Trends in the epidemiology of leprosy – Viet Nam, 1983–2006

Overview

Leprosy has been a major public health problem in Viet Nam. Many patients have been ostracized by their communities be-cause the disease is disfiguring, was considered incurable and was wrongly thought to be highly infectious. Given the strong stigma attached to leprosy, many patients who had successfully completed treatment and been cured were nonetheless leading segregated lives. Some of them congregated in leprosy villages or colonies, where people who have been affected by leprosy and face similar social problems have remained for a long time. In 1982, in order to improve the situation of people with leprosy, the Ministry of Health established the national leprosy control programme; multidrug therapy (MDT) was introduced in some pilot districts 1 year later.

Since 1982, new cases have been detected mainly through voluntary reporting, mass surveys and examination of contacts. A diagnosis of leprosy is made if a person has 1 of the following conditions: (i) a definite loss of sensation in a pale or red-dish skin patch; (ii) an enlarged and thickened peripheral nerve with loss of sensation or weakness, or both, of the muscles supplied by that nerve; (iii) acid-fast bacilli present in a slit-skin smear. Classification of disease is made based on the number of skin lesions. Leprosy is classified as pauci-bacillary if the person has <5 skin lesions; and as mult-ibacillary (MB) if the person has >6 skin lesions. All patients with positive slit-skin smears are classified as MB regardless of the number of skin lesions. All newly diagnosed cases are treated and followed by a health worker. Supervision is carried out by dermatologists once every 3 months. Individual records are kept, and annual reports are analysed in order to collect information on the preva-ence of registered cases, the number of