Leprosy Mailing List – March 15, 2018
Ref.: (LML) The true magnitude of leprosy
From: Joel Almeida, Mumbai and London
Recent reports of sample surveys are informative.
A national sample survey in India reported that there were 330,000 previously undetected cases of leprosy in the country. Three tiers of experts were used for diagnosis. These cases were in addition to about 125,000 new cases detected by the national programme each year. The magnitude of leprosy in India is several times greater than previously reported.
Therefore, many more people in India are at risk of permanent nerve damage, before during and after MDT, than previously reported. Unfortunately, there has been a huge reduction in trained leprosy workers who can monitor nerves during MDT. This exposes the people of India to unnecessary permanent disfigurement from leprosy.
It would be good to remedy this situation.
The first step is to acknowledge that the magnitude of leprosy in India is several times greater than that reported to WHO. Far from declining, leprosy appears to be increasing as suggested by the doubling of newly detected cases with visible deformity, at diagnosis, in the decade following 2005-6.
The next is to raise adequate national and international finance for services to avert permanent disfigurement during and after MDT.
Further, it would be good to expand the whole cake of finance for leprosy so that all useful strands of activity, from training to research to prevention to frontline services to better inclusion of those with disfigurements, can be ramped up.
Perhaps most importantly, a whole new generation of talent needs to be attracted to leprosy work to correct past errors and open new possibilities.
The situation in the Amazon region of Brazil might be even more serious. A recent sample survey of all schools in Manaus reported a prevalence of leprosy of 12 per 10,000 among schoolchildren. That's described as being 17 times higher than the registered rate.
It might be wise to put aside pretences about the decline of leprosy and prepare for the marathon ahead of us. Meanwhile, it would be good to prevent permanent disfigurement among the ordinary people who are paying the price for the past errors of others.
What we say to the world about leprosy needs to change, so that the magnitude of the problem is more accurately understood. The world will respond adequately. It tends to do so, once knowledge and understanding grow.
1. Katoch K, Aggarwal A, Yadav VS, Pandey A. National sample survey to assess the new case disease burden of leprosy in India. Indian J. Med. Res. 2017. 146(5):585-605
2. Pedrosa VL, Dias LC, Galban E, Leturiondo A, Palheta J Jr, Santos M, et al. (2018) Leprosy among schoolchildren in the Amazon region: A cross-sectional study of active search and possible source of infection by contact tracing. PLoS Negl Trop Dis 12(2): e0006261. https://doi.org/10.1371/journal.pntd.0006261
LML - S Deepak, B Naafs, S Noto and P Schreuder
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