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Cause
 Leprosy is a chronic disease caused by a
bacillus, Mycobacterium leprae (M. laprae).
M. leprae multiplies
very slowly and the incubation period of the disease is considered to be
about five years.
TRANSMISSION
Leprosy is transmitted by air through droplets
from the nose and mouth, during close and frequent contacts with untreated
cases.
Leprosy is one of the least infectious
diseases, because:
 Over 99% of the population has adequate
natural immunity;
Over 85% of the clinical cases are
non-infectious, and
An infectious case is rendered non-infectious
within one week, most often after the very first dose of treatment.
SYMPTOMS
Leprosy mainly affects the skin and peripheral
nerves.
If left untreated, it can lead to progressive
and permanent damage of nerves, leading to loss of sensation and sweating in
the extremities and paralysis of muscles in the hands, feet and face.
The disease is classified as paucibacillary (PB) or multibacillary
(MB), depending on the bacillary load.
PB leprosy is a milder disease characterized
by few (up to five) skin lesions (pale or reddish), whereas MB is associated
with multiple (more than five) skin lesions, nodules, plaques, thickened
dermis or skin infiltration.
HISTORY OF THE DISEASE
The first known written mention of leprosy is
dated 600 BC.
Leprosy was recognized in the ancient
civilizations of China, Egypt and India.
All countries of the South-East Asia Region
were known to be endemic for leprosy.
Throughout history, the afflicted have often been
ostracized by their communities and families. This situation has changed
since leprosy is now completely curable and there is greater awareness about
the disease.
HISTORY OF TREATMENT
The first breakthrough occurred in the 1940s
with the development of the drug dapsone, which
cured the disease. But the duration of the treatment of leprosy was many
years, even a lifetime, making it difficult for patients to be regular in
their treatment.
In the 1960s, M. leprae
started to develop resistance to dapsone, the
world’s only known anti-leprosy drug at that time.
TREATMENT TODAY
In 1981, a World Health Organization (WHO)
Study Group recommended multi-drug therapy (MDT), a combination of three
drugs.
MDT effectively kills the pathogen and cures
the patient.
Treatment provided in the early stages averts
disability.
With minimal training, leprosy can be easily
diagnosed by clinical signs alone.
WHAT IS MDT
MDT comprises of three drugs, dapsone, rifampicin and clofazimine. Rifampicin and clofazimine were discovered in the early 1960s.
MDT is safe, effective and easily administered
under field conditions.
MDT is available in convenient monthly
calendar blister packs.
Since 1995, WHO has been providing free MDT
for all patients in the world, initially through the drug fund provided by
the Nippon Foundation and since 2000, through the MDT donation provided by Novartis and the Novartis
Foundation for Sustainable Development.
Novartis has pledged
free supply of MDT till 2010.
HIGH EFFECTIVENESS OF MULTIDRUG THERAPY
Transmission of leprosy is interrupted after
the very first dose of MDT. In other words, patients are no longer infectious
to others after being administered the first dose of the treatment regimen.
PB patients treated with MDT are cured within
six months.
MB patients treated with MDT are cured within
12 months.
There are virtually no relapses, i.e. no
recurrences of the disease after treatment is completed.
No resistance of the bacillus to MDT has been
detected.
WHO estimates that early detection and treatment
with MDT has prevented about four million people from becoming disabled.
MDT is very cost-effective as a health
intervention, considering the economic and social losses averted.
THE ELIMINATION OF LEPROSY AS A PUBLIC
HEALTH PROBLEM
In 1991 World Health Assembly passed a
resolution to eliminate leprosy as a public health problem by the year 2000.
Elimination of leprosy as a public health problem is defined as a prevalence
rate of less than one case per 10,000 population.
Globally, the leprosy elimination goal was
achieved in 2000.
The global disease burden reduced from 5.2
million in 1985 to 805,000 in 1995 to 753,000 at the end of 1999 to about
219,826 cases at the end of 2005.
The South-East Asia Region, including India,
achieved the elimination goal in December 2005.
