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Comment & Response
October 16, 2019

HLA Screening for Dapsone Hypersensitivity in India—A Long Way Ahead

Author Affiliations
  • 1Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
JAMA Dermatol. 2019;155(12):1428-1429. doi:10.1001/jamadermatol.2019.3169

To the Editor We congratulate Liu et al1 for their work involving proactive HLA screening to prevent dapsone hypersensitivity syndrome (DHS) in patients with leprosy. Herein, we describe the practical difficulties in translating this screening into clinical practice in India.

Although people in both India and China have been affected by leprosy for centuries, the dynamics in these countries have changed considerably. China attained national-level leprosy elimination in 1982, whereas India attained this status in 2005.2 India still contributes maximally to the global leprosy burden, whereas China has been incredibly successful in reducing its annual new case detection rate to just 0.1 per 100 000 population in 2009 (the rate in India is about 100 times more) and even defines elimination as less than 1 case per 100 000 population (the definition in India is less than 1 case per 10 000 population).3 The focus in China is now on even earlier diagnosis of leprosy and preventing adverse effects caused by treatment, whereas India struggles to maintain its elimination status.1,3

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