Elimination of leprosy as a public health problem at the
global level in the year 2000 was a significant milestone in history.
Though the prevalence has come down to less than one case per 10 000
population globally, new cases are being reported from more than 100
countries. As per the leprosy statistics published by WHO in 2014, 215
656 new leprosy cases were detected worldwide. The WHO South-East Asia
Region alone contributed 155 385 cases, 72% of the global leprosy case
count. Leprosy is not uniformly distributed across the world; 96% of
leprosy is limited to 15 countries, which report more than 1 000 new
cases annually. Even in these high endemic countries, high leprosy
prevalence is recorded in certain endemic pockets, usually referred to
as ‘hotspots’. A small proportion of patients having visible deformities
in their hands, feet and eyes due to delayed detection, experience
stigma associated with disfigurement. Globally, 13 289 such new cases
with visible deformities or grade 2 disabilities were detected in 2013.
One in every ten new leprosy patients is a child. This fact needs
greater attention, as it causes childhood disabilities not unlike polio.
Globally, 19 796 new cases of leprosy were found in children. These
numbers are totally unacceptable and call for a review of the leprosy
programmes. We need to focus on the remaining leprosy “hotspots” with
renewed and invigorated efforts. An efficient treatment protocol for
leprosy was introduced by WHO in the early 1980s. There is no reason why
a person should suffer deformities and stigma from leprosy today.
One of the oldest diseases known to humanity, leprosy is still
attributed to causes like the curse of God and result of past sins and
so on. It continues to remain a target of myths and misconceptions.
Occasionally, instances of persons affected being separated from their
familiesand isolatedin a remote place or an island in some countries are
reported, albeit, in small numbers.
The stigma attached to the disease and low levels of awareness in the
community about it add to deterrence in early detection and treatment of
leprosy, which is the only time-tested way to completely reduce leprosy
cases to ‘zero’. An untreated patient is a source of infection. Leprosy
transmits to a healthy individual through air or skin-to-skin contact
with an infected person. It takes several years for a susceptible person
to acquire the disease. The earliest symptom of leprosy is a skin patch
and loss of sensation. In the absence of any discomfort at the outset,
an affected person tends not to report the patch.
WHO introduced the multidrug therapy (MDT) in the early 1980s as the main treatment protocoli.
MDT has multiple benefits; the infected person ceases to be infective
with a single dose; it is a complete treatment for leprosy; and it
reduces the risk of disabilities and consequent stigma. MDT eventually
reduces treatment costs on the health system. Over 16 million patients
from 125 countries across the globe have been treated with MDT which
helped rapidly reduce the prevalence of the disease to less than one
case per 10 000 population at national levels for leprosy to be declared
as eliminated in the year 2000. As of today, MDT regimen stands as a
robust protocol. In addition, WHO makes MDT available free of cost in
all countries.
Now that the number of leprosy cases has come down from 11 million in
1983 to under a quarter million, we need to renew our commitment for the
last mile in completely eliminating this disease from the world.
It is time for the leprosy programmes to re-energize to focus on the
remaining leprosy endemic areas or “hotspots”. Detection of leprosy in
children is an evidence of continued transmission of the disease in the
community, while grade 2 disabilities indicate delayed detection of the
disease. We now need to work towards ‘zero child cases with visible
deformity or grade 2 disability by 2020’ and detecting all ‘new leprosy
cases before disability’. Focused case-finding activities should be
rolled out in these areas for early detection of cases and complete
treatment with MDT; they still are the basic tenets of leprosy control
in the community. Enhanced global strategy to reduce disease burden due
to leprosy which is currently implemented in countries endemic to
leprosy emphasizes early detection and complete treatment. Breaking the
chain of transmission between the patients and healthy population
remains ‘the strategic choice’ for controlling leprosy.
Also, there is need for further research. Resistance to antimicrobials,
particularly rifampicin, is an imminent risk. Though the frequency is
low as per the available data, its impact on the success of MDT could be
substantial. Recognizing the need, WHO spearheaded an initiative of
developing a network of sentinel centres to monitor the occurrence of
drug resistance to leprosy in all leprosy-endemic countries. Till now,
the results from the sentinel centres are very encouraging. The
incidence is low and WHO believes in continuing such surveillance to
sustain the gains achieved by MDT in controlling leprosy.
Globally, more than 200 000 new cases have been detected every year for
the past five years in spite of leprosy control efforts. To overcome the
challenges in reducing the occurrence of new cases, the health
ministers from 17 endemic countries committed to the Bangkok Declaration
in 2013 which re-affirmed political commitment and urged countries to
enhance efforts to reach the unreached populations. The Bangkok
Declaration also includes leprosy-affected persons in the leprosy
control activities. The persons affected by leprosy are recognized as a
great resource; their involvement helps in early case detection and
reduction of stigma. International agencies and partners in leprosy
control pledged their continued support to the leprosy programme in the
summit.
To move towards endgame leprosy, WHO is developing a new global leprosy
strategy for 2016–2020 to detect all cases before disability and achieve
zero disability cases among children. The Nippon Foundation, Novartis
Foundation for Sustainable Development (NFSD), International Federation
of Anti-leprosy Associations (ILEP) and the networks of persons affected
by leprosy are joining forces with a commitment to support the leprosy
programme with funds and MDT supply until 2020. The nongovernment
organizations at national and sub-national level are supporting leprosy
programme activities to achieve ‘Zero child cases with disabilities due
to leprosy’.
Every person has a role to play in reducing the leprosy disease burden
and removing this age old scourge from the globe. We need to enhance
awareness about the early signs of the disease, make MDT available and
encourage acceptance of the affected at home, school or at the
workplace. These coordinated efforts would improve early case detection
and help us reach the goal of ‘zero child cases with visible deformity
or grade 2 disability by 2020’.
i WHO study group on Chemotherapy of leprosy control programmes, 1981.