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Comment & Response
October 16, 2019

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

Author Affiliations
  • 1Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
JAMA Dermatol. 2019;155(12):1429. doi:10.1001/jamadermatol.2019.2609

In Reply We thank Dr Bishnoi and colleagues for their interest in our study1 and for sharing us with the current epidemic status of leprosy and the focus of the disease control activities in India.

India has the highest prevalence of leprosy, with 126 164 new patients diagnosed in 2017 (0.67 cases per 100 000 population), accounting for nearly 60% of the total number of newly diagnosed patients in the world (data from National Leprosy Eradication Programme). We also agree that leprosy control activities should unmistakably focus on sustaining the elimination status. However, based on the dapsone hypersensitivity syndrome (DHS) incidence rate of 0.8% to 1.6% among patients with leprosy in India that was cited by Dr Vinay and colleagues, the annual incidence of patients with DHS may range from 1000 to 2000. A worldwide DHS mortality rate of 9.9% has been reported.2 Therefore, a screening policy prior to initiation of dapsone should be gradually implemented to prevent the occurrence of DHS and associated mortality in patients with leprosy in the future.

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