Friday, February 12, 2016

What is the actual situation of leprosy and its elimination

Leprosy Mailing List – February 7,  2016
Ref.:   (LML)  What is the actual situation of leprosy and its elimination
From:  Joel Almeida, Mumbai and London


Dear Pieter,

A recent claim asserts the following:

"With the introduction of multidrug therapy the number of new patients with leprosy decreased from more than five million patients in the mid-1980s to fewer than 200,000 in 2015." [http://www.huffingtonpost.co.uk/katharine-jones/leprosy-is-still-being-tr_b_9131736.html]

Five million appears to be contrary to the facts. There was no year in the 1980's where more than a few hundred thousand new patients were detected. 

With the introduction of multidrug therapy the number of newly detected patients increased from about 500,000/year in 1985 to about 800,000/year in 2001. This is attributable largely to intensified case finding.

From 2002 onwards, self-healing cases were largely excluded owing to the progressive suppression of case finding campaigns. This seems to explain, to an important extent, the drop in newly detected cases from about 800,000/year in 2001 to about 250,000/year in 2008.  250,000 is probably about the number of cases that would have been newly detected in 1985 if self-healing cases had been excluded then.

Since 2008, India has been reporting not only the number of newly detected cases but also the percentage of newly detected cases who show visible deformity. This percentage has been steadily increasing, indicating a progressive delay in diagnosis. When the number of newly detected cases in India is standardised by the percentage showing visible deformity, the underlying incidence rate of leprosy in India appears to have been increasing since at least 2008.

In short, the claim quoted above seems to contradict the true position, at least in India.  India is where nearly 60% of the world's new cases occur.

We may have discharged several million patients from registers, and largely eliminated leprosy services. However, those administrative actions are quite distinct from a reduced incidence rate of leprosy. Meanwhile, the prevalence and weight of disabling sequelae has been steadily increasing. This steadily increasing burden of leprosy is owing to the nerve damage (and consequent deformities) which occur in as many as 50% of multibacillary patients after the start of MDT.

Permanent nerve damage can largely be prevented.  But we need to appoint skilled, mobile leprosy workers for monthly monitoring of nerve function during the first 2 years after the start of MDT.  Then anti-inflammatory treatment can be started in time to protect nerves. That will help us shield children as well as adults from permanent nerve damage and visible deformity.

The facts in leprosy are powerfully persuasive.  The more accurately we represent them, the easier it becomes to mobilise political commitment, resources, skilled personnel, control programmes, patient care and research.  All those are needed to protect people better against M. leprae and its devastating consequences.  The leprosy fraternity has many heroically good and compassionate people. This is shown by how readily we place the well-being of the population at risk of leprosy above all other considerations.

Regards,

Joel Almeida

LML - S Deepak, B Naafs, S Noto and P Schreuder

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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