WHO introduced an efficient treatment protocol in the early 1980s. There is no reason why a person should suffer the deformities and stigma of leprosy today
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 World Health Organisation in 2014, 2,15,656 new leprosy cases were detected worldwide.
The WHO South-East Asia region, which includes India, alone contributed 1,55,385 cases, 72 per cent of the global leprosy case count. leprosy is not uniformly distributed across the world; 96 per cent 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 two disabilities were detected in 2013. One in every 10 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 families and isolated in 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 in the early 1980s as the main treatment protocol. 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-energise 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 two disabilities indicate delayed detection of the disease. We now need to work towards ‘zero child cases with visible deformity or grade two 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.
(The writer is Regional Director for the World Health Organisation's South East Asia programme)