P35
After an initial surveillance of drug resistance throughout the Comoros, no drug resistance to Mycobacterium leprae was detected.
S M Braet(1,2,3) A Jouet(4) A Aubry(6) M Van Dyck-Lippens(1) E Lenoir(4) Y Assoumani(7) A Baco(8) A Mzembaba(8) S Grillone(8) N Attoumane(8) E Cambau(9) S EG Vasconcellos(10) P N Suffys(10) L Rigouts(1) E Hasker(1) P Supply(11) B C de Jong(1)
1:Institute of tropical Medicine Antwerp; 2:University of Antwerp; 3:Research Foundation Flandres; 4:Genoscreen; 5:Inserm; 6:inserm U1135; 7:Damien Foundation; 8:National Tuberculosis and Leprosy control Program (Comoros); 9:Inserm 1137; 10:IOC-FIOCRUZ; 11:Université de Lille
Background: Leprosy persists in the Union of the Comoros, despite a strong leprosy control program, including post-exposure prophylaxis (PEP) with rifampicin offered to contacts of leprosy patients in the framework of a clinical trial, the PEOPLE study. To date, no resistance to anti-leprosy drugs has been reported, yet nationally representative data are lacking. The aim of this study was to perform a countrywide drug-resistance survey and investigate whether PEP – administered in 2015 and since 2019 – has led to the emergence of drug resistance to date.
Methods: From 2017–2021, in the ComLep and PEOPLE studies, over 1200 leprosy patients from the Anjouan and Mohéli islands were identified, based on clinical criteria. Of those, 284 samples had sufficient mycobacterial DNA to be tested by deep sequencing targeting 7 drug-resistance associated genes of Mycobacterium leprae (Deeplex Myc-Lep, Genoscreen, Lille), with a limit of detection of 10% for minority populations.
Findings: Among these 284 patients, six patients received PEP prior to developing clinical symptoms. No mutations were detected in any of the 7 drug resistance-related genes for any patient.
This drug resistance survey suggests full susceptibility of M. leprae to rifampicin, fluoroquinolones, and dapsone in the Comoros.
Discussion:
By sustainably applying targeted sequencing on biopsies preserved in Disolol at ambient temperature, an early warning system for resistance to anti-leprosy drugs, for both pauci- and multibacillary patients, is in place in the Union of the Comoros. This data suggests that PEP has not selected rifampicin-resistant strains to date.