3f - Public Health Challenges in Contact Tracing of Leprosy, Ireland, August 2024.

Background : We present a case of multibacillary leprosy with neurological involvement in a Haitian male living in a congregate setting in Cork, Ireland. This was the first case of leprosy notified in the South of Ireland in the last decade and presented complex public health challenges with contact tracing given the highly stigmatising nature of this neglected tropical disease, and absence of Irish guidelines for this disease.

Methods : Comprehensive contact tracing was undertaken in household and occupational settings, and among social networks of the index case. A rapid scoping review of international guidelines was undertaken. We defined a close contact as any person who had been in contact with the untreated index case for at least 20 hours/week, for at least three months in the preceding year. Chemoprophylaxis with single dose Rifampicin was offered to close contacts.

Results : Three individuals were identified as close contacts and administered chemoprophylaxis. Ten other individuals were considered possible close contacts; two of whom had left the country. Contact tracing decisions for all exposed individuals needed to be weighed against the decision to disclose potentially stigmatising information. Most international guidance in relation to contact tracing is from low/middle income countries, including settings where leprosy is endemic, and was often not directly applicable in the Irish context. An extensive public health risk assessment informed our decision not to classify the remaining seven individuals as true close contacts.

Conclusions This case presented significant challenges for contact tracing in a high-income setting and highlighted the relevance of EU countries to have their own guidance for the public health management of certain neglected tropical diseases, especially given recent trends of global migration.