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Leprosy – Past and Present
Global Scenario
Leprosy affected humanity as early as 300 B.C. The earliest possible
account of the disease dates back to 600 B.C and was well recognized
in ancient civilizations of China, Egypt and India.
Leprosy, since time immemorial has been feared by all. Considered to
be a curse or punishment from God, the afflicted have often been
ostracized by their communities and families. Many were sent to
Leprosariums, where they were provided with separate hospitals for
treatment. Left to fend for themselves, leprosy affected people
formed a group and started living in colonies, away from their
families, due to the stigma of the disease.
In 1991 the World Health Assembly passed a resolution to Eliminate
Leprosy as a Public Health Problem, defined as reaching a prevalence
of less than one per ten thousand population. Today, the diagnosis
and treatment of the disease is easy. With the invention of Multi
Drug Therapy (MDT), a combination of drugs called dapsone, rifampin,
and clofazimine, in 1982, the disease is completely curable. . It is
the most effective way of preventing disabilities in leprosy, as
well as preventing further transmission of the disease. MDT remains
the key element in the elimination of the disease as a Public Health
problem in many countries. This has been possible due to the
availability of MDT treatment free of charge to all patients
worldwide since 1995 by WHO with the aid of The Nippon Foundation
which provides a simple yet highly effective cure for all types of
leprosy. This free provision was extended in 2000, and again in
2005, and will run until at least the end of 2010.
Most previously highly endemic countries have now reached
elimination and those few that remain are very close to eliminating
the disease. However, pockets of high endemicity still remain in
some areas of Angola, Brazil, Central African Republic, Democratic
Republic of Congo, Madagascar, Mozambique, Nepal, and the United
Republic of Tanzania, including India. These countries remain highly
committed to eliminating the disease, and continue to intensify
their leprosy control activities.
Even though a lot has been achieved medically, socially, not much
has been done for the afflicted, since they are continued to be
discriminated upon. The age-old social stigma associated with the
advanced form of leprosy which causes physical deformities remains a
major obstacle to self-reporting and early treatment.
Figures on the Current Leprosy Situation *
- Approximately 410 000 new cases of leprosy were detected
during 2004 compared to a peak of 804 000 in 1998. At the
beginning of 2005, 290 000 cases were undergoing treatment.
- In 9 countries in Africa, Asia and Latin America leprosy is still
considered a public health problem; these countries account for
about 75% of the global disease burden.
- According to the latest available information, intensive efforts
are still needed to reach the leprosy elimination target in four
countries: Brazil, Madagascar, Mozambique, and Nepal.
- India reached elimination in the Year 2005.
Actions and Resources required *
- Political commitment needs to be sustained in countries where
leprosy remains a public health problem;
- In order to reach all patients, treatment of leprosy needs to be
fully integrated into general health services. This is a key to
successful elimination of the disease;
- Partners in leprosy elimination need to continue to ensure that
human and financial resources are made available for the elimination
of leprosy;
- The age-old stigma associated with the disease remains an obstacle
to self-reporting and early treatment. The image of leprosy has to
be changed at the global, national and local levels. A new
environment, in which patients will not hesitate to come forward for
diagnosis and treatment at any health facility, must be created.
The Strategy for Leprosy Elimination *
The following actions are part of the ongoing leprosy elimination
campaign:
- Ensuring accessible and uninterrupted MDT services available to
all patients through flexible and patient-friendly drug delivery
systems;
- Ensuring the sustainability of MDT services by integrating leprosy
services into the general health services and building the ability
of general health workers to treat leprosy;
- Encouraging self-reporting and early treatment by promoting
community awareness and changing the image of leprosy;
- Monitoring the performance of MDT services, the quality of
patients’ care and the progress being made towards elimination
through national disease surveillance systems.
* Source: WHO (www.who.org)
- Milestones in the History of Leprosy in India
In 1981, when the presence of the disease was considered to be at
its peak in India, the Prevalence Rate (PR) was 57 per ten thousand
population. The number of patients under treatment was about four
million then, it is about eighty three thousand now with a PR of
0.72 in March 2007.
India achieved the goal of Elimination of Leprosy as a Public Health
problem at the end of the year 2005. In the last decade itself 11
million people in India have been cured of the disease. Although,
India has achieved elimination at the national level, yet there are
some districts which remain endemic, where the struggle still
continues to fight for elimination.
Initiatives in the National Leprosy Eradication Program (NLEP) of
India **
Modified MDT Management
The Government has initiated procedures for modifying the MDT
management based on requisition as per the number of patients
detected in each PHC. This had been suggested by WHO. The new MDT
management scheme had been started experimentally in Orissa and
Kerala. Soon it is to be started in Andhra Pradesh and West Bengal.
Deformity Management and Medical Rehabilitation
The Central Leprosy Division of the Ministry of Health and Family
Welfare has recently launched a Deformity Management and Medical
Rehabilitation Program (DPMR) within the National Leprosy
Eradication Program (NLEP). This is meant to prevent, reverse or
manage the deformities caused by leprosy as this is the public face
of the disease and the root of social stigma. This program aims to
initiate and provide deformity management services in every part of
the country. It would include Prednisolone therapy for lepra
reactions, self care training, rehab aids, assisted care and
physiotherapy and Reconstructive surgery. Health Units both in the
Government and NGO sector are expected to work together in this.
