Rare Leprosy Case in Ireland Highlights Need for Improved Guidelines and Awareness in Low-Incidence Regions

Introduction

Challenges of the public health response to a rare case of non-native Mycobacterium leprae, Ireland, 2024.

A case report published in Eurosurveillance In an adult with an imported case of leprosy in Ireland shows that there are notable challenges in tackling the disease in settings where it is rare. The affected individual was one of five people with leprosy reported in Ireland in the last decade. The authors report challenges facing the public health response due to delayed recognition of symptoms by healthcare providers, lack of specific Irish and European guidelines, and contact tracing in a congregate setting.

Main article

Ahead of World Leprosy Day, this case study highlights the need for public health guidelines adapted to countries where the disease is very rare, as well as strategies to reduce stigma related to the disease. Leprosy is one of 24 neglected tropical diseases targeted for elimination by the World Health Organization (WHO) in its 2021-2030 roadmap. Although rare in Europe, it still represents a high burden of disease worldwide, with 182,815 cases reported worldwide.

Overview

The case involved a person in his 30s who was born and raised in the Caribbean, where leprosy is common. They had moved to Ireland 2 years before diagnosis from southern Brazil, where the incidence of leprosy is also high. The individual initially reported to a healthcare provider in late 2023 with neurological symptoms and lightened skin lesions. The patient was diagnosed after a 7-month investigation through a skin biopsy. After being treated with multi-drug therapy, they recovered from the infection.

The contact tracing strategy and risk assessment was based on WHO guidelines and policy documents as no specific guidelines were available in Ireland. Most international guidance on contact tracing comes from low- and middle-income countries, as few high-income countries have developed their own guidelines. There are considerable inconsistencies in guidelines in different countries in contact tracing, post-exposure prophylaxis eligibility, and follow-up approaches for affected individuals and contacts.

Public health response

The researchers identified a close contact as anyone who had been in contact with the initial untreated case for at least 20 hours per week, for at least 3 months in the previous year, according to the WHO definition.

One of the individual’s eight housemates, his partner and a work-related contact were identified as close contacts under WHO criteria. Ten other adults were also considered possible close contacts. Given the stigma of the disease, public health experts ruled out extensive contact tracing of all household members as it could have threatened the individual’s livelihood and access to housing, both of which were reported to be precarious.

According to WHO, Western Australian and British guidelines, clinicians offered single-dose rifampicin chemoprophylaxis to the three true close contacts for the affected individual. This treatment has been shown to offer a protective effect in leprosy contacts where the disease is common. However, there is some uncertainty about whether these results also apply to settings where leprosy is rare, and international guidelines are less consistent.

The incubation period for leprosy is highly variable and ranges from 2 to 5 years, but can be shorter or extend up to 20 years or more. Most international guidelines recommend annual follow-up for close contacts given this unusually long incubation period, with some variation on the duration of follow-up. Therefore, arrangements are made with local primary care physicians to conduct annual follow-ups with the three contacts for the case for a minimum of 5 years, as recommended by the World Health Organization.

Recommendations

The report shows the significant challenges in responding to leprosy in high-income countries, where it is rare. Countries should consider developing tailored strategies for these settings, which should prioritize continued education of health professionals about the disease, as well as robust measures to counter stigma and improve access to mental health for affected people. The authors also recommend a more harmonized approach to responding to sporadic cases, with greater standardization across public health guidelines.

Related information

This case highlights the continued need for awareness and preparedness in countries with low leprosy incidence. While diagnosis was challenging due to its rarity, it also highlights the importance of continuing education for healthcare professionals and the development of specific guidelines to address such diseases. More comprehensive public health strategies and a reduction in stigma are essential to ensure timely diagnosis and treatment, ultimately improving patient outcomes and community health. This case serves as a reminder of the global nature of infectious diseases and the need for robust and adaptable health systems.

Attribution/source(s):
This peer-reviewed publication was selected for publication by the editors of Discapsed World (DW) due to its significant relevance to the disability community. Originally written by Eurosurveillanceand published on 01/2025/24, content may have been edited for style, clarity, or brevity. For more details or clarifications, Eurosurveillance He can be contacted at EuroSurveillance.org. NOTE: Discaped World does not provide any warranty or endorsement related to this item.

Information and page references

Discapsed World (DW) is a comprehensive online resource providing information and news related to disabilities, assistive technologies, and accessibility issues. Founded in 2004, our website covers a wide range of topics, including disability rights, healthcare, education, employment and independent living, with the goal of supporting the disability community and their families.

Cite this page (APA): Eurosurveilance. (2025, January 24). The rare leprosy case in Ireland is highlighted to improve guidelines and awareness in low incidence regions. Disabled World (DW). Retrieved January 26, 2025 from www.disapabled-world.com/news/uk/ireland/leprosy-case.php

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