24 - 04 - 2019

Unfinished business on the leprosy front

ONE of the oldest diseases known to mankind, leprosy continues to be a major public health concern in India despite significant developments in management strategies.

India accounts for more than half of the leprosy burden worldwide. The other high-burden countries include Brazil and Indonesia. Of the new cases, approximately 8.9 per cent are children and 6.7 per cent have visible deformities. Scaled-up interventions are needed with the focus on preventing transmission of leprosy.

Leprosy is a chronic infectious disease affecting peripheral nerves and the skin. It usually manifests as light or red-coloured patches on the skin, loss of sensation or abnormal sensation, and muscle weakness. It is a curable disease; treatment is provided by the government free of cost. If untreated, the disease may lead to deformities such as claw hand, foot drop and ulceration on the hands and feet. Over time, it may affect the eyes, joints and bones.

In India, there is still fear and stigma associated with leprosy. Patients often face discrimination. The deformities and complications associated with leprosy are witnessed less frequently nowadays owing to the availability of multi-drug therapy used to cure the disease and strategies to prevent and repair deformities.

Public awareness regarding leprosy is of the utmost importance for early detection, control of transmission and cure. People need to be educated by health professionals, social workers and the media to remove the stigma associated with the disease. Several prevalent myths have been major roadblocks in the battle against leprosy. According to one, the ailment is a ‘punishment’ for past sins. Such myths often make patients seek treatment belatedly, leading to irreversible nerve damage and disabilities. Early detection of leprosy is vital as it offers the dual advantage of ensuring initiation of treatment at an early stage and reducing the chances of transmission to close contacts. Health professionals treating patients must screen close contacts and family members of the patient, especially children, for early signs of leprosy.

Various amendments have been passed in Parliament, seeking to end discriminatory laws against leprosy, such as holding it as a ground for divorce and considering it an incurable and virulent disease. Every year, Mahatma Gandhi’s martyrdom day (January 30) is commemorated as World Leprosy Day to generate awareness among people regarding the disease, reduce stigma associated with it and remember the Father of the Nation’s selfless work for the welfare of leprosy patients. The National Leprosy Control Programme (NLCP) was launched by the Union Government in 1955 to treat and control the transmission of the disease. In 1983, the NLEP (National Leprosy Eradication Programme) was launched as a centrally sponsored health scheme under the Union Ministry of Health and Family Welfare. Multi-drug therapy (MDT) a three-drug combination of rifampicin, dapsone and clofazimine that is administered for six to 12 months has been implemented by the NLEP since 1982 to cure the infection. Significant success in controlling and treating leprosy has been achieved owing to the efforts of the NLEP and the introduction of MDT. The goal of elimination (less than one case/10,000 people) of leprosy at the national level was achieved in December 2005, down from a prevalence rate of 57.8/10,000 in 1983. Attempts are being made to achieve eradication of leprosy. Since the introduction of MDT, 16 million cases of leprosy have been treated and 4 million deformities have been prevented till now.

India still accounts for around 60 per cent of the newly detected cases and is categorised among the 22 ‘global priority’ countries. The new-case detection rate has not declined significantly over the past few years. According to the NLEP progress report, 1.35 lakh new cases were detected during 2016-17. This shows an Annual New Case Detection Rate (ANCDR) of 10.17 per lakh population. After achieving disease elimination in 2005, funds have been diverted from the leprosy control programme to programmes for controlling other diseases. However, four states (Bihar, Chhattisgarh, Jharkhand and Odisha) and two union territories (Dadra and Nagar Haveli, and Lakshadweep) are yet to achieve this epidemiological goal of elimination. Due to a significant migrant population in Chandigarh, the leprosy burden in the union territory is high. The Department of Dermatology at the PGI has been running a weekly leprosy clinic since the past more than 30 years.

To improve the detection of new cases and expedite treatment, the NLEP recently launched an active case-finding strategy known as the Leprosy Case Detection Campaign (LCDC), which led to the detection of 34,000 new cases in 2016, especially from highly endemic areas accounting for around 25 per cent of the total fresh cases. Research on vaccines against leprosy is still going on. Various vaccines have been tried, but none have been uniformly effective and are used more for boosting the immune system to help in the faster clearance of the disease in leprosy patients and indirectly in prevention of transmission. Single-dose rifampicin, given to the close contacts of patients, has been found effective in preventing transmission. This strategy can be adopted for use on a mass scale in leprosy-endemic areas. 

It is hoped that the disease will be eradicated in the near future with the initiatives of the health authorities, strong political will and community participation. Efforts need to be made to reduce deformity through early detection, self-care, physiotherapy and reconstructive surgery and developing sound surveillance systems.

 

Dr Sanjeev Handa
Head, Dept of Dermatology, Venereology & Leprology, PGIMER, Chandigarh