1. HANSEN’S DISEASE :
IMMUNOPROPHYLAXIS &
IMMUNOTHERAPY

2. Introduction
• Vaccine : Lat ‘ La Vaccha’ – ‘Cow’
• Chronic infectious disorder with long, variable
incubation period and high generation time
• Immunomodulators regulate immune system
 prevent Neuritis / Reactions to live / dead
bacilli with Chemotherapy targeted at live
bacilli

3. Immunoprophylaxis
• Enhance Host Immunity to control infection by
provoking protective repsonse to AGs
Types of Vaccines :
• Killed (No inf / high Antigenicity)
• Live, Attenuated (Low Virulence / High AG –
natural history)
• Cross-reacting AGs ; Non-pathogenic
• Immunogenic Subunits

4. Vaccines in use
• BCG
• HKML / HKML-A
• Mw
• M vaccae
• ICRC

5. BCG
• 20th C ; used for immunization
in cattle / humans against Mtb
• Live, Attenuated
• M bovis derivative
• Modest response alone
• may prevent BT / BB
• Used with HKML / HKML-A to increase AG and initiate
protective response

6. Mw
• M welchii - HK
• Mycobacterium indica praNII
• cultivable Non-pathogenic Mycobacterium
used for Cross-sensitization
• Shares AG with ML / Mtb (65/18/13 kDa)

7. M vaccae
• Derived from cowdung
• HK
• Cultivable non-pathogenic
bacteria with shared AG
• Commercially available

8. ICRC bacillus
• Indigenous, HK
• Cultivable MAIC or from Leprosy patients
• HMW Glycolipoprotein PP-I Sonicated Subunit
vaccine in Ph I / II Clincial trials In India

9. • aa

10. Immunotherapy
• Addition of Immunomodulators and Cross-
reacting antigens to regulate host immunity
and achieve :-
– Higher Bacillary Clearance (Viable / Dead)
– Reduce Incidence and severity of Reactions /
Neuritis
– Restore effective immunity  prevent relapses
and re-infection
– Reduce duration of treatment
– Lepromin conversion

11. Classification
• Antigenically-related Mycobacteria with
shared Ags (BCG/HKML/Mw/ICRC/M vaccae,
habana, gordonnae, phlei)
• Drugs
(Levamisole/Corticosteroids/Zinc/Clofazimine/
Colchicine/Thalidomide/CsA)
• Other Immunomodulators (Transfer

12. BCG
• Maiden Immunomodulator
• 0.1 ml ID at 0-6-12-18-24 months with MB-MDT
in LL patients
• Lepromin Conversion / Smear negativity / fall in BI /
faster granuloma clearance
• No change in Reactional severity / incidence
• BCG + HKML = Beneficial in Indeterminate Hansen’s /
LL / Household contacts with Histological
Upgradation

13. Mw
• HK preparation with MB-MDT @ 0.1 mL ID (5 x
109 bacilli) as 1st dose  0.05 mL ID every 03
months (Total = 08 doses) in BL/LL patients
• Reduction in BI / MI, Granuloma resolution,
Smear Negativity @ 52 months, reduction in
ENL incidence

14. • ICRC + MB-MDT  Lepromin Conversion with
RRs reported
• Other Cross-Sensitizing cultivable
Mycobacterium species viz gordonnae /
habana / phlei are being studied

15. LEVAMISOLE
• Broad-spectrum Anthelminthic
• Regulates defective T-cell function
• 150 mg 2 /wk PO x 06 wks  Pt on DDS 100
mg daily for 05 years showed Smear
Negativity in 01 yr

16. ZINC
• Immunomodulator for LL / ENL
• Inhibits complement-dependent Immune
complex formation / PMN chemotaxis
• Faster clinical improvement, reversal of
Madarosis, histological upgradation with DDS
as compared to DDS alone

17. Other Drugs
• Corticosteroids
• Thalidomide
• CsA
• Clofazimine
• Colchicine
• AZA

18. Other Immunomodulators
• LAWRENCE’S TRANSFER FACTOR transient
• CYTOKINES (IFN-G / IL-2) I/L ; local effect
• ACETO-ACETYLATED ML (AA)
• DE-LIPIDIFED CELL COMPONENTS ML (DCC)
• SOLUBLE PROTEIN CELL WALL COMPONENT (SPC)
• ISOLATED CELL WALL CORE AG (CWC)

19. THANK YOU