Leprosy Mailing List – November 27, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Hemanta Kumar Kar, Delhi, India
Dear Pieter,
I fully agree with Sunil (LML, 20-11-2015). Around 2 lacks and odd new leprosy patients are being detected every year around the world, the majority from India, with slow reduction of new cases from year to year. Uniform MDT is a viable option to implement if it is given for 1year instead of 6 months for the obvious reasons discussed from time to time.
Number one is the problem of missing many MB cases because lack of complete examination of whole body area leading to missing of some lesions, both skin and nerve. That leads to under diagnosis of MB cases as PB. This could be solved with U-MDT.
Secondly there are cases of LL being missed frequently because of stoppage of doing SSS examination by National Program managers. Many of them are remained undiagnosed until they develop certain complications like reaction, neuritis leading to deformity and landed directly in tertiary care set up in late stage. That is one of the reasons of slow reduction of new cases.
Thirdly, both type 1 and type 2 reactions develop in more number cases beyond 6 months of treatment particularly in MB cases. It will be inappropriate to stop multidrug treatment after 6 months while steroid administration is going on beyond that period to control reactions/ neuritis without MDT.
Therefore, at this crucial juncture implementation of 6 months U-MDT regimen will be too early and may be suicidal for the program. I am sure WHO/ Novartis can afford MDT for few more years for 1 year regimen rather than 6 months. We all hope that the WHO will take care of these problems and take an appropriate decision for ultimate eradication of leprosy from the world.
Warm Regards,
Kar
Dr Hemanta Kumar Kar
Professor in Dermatology,North Delhi Municipal Corporation Medical College Delhi -110007
Former Director, Dean and Med. Superintendent
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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