Leprosy Mailing List – February 7, 2016
Ref.: (LML)
What is the actual situation of leprosy and its elimination
From: Joel Almeida, Mumbai
and London
Dear
Pieter,
A recent claim asserts the
following:
"With the introduction of multidrug therapy the number of new patients with
leprosy decreased from more than five million patients in the mid-1980s to
fewer than 200,000 in 2015." [http://www.huffingtonpost.co.uk/katharine-jones/leprosy-is-still-being-tr_b_9131736.html]
Five million appears to be
contrary to the facts. There was no year in the 1980's where more than a
few hundred thousand new patients were detected.
With the introduction of
multidrug therapy the number of newly detected patients increased from about
500,000/year in 1985 to about 800,000/year in 2001. This is attributable
largely to intensified case finding.
From 2002 onwards,
self-healing cases were largely excluded owing to the progressive suppression
of case finding campaigns. This seems to explain, to an important extent, the
drop in newly detected cases from about 800,000/year in 2001 to about
250,000/year in 2008. 250,000 is probably about the number of cases that
would have been newly detected in 1985 if self-healing cases had been excluded
then.
Since 2008, India has been
reporting not only the number of newly detected cases but also the percentage
of newly detected cases who show visible deformity. This percentage has been
steadily increasing, indicating a progressive delay in diagnosis. When the
number of newly detected cases in India is standardised by the percentage
showing visible deformity, the underlying incidence rate of leprosy in India
appears to have been increasing since at least 2008.
In short, the claim quoted
above seems to contradict the true position, at least in India. India is
where nearly 60% of the world's new cases occur.
We may have discharged several
million patients from registers, and largely eliminated leprosy services.
However, those administrative actions are quite distinct from a reduced
incidence rate of leprosy. Meanwhile, the prevalence and weight of disabling
sequelae has been steadily increasing. This steadily increasing burden of
leprosy is owing to the nerve damage (and consequent deformities) which occur in
as many as 50% of multibacillary patients after the start of MDT.
Permanent nerve damage can
largely be prevented. But we need to appoint skilled, mobile leprosy
workers for monthly monitoring of nerve function during the first 2 years after
the start of MDT. Then anti-inflammatory treatment can be started in time
to protect nerves. That will help us shield children as well as adults from
permanent nerve damage and visible deformity.
The facts in leprosy are
powerfully persuasive. The more accurately we represent them, the easier
it becomes to mobilise political commitment, resources, skilled personnel,
control programmes, patient care and research. All those are needed to
protect people better against M. leprae and its devastating consequences.
The leprosy fraternity has many heroically good and compassionate people.
This is shown by how readily we place the well-being of the population at risk
of leprosy above all other considerations.
Regards,
Joel Almeida
LML - S Deepak, B Naafs, S
Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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