***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Despite almost 30 years of effective chemotherapy with MDT , the global new case detection rate of leprosy has remained quite constant over the past years . New tools and method ologies are necessary to interrupt the transmission of M. leprae . Single-dose rifampicin ( SDR ) has been shown to prevent 57 % of incident cases of leprosy in the first two years , when given to contacts of newly diagnosed cases . Immunization of contacts with BCG has been less well documented , but appears to have a preventive effect lasting up to 9 years . However , one major disadvantage is the occurrence of excess cases within the first year after immunization . The objective of this study is to examine the effect of chemoprophylaxis with SDR and immunoprophylaxis with BCG on the clinical outcome as well as on host immune responses and gene expression profiles in contacts of newly diagnosed leprosy patients . We hypothesize that the effects of both interventions may be complementary , causing the combined preventive outcome to be significant and long-lasting . Methods / design Through a cluster r and omized controlled trial we compare immunization with BCG alone with BCG plus SDR in contacts of new leprosy cases . Contact groups of around 15 persons will be established for each of the 1300 leprosy patients included in the trial , result ing in approximately 20,000 contacts in total .  BCG will be administered to the intervention group followed by SDR , 2 months later . The control group will receive BCG only . In total 10,000 contacts will be included in both intervention arms over a 2-year period . Follow-up will take place one year as well as two years after intake . The primary outcome is the occurrence of clinical leprosy within two years . Simultaneously with vaccination and SDR , blood sample s for in vitro analyses will be obtained from 300 contacts participating in the trial to determine the effect of these chemo- and immunoprophylactic interventions on immune and genetic host parameters . Discussion Combined chemoprophylaxis and immunoprophylaxis is potentially a very powerful and innovative tool aim ed at contacts of leprosy patients that could reduce the transmission of M. leprae markedly . The trial intends to substantiate this potential preventive effect . Evaluation of immune and genetic biomarker profiles will allow identification of pathogenic versus ( BCG-induced ) protective host biomarkers and could lead to effective prophylactic interventions for leprosy using optimized tools for identification of individuals who are most at risk of developing disease . Trial registration Netherl and s Trial Register : Background With 249,007 new leprosy patients detected globally in 2008 , it remains necessary to develop new and effective interventions to interrupt the transmission of M. leprae . We assessed the economic benefits of single dose rifampicin ( SDR ) for contacts as chemoprophylactic intervention in the control of leprosy . Methods We conducted a single centre , double blind , cluster r and omised , placebo controlled trial in northwest Bangladesh between 2002 and 2007 , including 21,711 close contacts of 1,037 patients with newly diagnosed leprosy . We gave a single dose of rifampicin or placebo to close contacts , with follow-up for four years . The main outcome measure was the development of clinical leprosy . We assessed the cost effectiveness by calculating the incremental cost effectiveness ratio ( ICER ) between the st and ard multidrug therapy ( MDT ) program with the additional chemoprophylaxis intervention versus the st and ard MDT program only . The ICER was expressed in US dollars per prevented leprosy case . Findings Chemoprophylaxis with SDR for preventing leprosy among contacts of leprosy patients is cost-effective at all contact levels and thereby a cost-effective prevention strategy . In total , $ 6,009 incremental cost was invested and 38 incremental leprosy cases were prevented , result ing in an ICER of $ 158 per one additional prevented leprosy case . It was the most cost-effective in neighbours of neighbours and social contacts ( ICER $ 214 ) , slightly less cost-effective in next door neighbours ( ICER $ 497 ) and least cost-effective among household contacts ( ICER $ 856 ) . Conclusion Chemoprophylaxis with single dose rifampicin given to contacts of newly diagnosed leprosy patients is a cost-effective intervention strategy . Implementation studies are necessary to establish whether this intervention is acceptable and feasible in other