Leprosy: improved reporting, active case-finding and enhanced data collection reveal hidden cases
19 September 2017 | Geneva | New Delhi −− The World Health Organization (WHO) has reported a modest increase in the number of new leprosy cases worldwide. A total of 2810 additional cases1 were notified in 2016 compared with 2015. 2
“The increase is due to the excellent work of national programmes and is directly linked with active case-finding (thereby reducing the number of hidden cases), improved reporting and enhanced data collection,” said Dr Erwin Cooreman, who heads the Global Leprosy Programme housed in WHO’s South-East Asia regional office in New Delhi, India. “Although the number of new cases increased worldwide, a slight decrease is noted in WHO’s African and Americas Regions.”
WHO recently introduced the concept of “one report for leprosy” by launching an online data collection tool to facilitate the collection of epidemiological and programmatic indicators from Member countries. The tool, modelled on the DHIS-2 platform, merges for the first time epidemiological data and information on stock levels of multidrug therapy (MDT).3
“We received reports that contained prevalence data, new multibacillary cases, disaggregated data on children, women and foreign born people. New Grade 2 Disability (G2D) cases among adults and children, cure rates, relapses and information on laws or legislation discriminating against persons affected by leprosy were also reported,” added Dr Cooreman.
Additionally, national programmes collected information on different aspects of leprosy, including the number of MDT retreatment cases, surveillance of antimicrobial resistance and methods of detection of leprosy cases.
A composite index using key parameters of the Global Leprosy Programme (such as prevalence, new case detection, proportions of female, child and G2D cases) was applied to the leprosy data of all countries. In all, 22 countries4 from five WHO regions have been identified as “global priority countries” for leprosy.
During 2016, a total of 2743 cases of leprosy relapse were reported by 54 countries. Brazil reported 1431 cases, India 536 and Indonesia 229; the remaining 547 cases were reported by 51 countries.
The current global leprosy situation calls for national programmes to focus on sustaining political commitment, working towards universal health coverage to reach population groups at risk, intensifying early case detection activities, and strengthening partnerships with nongovernmental organizations and networks of persons affected by leprosy.
In addition to continuing to administer MDT to patients, new preventive approaches need to be considered to break the chain of transmission and reach zero disease status.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes.
Leprosy is curable and treatment provided in the early stages averts disability. MDT is made available through WHO – donated by Novartis since 2000 (and earlier by The Nippon Foundation) free of charge to all patients worldwide since 1995 – and provides a simple yet highly effective cure for all types of leprosy.
In 2016, WHO launched a new global strategy which aims to reinvigorate efforts to control leprosy and avert disabilities, especially among children affected by the disease in endemic countries.
1Sri Lanka did not report cases to WHO in 2016.
2In 2015, a total of 211 973 new cases were reported. In 2016, a total of 214 783 were reported, representing an increase of 2810 cases.
3 The combination used in MDT depends on the classification of leprosy. Rifampicin, the most important antileprosy medicine, is included in the treatment of both types of leprosy. For the treatment of patients with multibacillary leprosy, WHO recommends a combination of rifampicin, clofazimine and dapsone; for patients with paucibacillary leprosy, MDT uses a combination of rifampicin and dapsone.
4 Angola, Bangladesh, Brazil, Comoros, Côte d’Ivoire, Democratic Republic of the Congo, Egypt, Ethiopia, Federated States of Micronesia, India, Indonesia, Kiribati, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, South Sudan, Sri Lanka, Sudan and the United Republic of Tanzania.