In the accompanying paper, Moet and colleagues report a randomised controlled trial of chemoprophylaxis using rifampicin in household contacts of patients with newly diagnosed leprosy.1 The potential for chemoprophylaxis to reduce transmission of leprosy caused much interest in the 1960s and 1970s. A series of trials was conducted in household contacts and in highly endemic communities using dapsone, usually given twice weekly over a period of years. A meta-analysis based on 12 of these trials (six randomised controlled trials and six non-randomised controlled trials) showed that dapsone provided significant protection (relative risk 0.4, 95% confidence interval 0.29 to 0.55) against leprosy.2 Although the efficacy rate in community trials was higher than in trials in household contacts the numbers needed to treat to prevent one new case were also higher.

Interest in chemoprophylaxis waned in the 1980s and 1990s with the introduction of short course multidrug treatment in 1982 and the launch of the leprosy elimination strategy in 1991.3 This strategy proved highly successful in reducing the prevalence of cases …