leprosy endemic areas of the world Chemoprophylaxis was carried out on high risk group of extended contacts of new leprosy cases in Nyaungdon Township , Ayeyarwaddy Division , Myanmar and serological response was followed up for two years . In September 2003 , blood sample s were collected from 829 contacts after getting informed consent and sera were tested for immunoglobulin M antibodies using NTP-BSA ELISA test . These 300 seropositives were r and omized to treated and non-treated groups . In each group 102 each were enrolled in adults and 48 each in children . A single dose of ROM ( rifampicin , ofloxacin and minocycline ) and RMP ( rifampicin ) by body weight was administered to treated group of above 15 years and those below 15 years respectively . The vitamins were administered to non-treated group . The blood sample s of all contacts were collected again in September 2004 and September 2005 and ELISA was carried out on paired sample s on one plate . The mean optical density ( OD ) titers before vs after chemoprophylaxis were 0.24 vs 0.10 and 0.20 vs 0.09 in treated and non-treated group respectively in adults and 0.25 vs 0.11 and 0.22 vs 0.11 respectively in children after one year . These were 0.24 vs 0.17 and 0.20 vs 0.19 respectively in adults and 0.25 vs 0.19 and 0.22 vs 0.20 respectively in children after two years . The difference of mean antibody titers before and after chemoprophylaxis in treated group was significantly reduced compared to non-treated group in adults but was not significant in children . The findings show that there is a significant role of chemoprophylaxis on serological response in the form of decreasing antibody titer among the adult group of extended contacts ABSTRACT A total of 100 untreated new leprosy patients were recruited prospect ively and examined for the presence of phenolic glycolipid I ( PGL-I ) antigen in their serum specimens by dot enzyme-linked immunosorbent assay ( ELISA ) using rabbit anti-PGL-I antiserum . The presence of circulating PGL-I antigen was closely related to the bacterial indices ( BI ) of the patients . The PGL-I antigen was detectable in 27 ( 93.1 % ) of 29 patients with a BI of 4.0 or above and in 15 ( 68.2 % ) of 22 patients with a BI of 3.0 to 3.9 . However , none of the 37 patients with a BI of less than 1.9 had detectable PGL-I antigen by the methods used in this study . The level of PGL-I in serum declined rapidly by about 90 % 1 month after the start of multidrug therapy . This study showed clearly that anti-PGL-I IgM antibodies and circulating PGL-I antigen levels reflect the bacterial loads in untreated leprosy patients . The serological parameters based on the PGL-I antigen may therefore be useful in the assessment of leprosy patients at the time of diagnosis and possibly in monitoring patients following chemotherapy BACKGROUND : After the introduction of the multidrug therapy , there was a decline in the coefficients of prevalence and detection of new cases of leprosy . However , the records of drug resistance and relapses are threatening factors in leprosy control . Hence , new alternative schemes and monitoring of adverse effects to avoid treatment ab and onment are important considerations . OBJECTIVE : Describe the side effects of a multidrug regimen containing minocycline , ofloxacin , and clofazimine in multibacillary leprosy patients . METHODS : We conducted a prospect i ve , descriptive , and observational study with multibacillary patients , including cases of intolerance to st and ard MDT and relapses . The study was carried out at Fundação Alfredo da Matta ( Alfredo da Matta Foundation ) , in Manaus , Amazonas , from April 2010 to January 2012 . The patients received alternative therapy , which consisted of daily self-administered doses of 100 mg of minocycline , 400 mg of ofloxacin , and 50 mg of clofazimine and a supervised monthly dose of 300 mg of clofazimine for six months , followed by eighteen months of daily doses of ofloxacin 400 mg , clofazimine 50 mg , and a supervised monthly dose of clofazimine 300 mg . Results : Twenty-one cases were included . Mild and transitory side effects occurred in 33.3 % of patients . Of the total episodes , 45.9 % were attributed to ofloxacin and they included abdominal pain , nausea , vomiting , headache , and insomnia ; 21.6 % were due to clofazimine , with 100 % of patients presenting skin pigmentation . The mean time for the development of adverse effects after beginning the therapy was 15.2 days . CONCLUSION : All patients tolerated the drugs well , and compliance was satisfactory , with