Tuesday, January 29, 2019

Will leprosy be eliminated from the country this year?

Leprosy was eliminated from India in 2005, yet leprosy continues to be prevalent in the country as is evident from the NLEP Annual data for the year 2017-18 on the status of leprosy in India. Elimination means a prevalence rate of less than 1 case per 10,000 population at national level.

As on March 2018, at least seven states had more than 5000 cases. With 14,338 cases, Bihar had the highest no. of cases followed by UP with 12, 583 cases; Maharashtra (9836 cases), West Bengal (9175 cases), Chattisgarh (6499 cases), Odisha (6325 cases) came next (Source: National Leprosy Eradication Programme website).

Three states still have a prevalence rate exceeding the required less than 1 case per 10,000 population: Chattisgarh (2.25), Bihar (1.18) and Odisha (1.38).

Leprosy is now being detected from parts of the country not known to be prevalent for leprosy. Also, cases of multibacillary leprosy(>5 lesions with involvement of≥2 nerves) as well as cases with deformities are being detected indicating advanced stage of the disease. This means late diagnosis or failure of early leprosy detection. Early detection is crucial to its elimination.

The special Leprosy Case Detection 15-day Campaign for early detection of leprosy cases in high endemic districts conducted in 2016 had identified more than 32,000 confirmed cases.

Leprosy: At a glance

·         Leprosy, also known Hansen's disease is an infectious disease caused by mycobacteria of the Mycobacterium leprae complex that involve the skin and peripheral nerves. 
·         Early diagnosis and a full course of treatment are critical for preventing lifelong neuropathy and disability. 
·         Leprosy is probably spread by the respiratory route. In the US, it is also a zoonosis; contact with armadillos has been documented in some cases. 
·         Leprosy is classified using the following categories: tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), lepromatous (LL), and indeterminate (I). 
·         Early physical exam findings include hypopigmented/reddish skin patches, diminished/loss of sensation in involved areas, paresthesias, painless wounds or burns and tender, enlarged peripheral nerves. 
·         The diagnosis is established when at least one of these physical findings is present and a skin biopsy obtained from the leading edge of the skin lesion confirms the presence of acid-fast bacilli in a cutaneous nerve. 

Achieving and maintaining elimination status of Leprosy by 2018 was one of the targets under the National Health Policy 2017 (Source: Press Information Bureau, March 23, 2018).

A nationwide post-exposure prophylaxis was also launched last year with single-dose rifampicin for all contacts of leprosy cases detected as per the 2018 WHO guidelines on the diagnosis, treatment & prevention of leprosy.

The WHO guidelines recommend the “use of single-dose rifampicin (SDR) as preventive treatment for adult and child (2 years of age and above) contacts of leprosy patients, after excluding leprosy and tuberculosis (TB) disease and in the absence of other contraindications”.

Now the Govt. has planned elimination of leprosy under Sparsh leprosy Awareness Campaign (SLEC) by 2nd Oct, 2019 to commemorate the 150th Birth Anniversary of Mahatma Gandhi vide a letter from Dr Anil Kumar, Deputy Director General (Leprosy) DO No. X-11016/07/2015-Lep, dated 14th Sept. 2018 (Source: National Leprosy Eradication Programme website).

Will leprosy be eliminated from the country this year?

We hope for the best, but this target appears elusive for now.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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