by University of Melbourne Associate Professor Sarah Dunstanprincipal investigator in infectious diseases and global health cross-disciplinary leader at the Doherty Institute.
Although many people think of leprosy as a disease of the past, approximately 200,000 new cases of leprosy are reported each year worldwide. The ACCELERATE project, led by researchers at the University of Melbourne’s Doherty Institute, aims to combine genomics with public health efforts in Nepal to better understand how leprosy spreads and improve strategies towards zero transmission.
What is leprosy?
Leprosy has plagued humanity since ancient times. Perhaps surprisingly, however, this neglected tropical skin disease still affects communities around the world, with approximately 200,000 new cases reported each year worldwide. Caused by bacteria Mycobacterium leprae, Leprosy is an infection that primarily affects the skin and peripheral nerves and can cause long-term disability and visible disfigurement if left untreated. Beyond its physical effects, leprosy carries significant social stigma and mental health consequences, with affected people often facing discrimination, isolation and delays in treatment.
Leprosy is both treatable and, in most cases, preventable. It can be cured with standard multidrug therapy. Despite significant progress in reducing incidence worldwide in the second half of the 20th century, transmission continues. Gaps in early detection, incomplete understanding of transmission, and unequal access to health services mean the disease persists in some settings, particularly among poor and marginalized communities.
Who is at risk for leprosy?
Leprosy disproportionately affects people living in poverty and underserved communities. The risks are greater when health services, education, and living standards are limited. Close household contacts of people with leprosy face an increased risk, particularly as 30-60% of those diagnosed report having no known contacts, indicating that the route of transmission is not fully understood.
Other risk factors include areas of persistent transmission (“hotspots”), delays in diagnosis due to stigma and limited access to health services, and movement of people that can introduce tensions into new communities. Nepal exemplifies this trend. Although the country declared leprosy eradicated as a public health problem in 2010, the number of people diagnosed with the disease has since increased in some districts, uncovering hidden sources of infection and highlighting the need for targeted case detection.
Genomics and leprosy
Genomics is beginning to become clear Mycobacterium leprae, However, some scientific challenges remain. Unlike many bacteria, Mycobacterium leprae The inability to grow in laboratory culture limits large-scale genetic studies. Advances in DNA sequencing and metagenomic techniques have enabled researchers to recover whole genomes directly from clinical specimens, even when pathogen DNA is lacking.
Genomic analysis has revealed different strains circulating around the world and identified mutations associated with drug resistance. Other studies suggest that specific bacterial strains may influence clinical symptoms and infection patterns. Genomics can therefore help distinguish between locally endemic and transboundary infections, detect and monitor the emergence of drug resistance, and guide targeted case finding, contact management, and preventive measures.
ACCELERATE project in Nepal
ACCELERATE, a research project led by Sarah Dunstan, Associate Professor at the University of Melbourne and Principal Researcher at the Doherty Institute, Mycobacterium leprae To understand the epidemiology, transmission dynamics, and persistence of the disease in two regions of Nepal with the aim of improving disease management strategies.
The team is working with multiple partners in Nepal, including Virat Nepal Medical Trust, Nepal Center for Molecular Dynamics, Lalgad Hospital and Shining Hospital, to recruit leprosy patients for the study. Community health workers and hospital staff identify leprosy patients in communities in Mahottari and Bank districts, areas with high incidence of leprosy and high multidimensional poverty index. The samples will be transported to a partner laboratory in Kathmandu and then to Melbourne for sequencing and analysis.
Through genomic analysis, the ACCELERATE project hopes to unravel the complexities of leprosy epidemiology and persistence and improve diagnostic, therapeutic, and vaccine strategies.
Nepal’s ACCELERATE project commemorates World Polio Day
Local capacity building and community engagement
ACCELERATE also focuses on strengthening local scientific capacity by training molecular epidemiologists and bioinformaticians in Nepal. The project will work closely with communities, NGOs and government stakeholders to ensure research findings are translated into policy and practice. Recently, ACCELERATE team member Manoj Sah attended a stakeholder consultation workshop and contributed to the development of the Nepal National Leprosy Strategy (2026-2030).
In other words, ACCELERATE blends hands. Public health activities involving amputation Use edge genomics to discover hidden cases, understand how leprosy spreads, prevent drug resistance, and move closer to the goal of zero infections.
The ACCELERATE project is funded by a LEO Foundation grant to the University of Melbourne and the Virat Nepal Medical Trust in Kathmandu.