no serious events . Unlike other st and ard MDT studies had shown , no treatment was stopped due to side effects . Nevertheless , patient follow-up and studies with bigger sample s are necessary to guarantee the efficacy and safety of the alternative regimen as a second-line scheme in multi-drug therapy OBJECTIVES The COLEP trial in Bangladesh showed a 57 % reduction in leprosy incidence among contacts of newly diagnosed patients in the first 2 years after chemoprophylaxis with single dose rifampicin ( SDR ) . We assessed the impact of this intervention after 6 years and identified characteristics of the leprosy index patients predicting the effectiveness of this intervention . DESIGN The cohort of 1037 patients and their 28 092 contacts that participated in the r and omised placebo controlled field trial with single dose rifampicin was followed for 6 years . The leprosy status of contacts was established at 2 , 4 and 6 years after the intervention . We assessed the association between characteristics of the index leprosy patients  and the development of clinical leprosy among their contacts using logistic regression . RESULTS The protective effect of SDR  was seen only in the first 2 years , with no additional effect after 4 and 6 years . However , the total impact of the intervention was still statistically significant ( P = 0.025 ) after 6 years and no excess cases were observed in the SDR arm at a later stage . The intervention prevented leprosy in contacts that actually received SDR , but did not offer protection to members of the same contact group who did not take chemoprophylaxis . The intervention was most effective in contact groups of female index patients , an enhanced effect was also observed in contact groups of patients belonging to a cluster of two or more leprosy patients at intake as well . CONCLUSION These easy to recognise patient characteristics indicate a possible enhanced risk of transmission of Mycobacterium leprae to contacts in the vicinity of patients and are useful for deciding about preventive measures , such as early detection or chemoprophylaxis Review question / objective What is the effectiveness of rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy ? What are the experiences and acceptability with the use of rifampin chemoprophylaxis in the prevention of disease from contacts with patients who have leprosy , in patients with leprosy following treatment and in family and health care professionals ? Background Leprosy is globally acknowledged as a millenary and stigmatizing disease and a condition with attributed consequences such as physical deformities and disabilities . From a multi‐causal perspective , there is evidence that leprosy occurs more often in men than in women , is distributed across all age groups and occurs mainly among people living in unfavorable socioeconomic circumstances , who are also the most affected by public segregation policies . 1–4 In 2013 , a total of 215,656 new cases of leprosy were detected worldwide . Regions with the highest number of cases are Southeast Asia ( 72.1 % ) the Americas ( 15.3 % ) . Whereas the countries with the highest prevalence were India ( 58.8 % ) and Brazil ( 14.4 % ) . 5 Hansen 's bacillus ( Mycobacterium leprae ) is considered a microorganism of high infectivity and low pathogenicity and virulence . It is transmitted via nasal oropharyngeal secretions and breaks in the skin of infected patients . Therefore , the main form of transmissibility is inter‐human and the greatest risk of contagion is cohabitation with these patients .1–3 It is estimated that most individuals have a natural resistance to Mycobacterium leprae ( M. leprae ) and that some are prone to developing a severe form of the disease , the multibacillary forms . Studies on exogenous reinfection and endogenous reactivation in chronic diseases , such as tuberculosis and leprosy , show that susceptible individuals become infected by the bacillus through contact with multibacillary patients .1–3,6,7 The surveillance of leprosy contacts is a priority action for control of the disease . Children are exposed to the highest risk of becoming infected by being in contact with a family member or anyone close to them who has the disease . Having a current case of le 
    Output:
    
The qualitative findings showed social acceptability of rifampicin .
Conclusions Chemoprophylaxis with one dose of rifampicin is found to be effective in preventing contacts of leprosy patients from contracting the disease .
Also , there is indication that this strategy is socially accepted