective in preventing further transmission of the Leprosy condition.

The combination of chemoprophylaxis and immunoprophylaxis was found to be the most active strategy of controlling and preventing the transmission of leprosy among subclinical patients. The study noted that the combined strategy involved the administering of BCG vaccine and RIF medication to prevent the transmission of the leprosy as the most effective to countering a weakening mycobacteria.

The second study that was considered for the purposes of this study was conducted by Dos Santos et al. in 2018 entitled Chemoprophylaxis of leprosy with rifampicin in contacts of multibacillary patients: study protocol for a randomized controlled trial. The study was conducted to determine the effectiveness of the Chemoprophylaxis in preventing people from getting infected with leprosy in an environment where the majority of people have leprosy. The study took a design if administering rifampicin dosage to non-affected people in an environment where they made regular contact with leprosy infected patients who were under care. The aim of the study was to investigate whether the single-dose rifampicin in leprosy contacting patients had an effect of preventing one not to be affected with the condition before the patients' vaccination with BCG. However, the study was limited to trial and registration. It was based on the Brazilian registry of clinical trials and thus biased on cases of other environments around the world.

The study found out that a combination of chemoprophylaxis and immunoprophylaxis was effective in altering the transmission and infection of people from m.lapae bacteria in a subclinical setting as it reduced the new cases of people affected by leprosy and also interfered with the sub-parameters of the laboratory infection. The authors attribute the effectiveness of the combined preventive measure as the main importance in preventing transmission of leprosy in a subclinical setting. It is also evident that the combination of chemoprophylaxis and immunoprophylaxis were found to expand the knowledge of immunization of leprosy as another importance in preventing transmission of the disease condition to the uninfected.

The third study to be systematically reviewed in this study was conducted by Bakker et al. in 2005 titled Prevention of leprosy using rifampicin as chemoprophylaxis. The study aimed at investigating whether rifampicin can be used as chemoprophylaxis in preventing leprosy. The study was conduct...