Depending on the need, services would be available in primary
secondary and tertiary levels of health country throughout the
country.
Sustained Action Plan
Focused attention on the endemic districts and blocks has remained a
major strategy in NLEP and much of the recent success of the program
is attributed to this.
- In 2004, 174 districts and 836 blocks were identified as high
endemic (PR over 5) and Block Level Awareness Campaign (BLAC) was
organized.
- By 2005 the number of blocks with PR greater than 5 had dropped to
150, so the threshold of high endemicity was lowered to PR above 3.
Forty six districts and 552 blocks were identified and BLAC was
held.
- In 2006 only 30 blocks remained that had a PR of more than 5 and
140 blocks remained with PR over 3. Hence the threshold was lowered
further to a PR of over 2. In this way 29 districts and 433 blocks
had been identified where focused attention was given. The priority
blocks are spread out in 14 states and the priority districts in 7
states. A special series of IEC programs and intensified attention
on program management was executed in these blocks in September
2006. This month was designated Intensive Supervision Month.
The other activities to improve the quality of diagnosis, treatment
and record keeping at the peripheral level by means of continuous
training and monitoring continue.
Awareness Building
Information campaigns about leprosy in high risk areas are crucial
so that patients and their families, who were historically
ostracized from their communities, are encouraged to come forward
and receive treatment. The most effective way of preventing
disabilities in leprosy, as well as preventing further transmission
of the disease, lies in early diagnosis and treatment with MDT.
Statistics of Current Leprosy Situation
- The PR has fallen from 0.84 in March 2006 to 0.72 at the end of
March 2006
- Total number of cases under treatment has fallen from 95,151 to
82,800 in the same period.
- 29 out of 35 states and Union Territories have achieved
elimination with Bihar at a PR of 1.06 very near to it.
- No state has a PR more than 2.
- At the district level 488 districts out of 611 have achieved
elimination.
- 83% of states have PR below 1 (74% in 2005-06)
- 80% of districts have PR below 1 (73.6% in 2005-06)
- Epidemological indicators of June 2007 by NLEP :
- Prevalence Rate - 0.80 per ten thousand population
- Cases on record – 91,744
- MB proportion (As percentage of new cases) – 49.38%
- Female proportion (As percentage of new cases) – 33.63%
- Child Proportion (As percentage of new cases ) – 09.25%
- Visible deformity (As percentage of new cases) – 2.06%
- Number o states which have achieved elimination – 27 (out of 35)
Post Elimination Era: New Paradigms in Leprosy **
In the post elimination era the National Leprosy Eradication Program
envisages an expansion in the scope of the program. In keeping with
the WHO Global Strategy 2006-2010 and the Eleventh National Plan the
program now calls for a further reduction of the leprosy burden,
providing quality leprosy services, enhancing disability management
and reducing stigma and discrimination through increased advocacy.
In view of the need to sustain leprosy services for the future a
shift from the campaign approach towards sustainable integrated
quality services is being put in place. The program will strive to
continue providing basic diagnosis and treatment of leprosy of
better quality along with additional appropriate services for
deformity care, drug management, awareness and advocacy.
Annual Plan 2007-08 **
The main strategies in the National Annual Plan for the year 2007-08
are
- Further integration of leprosy services in the General Health
Care system. This would also include special initiatives like
special attention on the urban areas and strengthening of the
referral system.
- Continuing and strengthening of the Deformity Prevention and
Medical Rehabilitation Program for patients deformed by the disease
- Training of program personnel.
- Infrastructure maintenance
- Information Education and Communication
** Source WHO (www.whoindia.org)
- Leprosy FAQS –
What is Leprosy?
- Leprosy, or Hansen's disease, is a chronic infectious disease
caused by the bacterium Mycobacterium leprae.
- M. leprae multiplies very slowly and the incubation period of the
disease is about five years. Symptoms can take as long as 20 years
to appear.
- Leprosy affects the skin and the nerves
How is Leprosy Transmitted?
- Leprosy is thought to be transmitted through the air via droplets
from the nose and mouth during close and frequent contact with
untreated infectious case
Fears
Leprosy is contagious
- Leprosy is hereditary
Facts
- Leprosy if completely curable, at any stage, with Muti Drug
Therapy (MDT)
- Leprosy is Non contagious
- Leprosy is Non hereditary
- Medication is available free of cost in every district at all
leprosy units, many hospitals, PHCs and CHCs
- 11 mn people have been cured in India of the disease in the past
decade
- Touch with an infectious patient does not spread leprosy. Only
prolonged contact with an untreated infectious case can spread
leprosy
- More than 85% of leprosy cases are non-infectious
- Over 95% of population is immune to leprosy
- There is no need to isolate people with leprosy, for the fear of
transmission of disease, and the social stigma is unjustified
- Deformities in advance stage of Leprosy are not because of the
disease but due to negligence and repeated trauma or burn
- Leprosy affected beggars often do not spread the disease as they
are already cured or burnt out cases and deformity is not related to
infectivity of the patient.
- There is no vaccine for the disease but research is on to find it
- People can get information about free leprosy services and
treatment from Medical Officers of PHCS and District Leprosy Officer
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