LAUSR

Cavaliero and colleagues [1,2] describe a high yield of retrospective active case finding for leprosy in Cambodia, which has a fairly low level of endemicity. We conducted a comparable survey in high prevalence villages on the island of Anjouan, Comoros, which is highly endemic for leprosy with an annual incidence rate of 550 per 1,000,000 population reported for 2019 [3]. Over the last 15 years, leprosy incidence on Anjouan has been consistently high, approximately 912 per 1,000,000 per year on average. For years, the National Leprosy Programme (NLP) has been conducting so-called “mini campaigns” or “skin camps,” based on the “camp approach” in which inhabitants of villages are invited for screening for all kinds of skin conditions in a central location [4]. Yet, when door-to-door screening was conducted in some of these villages served earlier with mini campaigns, very high numbers of new leprosy cases were detected [5]. On Anjouan, in addition to mini campaigns, household contacts of leprosy patients diagnosed are either visited in their homes by nurses trained in leprosy or invited to present to Primary Health Care (PHC) facilities for leprosy screening. In the ongoing PEP4LEP trial, conducted elsewhere, the effectiveness of the skin camp approach is being compared to self-presentation of contacts at health centers [6].