1. Elimination of Leprosy
Dr. C.R.Revankar
MD, DPH
Public Health Physician & Leprologist

2. Contact :
, Garden view Society, Bhavani Nagar, Marol, Andheri-East, Mumbai(Bombay) , India &

3. Leprosy : How important for you
Leprosy(Hansen): Easy to diagnose, treat and cure.
3 million people are with leprosy related disabilities in the world million new cases were identified in 2001(WHO 2002)

4. Objectives
After this lecture one should be able to-
Describe epidemiology of leprosy disease including disability in terms of time trends, impact of leprosy elimination strategies etc

5. Leprosy (Hansen’s) Disease
Chronic infectious disease caused by Mycobacterium leprae, affects nerves, skin and mucosa
Causes nerve damage & disabilities
- leading to social stigma, ostracism
& denial of human rights

6. Leprosy Case
A patient with active signs of leprosy- need or is under MultiDrugTherapy (WHO 1988)
Patients with residual signs are Inactive and Cured & should not be included for prevalence rate

7. Leprosy Elimination
Leprosy Elimination:Reducing Prevalence Rate (PR) to less than one active leprosy case per 10,000 population as a Public Health problem (WHO1991)
Priority:Communicable part of the disease (Transmission)

8. Leprosy Eradication/Extinction
Eradication: Absence of disease agent in nature in a geographic area after deliberate control measures (WHO2002)
Extinction: Specific disease agent no longer exists in nature or laboratory(WHO 2002)

9. A World Without Leprosy
Concept encompasses - early diagnosis, treatment, physical, socio-economic, psychological and rehabilitation of leprosy patients
No problems related to Leprosy in the world (ILA 1998)

10. Global public health strategy-1
To achieve leprosy elimination
Adequate, regular MDT
Leprosy awareness
Leprosy Elimination campaign
Special Action Projects for
difficult areas (SAPEL)

11. Global public health strategy-2
Action plan, review meetings
Resource mobilization, technical
support, Capacity building, drug
supply, monitoring, evaluation &
documentation

12. Transmission Organism: Mycobacterium leprae
Source: Untreated infectious patients (Multibacillary type)
Exit: Nasal mucosa, ulcerated skin
Entry: Airborne like TB

13. Epidemiology-1 develop clinical disease Incubation period: 3-5 years,
1%-2% exposed population
develop clinical disease
Incubation period: 3-5 years,
can occur after several years
Male:Female ratio: Generally 2:1

14. Epidemiology-2 Geographic variation
Lepromatous (MB type) -18% (Tanzania) to 63% (West Malaysia)
Neuritic leprosy-18% in India
Lucio type - Mexico

15. Epidemiology-3 7.6% in Cameroon Higher rate of Foot drop in
Deformities - 80% in Taiwan
7.6% in Cameroon
Higher rate of Foot drop in
India and wrist drop in Japan
Prevalence rate—varies from
per population

16. Epidemiology-4
Prevalence rate/10000
Agewise >14
(slums)
slums non-slums schools

17. Global Leprosy Situation-2001
No.of cases registered: Prevalence rate: 1.4 /10000 New cases detected: Detection rate: 11.9/ South-East Asia region contributed 76.9% of the global case load

18. Leprosy: top 6 countries-2001
700000
600000
500000
400000
300000
200000
100000
India
Brazil
Nepal
Myanmar
Madgas'r
Moza'que
Prevalen
Detection

19. Leprosy: 6 top countries
6 top endemic countries: India, Brazil, Myanmar, Madgascar, Mozambique, Nepal contribute
85% of global case load:
(69% from India) • 91% of global case new cases (81% from India)

20. Magnitude of Disabilities (1995)
500000
B'desh
China
India
Indonesia
Thailand
Vietnam
Guinea
Nigeria

21. Diagnosis of Leprosy
More than 95% of cases can be diagnosed clinically even by paramedical workers
Skin smears for M.leprae would assist in suspected infectious cases
Biopsy/PCR may be needed rarely

22. Diagnosis- infectious leprosy
Detection of 5%-10% skin smear positive leprosy patients is more important as they infect others.
If no smear facility, detect 30%-40% of cases with multiple skin lesions.

23. Paucibacillary leprosy(PBL)
From “Leprosy” book by Yawalkar 2002

24. Multibacillary leprosy(MBL)
From “Leprosy” book by Yawalkar 2002

25. Classification for Treatment
Multibacillary(MB) leprosy: >5 skin lesions:39% •Paucibacillary(PB) leprosy: skin lesions:52%
Single skin lesion PB:9%
(WHO 2002)

26. Multi Drug Therapy
Kill all viable bacteria & make a patient non infectious
Cure an active leprosy patient quickly from a public health point
Residual signs of inactivity may persist including persister bacilli in the deeper tissues

27. Impact of MDT Program
Cases cured: 12 million (2002) Fall in case load: 12 million (1977) to 0.64 million (2002) Deformities prevented:1-2 million
Relapse rate: < 1 /1000 (WHO 2002)

28. Trend of Leprosy :1985-2001 -32 countries (WHO)

29. Child case /Total new cases -32 countries: 1985-1997 (WHO)

30. Disabled among new cases -32 countries:1985-1997 (WHO)

31. Cumulative disabled leprosy cases -32 countries-1985-1997

32. Urban Leprosy Issues-1 Leprosy Elimination in urban
areas is challenged by -
Rapid increase in population, migration, slum/shanty towns, density, poor living conditions and violence

33. Urban Leprosy Issues-2
Favorable to maintain reservoir of infection and transmission
Difficulty in finding hidden cases,
relapse and treatment completion,
private health care participation

34. Post-Leprosy Elimination issues-1
Continued transmission
Early detection of MB case,
relapse, rifampicin resistance
Sub clinical infection, carriers
Eradication model, integration
Uniform MDT for six months

35. Post-Leprosy Elimination issues-2
Early detection & treatment of
reactions in 30%-40% of cases
Prevention of nerve damage
Prevention & Care of disabled

36. Post-Leprosy Elimination issues-3
Patients dissatisfaction for residual
signs after MDT
Immunoprophylaxis
Chemoprophylaxis
Immunotherapy

37. Partners in Leprosy Elimination
WHO, Nippon Foundation,
Novartis, World Bank, Danida,
ILEP agencies
National Governments &NGOs endemic countries