Leprosy case in Munster prompts vigilance strategy call

Several recommendations on how European countries should respond to leprosy have been made following a case in the Cork/Kerry region.

Researchers from University College Cork, the Department of Public Health in HSE South West, and the Department of Infectious Diseases in Cork University Hospital compiled the report, which was published in European medical journal Eurosurveillance, this week.

The case, diagnosed in summer 2024, is one of just five of leprosy notified in the Republic of Ireland in the last decade — and the first in the South-West.

The individual, in their 30s, was living in a congregate setting with eight other adults, and was born and grew up in a Caribbean country where leprosy remains endemic. They moved to Ireland from southern Brazil two years before the diagnosis — after living in the region for 10 years.

This individual initially presented to clinical services in late 2023 with a history of pain and numbness in the right arm and hand, along with several raised hypopigmented lesions on the face, thorax, arms, and legs.

They underwent a number of investigations over seven months, before being diagnosed with leprosy on a skin biopsy in summer 2024, and received multi-drug therapy for neurological symptoms — which has resulted in recovery. In Ireland, there are no specific guidelines for the management of close contacts of leprosy, which caused issues for clinical staff who were unsure how much contact tracing should be done.

Several international guidelines recommend contact tracing and examination of all household contacts, but the report notes that this guidance is likely to be based on the assumption that all household contacts form part of a nuclear family or, at a minimum, interact with one another and spend considerable periods of time together in shared living spaces.

The HSE South West case did not share living spaces with the majority of their housemates for any substantial periods of time, and the HSE “was unable to find tailored guidance” on what the protocol should be in this living setting — which, they noted, is increasingly common in Ireland.

On detailed questioning, only one of the case’s housemates was considered to have interacted sufficiently with the case to be considered a close contact.

In addition, two other individuals were identified as close contacts: The case’s partner and one work-related contact with whom they had spent prolonged periods of time.

No credible source of infection was identified among their Irish contacts.

Some 10 other adults were considered potential close contacts, but the report explained: “Given the highly stigmatising nature of leprosy infection and its low infectivity, we considered that extensive contact tracing of all household members could be harmful to the index case — potentially jeopardising their housing or employment status, both of which were described as being informal or precarious.”

The report concludes that even countries where leprosy infections are not common should “remain vigilant to the possibility of cases of leprosy arising”, and they should consider developing tailored strategies to address this.

These strategies should prioritise ongoing education for healthcare professionals to recognise and diagnose leprosy, and should also encompass robust measures to combat stigma and ensure access to comprehensive mental-health support for affected cases.