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

Leprosy Mailing List, August 24th, 2009

Ref.: We are not going to eliminate leprosy while we do not treat reservoir cases adequately!
From: Ganapati R., Munbay, India
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Dear Dr Warren,

Many knowledgeable clinicians will definitely like to join your cry in the wilderness (ref LML, August 20, 2009). Your views on “reservoir cases” representing the very basis of leprosy transmission have been deliberately ignored by the guardians of public health since the advent of MDT. In their attempt to over- simply the complex clinical facets of the disease, they devised a “made easy” solution for collecting statistics and have painted a rosy picture. Many are still gloating over the success of reaching the goal of 1 case per 10,000 population. Over this long period the science of clinical leprology unfortunately has been sidelined.

In our experience in Bombay, true relapses in multibacillary leprosy with bacterial positivity are encountered as late as 10 to 15 years after stopping treatment (irrespective of the treatment regimens and duration of therapy) raising the possibility of recycling of transmission of the disease. Poorly managed type 1 and 2 reactions with uncontrolled neuritis are thronging our referral centres.

It is a paradox that donors are made to believe that leprosy is eradicated. NGOs solely depending upon public donations are virtually deprived of money and manpower.

Your emphatic reference to the prevailing poor knowledge about relapses and nerve damage due to reaction should be an eye opener to the public health experts and make them devise a fresh mass strategy to eradicate the disease before it is too late.

With regards,

Dr R Ganapati,
Director Emeritus,
Bombay Leprosy Project