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Leprosy Mailing List – November 8, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: P. Narasimha Rao, Hyderabad, India
Dear colleagues,
WHO came out with the draft of it strategy for leprosy for the years 2016-2020, titled “Universal Elimination of Leprosy, Towards zero disabilities among new child cases Plan period: 2016-2020”.1 This document proposes a broad based action plan towards "Universal Elimination of Leprosy" with good strategic operational changes for elimination of leprosy.
However, this draft also mentions promoting globally ‘Uniform-MDT’ of 6 months (with 3 drugs) as best care for all leprosy patients. It also mentions that it would be one of its key tenets of strategy for next five years.
{“Universal Elimination of Leprosy, Towards zero disabilities among new child cases Plan period: 2016-2020”. Draft: Dated 6th October 2015
Executive summary: 4th point. “ Promote use of shorter, uniform treatment regimen for all categories of leprosy (Target: Use of uniform MDT in the programme)”.
Sub-head 2.5. Other Programme performance Indicators’ mentions that ‘prompt treatment with uniform MDT regimen shortening the duration….. will be the key tenets of the global leprosy strategy for the next five years (2016-2020). Sub head 4.2. Intensified action to reduce leprosy and its transmission, the proposed strategy plans to ‘Improve case management including “Uniform MDT’}.
Many leprosy workers of India are apprehensive and worried about this proposal to implement 6-month UMDT for leprosy patients. Many strongly feel that its implementation in the present form can jeopardize the leprosy program that is already beleaguered due to various reasons. The ‘Indian Association of Dermatologists Venereologists & Leprologists’ (IADVL), which is the largest professional body of dermatologists and leprologists comprising over 8000 members from all over India is expressing similar apprehensions. Many members of ‘Indian association of leprologist’ ( IAL) are also concerned.
Some of the reasons for these apprehensions are as follows:
<![if !supportLists]>1. <![endif]>The WHO proposed recommendation appear to be based on reports arising from its field trials of U-MDT conducted over last decade. However, it should be noted that in all these trials comparison of UMDT’s efficacy vis a vis 12 month WHO MDT was not done. Few comparative studies of these two regimens reported so far2 observed that the 6 months U-MDT is a good regimen for PB leprosy but MB patients on U-MDT regimen showed a high rate of non-response & progression of disease and other clinical problems on follow-up after RFT.
<![if !supportLists]>2. <![endif]>The numbers of leprosy are falling world over, including in India. For the year 2014, the total number of cases on record globally was only 175,554 and new cases 213,89. Hence the reason for reduction of duration of MB therapy cannot be budgetary constraints due to increase in numbers.
<![if !supportLists]>3. <![endif]>However note that MB case percentage is on raise, with 61% being multi-bacillary cases as per 2014 statistics. The 12-month WHO MB-MDT is a robust & proven effective regimen to bring down these numbers substantially in the next few years. There is no reason to abandon this regimen for MB patients.
<![if !supportLists]>4. <![endif]>The introduction of proposed shorter duration U-MDT can bring down the prevalence of the disease drastically for operational reasons; however, it will not strengthen the program as there will be clinical problems related to persistence of disease activity, poor clinical improvement, reactions, nerve damage and relapses/reactivation of disease in MB patients on such a shortened regimen. In addition, partially treated (UMDT) MB patients with high BI can promote the risk of drug resistance in the community as well.
<![if !supportLists]>5. <![endif]>As such at present there is no valid reason to further shorten the duration of therapy for MB leprosy. Or to introduce shortened U-MDT, with inconclusive evidence of its efficacy, or its superiority over 12 months regimen, for MB leprosy.
It is imperative that authorities working on this strategy document should have a re-look on long term potential damage such a shortened U-MDT regimen can cause on leprosy program in India and worldwide.
It is a request of many concerned leprosy workers of India to all those involved in planning of this WHO strategy for next 5 years to reconsider recommending U-MDT for all leprosy patients as mentioned in the draft ‘WHO proposal for 2016-2020’ and put in abeyance in its present form in the final document till it is studied and discussed thoroughly for evidence of its superiority over the present robust 12-month WHO-MB MDT regimen.
With best regards,
P Narasimha Rao
Dr. P. Narasimha Rao, MD, D.D, PhD
Prof of Dermatology,
Bhaskar Medical college,
Hyderabad
Phone- <![if !vml]>
<![endif]>040-23514566
<![endif]>040-23514566
Mobile-09849044898
1. Universal Elimination of Leprosy, Towards zero disabilities among new child cases Plan period: 2016-2020. Draft dated 6th oct 2015.
2. Rao PN et al. Comparative study of Uniform-MDT and WHO MDT in Pauci and Multi bacillary leprosy patients over 24 months of observation, Lepr Rev (2009) 80, 143–155
Enclosed as attachment: WHO draft proposal for leprosy; 2016-2020
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
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