Immunoepidemiological studies on subclinical infection among leprosy household contacts in Thailand

Three-thousand-fourteen leprosy house-hold contacts in Thailand were surveyed by their personal history, physical examination, and immunological tests. The results were compared with those obtained from villagers in leprosy-endemic and nonendemic areas. The percentages of young people, students, children and grandchildren of the patient, the contacts of multibacillary leprosy cases, long duration of contact, BCG vaccination, FLA-ABS and Dharmendra's lepromin-positive responders were significantly higher in the household contacts than those in the villagers. The percentages of neural and dermal symptoms were not significantly different between the household contacts and the villagers in the endemic area, but the percentages were higher than those of the villagers in the nonendemic area. A PPD skin test was more frequently negative in the former two groups than in the latter. Both FLA-ABS and lepromin tests showed a significant correlation with the age of the contacts, their occupations, blood relation to the patient, the duration of contact, BCG vaccination, dermal signs such as an ill-defined plaque or macule with or without sensory loss, but did not correlate with sex, type of leprosy in the patient, or other skin diseases. The FLA-ABS test in the house-hold contacts and the villagers in an endemic area showed a significant correlation with the neural signs, such as enlargement of the peripheral nerve without sensory loss. These suspicious dermal and neural signs and symptoms were therefore considered signs of Mycobacterium leprae infection. The FLA-ABS test was sufficiently sensitive for detecting this infection and did not correlate with the lepromin or PPD skin tests. FLA-ABS-positive but lepromin-negative responders were found in 33.5% of the house-hold contacts. They were considered to be a high-risk group who may develop clinical leprosy. Nearly half of them were treated with dapsone or BCG according to the results of the PPD skin test. Follow up of these contacts, together with the remaining contacts without treatment, is in progress.