The Regional prevalence rate steadily declined
from 4.6/10,000 population in 1996 to 0.82/10,000 population as of July 2006.
The Regional new case detection also declined
from a peak of 47.8/100,000 in 1998 to 11.9/100,000 as of March 2006.
Between 1985 and 2005, more than 15 million
leprosy cases were cured globally. Of these, about 12.8 million were from the
SEA Region, of which India
accounted for about 11.8 million.
The SEA Region has made substantial
contribution to the achievement of leprosy elimination globally.
CURRENT LEPROSY SITUATION
At the beginning of 2006, about 219,826 cases
were under MDT globally and the prevalence rate was about 0.2 per 10,000 population.
Globally, 296,499 new cases of leprosy were
detected during 2005.
The top 10 countries in new case detection in
2005 are India, Brazil, Indonesia, DR Congo, Bangladesh, Nepal, Mozambique,
Nigeria, Ethiopia and Tanzania. Together, they constitute about 96% of the
2005 global new case detection.
The SEA Region contributed to about 69% of the
2005 global new case detection.
Six countries (small countries with <1
million population excluded), Brazil,
DR Congo, Madagascar, Mozambique, Nepal
and Tanzania
are yet to achieve the elimination goal.
In the SEA Region, two countries, Nepal and
Timor-Leste (population of Timor-Leste is less than 1 million) are yet to achieve
elimination.
As of December 2005, the PR in Nepal was
1.81/10,000 and Timor-Leste 1.89/10,000 population.
These countries are expected to achieve elimination in 2006 or 2007.
REMAINING CHALLENGES
Achieving elimination in the remaining
countries and sustaining elimination in the countries that have achieved the
goal at the national level.
Sustaining political commitment and ensuring
adequate resources in order to sustain elimination at national level, and
progress towards further reducing the burden of leprosy.
Strengthening integration of leprosy services
into the general health system through capacity building and skill
development, in order to ensure and sustain quality leprosy services,
including diagnosis and treatment and prevention/care of disabilities.
Ensuring a wider coverage of leprosy services,
especially in currently under-served population groups such as remote rural
areas, urban slums, migrant labour.
Increasing and sustaining community awareness
through sustained advocacy and IEC activities to promote voluntary case
detection and decrease the stigma.
Minimizing/preventing operational factors,
such as:
Setting case detection targets and basing performance
appraisal on target achievement
Over-diagnosis and re-registration of cases
due to:
 Non-adherence to WHO-recommended case
definitions
Active search and surveys repeatedly targeting
the same population groups
Repeated leprosy elimination campaigns in the
same areas
Lack of “Quality” and “Accuracy” of diagnosis
Multiple registration
Wrong classification - PB cases recorded as MB
(more frequent than vice-versa)
Delayed treatment completion due to:
Irregularity
Drug shortage at peripheral level
Delayed release from treatment
Over-treatment
Non-existent cases
Job insecurity among vertical staff leading to
large number of suspect/doubtful cases being recorded as leprosy cases
Preventing discrimination and displacement of
leprosy affected and ensuring community based rehabilitation and integration
of cured/disabled leprosy persons into the community.
Streamlining the MDT supply and stock
management at all levels, considering the low endemic situation.
Strengthening existing partnerships and
identifying new partners to support leprosy activities.
THE STRATEGY FOR LEPROSY ELIMINATION
Sustain leprosy services and activities in all
endemic countries.
Use annual new case detection and cure rates
as the main indicator to monitor progress.
Ensure high-quality diagnosis, case
management, recording and reporting in all endemic countries.
Strengthen routine and referral services.
Discontinue the campaign approach, since they
are not cost-effective any more and lead to over-detection.
Develop tools and procedures that are
home/community-based, integrated and locally appropriate for the prevention
of disabilities/impairments and for the provision of rehabilitation services.
Promote operational research in order to
improve implementation of a sustainable strategy.
Encourage supportive working arrangements with
partners at all levels.
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