Leprosy Mailing List – July 24th, 2012
Ref.: About leprosy elimination and control
From: J A Barreto, Bauru, S Paulo, Brazil
Dear Salvatore,
Thank you very much to Drs Mondjo, Vijayakrishnan and Adallah for their comments. I would also like to express my opinion about the "elimination" of leprosy strategy.
Today, I do not think that the aim of elimination, by itself, is wrong. However, I agree that it is not the right way in which it was reached in the world, as well as the results the patients have now to undergo.
When evaluating what happened in Brazil, i.e., the detection rate, after the elimination goal was ruled out (2006), it is clear that detection of new cases of leprosy over the last seven years decreased from almost 50.000 to 30.000. This happened only because physicians do not know what is leprosy and how they could diagnose it. This explains the tendency to increasing grade 2 disabilities and, the absence of fall in the detection rate among children; as well as the detection rate of 25-30% of new leprosy cases among the examined household contacts. This is what I have found every time I went to the field (see www.dahwmt.org.br).
Leprosy knowledge was lost due to WHO`s new classification (number of lesions), and leprosy is now often missed as a differential diagnosis. Lepromatous leprosy (diffuse infiltration without patches) does not exists in this classification, as well as Primary neural leprosy (number of nerves are not a criteria). Borderline patients with less than 6 lesions are being undertreated as paucibacillary (PB), with a poor prognosis, all over the world. The Brazilian Health Ministry diminished the undertreatment of smear positive patients in our country, after the reintroduction of bacilloscopy (smear taking and reading). Though it is still badly done.
In the last five years (2007-2011), in our Institute, located at the centre of the state of São Paulo, where leprosy is said "eliminated" since 2005, we diagnosed already 174 new cases coming only from cities of our state. The mean time interval since the beginning of symptoms till the diagnosis at National reference centre was 2 years, even here (the richest state of Brazil). Among the patients we diagnosed, 65% had disability grade higher than zero, and 26% showed grade 2 on the diagnosis. How could this still occur? Because to establish the diagnosis is still extremely centralized in our state. In São Paulo the leprosy knowledge is one of the lowest in Brazil among physicians (see article on the site www.dahwmt.org.br), because they often think that leprosy is rare here.
We are working hard, in order to decentralize the access to diagnosis and treatment of leprosy patients. Soon, the Leprosy Elimination Monitoring will show the complete diagnosis of the situation of the health attention for leprosy patients in Brazil.
Regards,
Jaison
Dr Jaison A. Barreto, MD, PhD
Chief of the Leprosy Section
Instituto Lauro de Souza Lima
Bauru, SP, Brazil
LML - S Deepak, B Naafs, S Noto, P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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