We are not going to eliminate leprosy while we do not treat reservoir cases adequately!

Leprosy Mailing List, August 20th, 2009



Ref.: We are not going to eliminate leprosy while we do not treat reservoir cases adequately!
From: Warren G., Sidney, Australia

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Dear Salvatore,

Thank to Dr Pannikar for the latest in WHO statistics (LML Aug. 18th , 2009). I used to get them direct but that seems to have ceased. I much preferred to read the ones from India showing how many cases they are finding which somehow do not get on the register.

Is there anyway we can get WHO to be more realistic? One of my objections is that their figures do not come from every country. Yes, I know that is the choice of the country to send in or not, but some countries not there do have considerable case loads, and many do not want to acknowledge that!

Another objection is that they record so few relapsed cases. Yes, easy when the patient I removed from the register when he has completed the WHO MDT! If he reappears with new lesions he is a new case! WHO say very few relapses! I hate to think of the number I personally have seen in the last 20 years. Patient who have officially completed the WHO MDT.

Next is that applying the WHO definition eliminates a lot of the early LL type patients we see on east Asia (especially in Chinese skins). With over 15 years resident in Hong Kong I know that many LL patients do not develop sensory abnormalities for 10-20 years during which time they can be highly infectious, and in a large proportion there is no obvious skin lesion though if you are very astute you may realises the skin is infiltrated in very large patches! The use of slit-skin smears or even nose blows will show these people with high Bacillary Index. Once our main proof and very useful is recording progress!

Am I a voice crying in the wilderness? One problem is that the general public read the WHO statements and believing them say that leprosy work no longer requires extra funding!

Another is that Countries that use WHO free MDT often do not finish treatment. Very few true well established LL patients will be completely "cured" in 12 months, especially if they have had steroids with the MDT. Many continue with ENL and get progressive nerve involvement, but the local medicos say: - Oh They have finished MDT- No they are not on it specific anti-leprotics-

Please can there be some way of getting this rectified. We are not going to eliminate leprosy while we do not treat these reservoir cases adequately!


Grace Warren.