Leprosy Mailing List Blog: Fw: Ref.: (LML) Declaring Leprosy as a Notifiable disease

Leprosy Mailing List – May 30, 2025

Ref.: (LML) Declaring Leprosy as a Notifiable disease

From: Claudio Salgado, Marituba, Brazil

Dear colleagues,

I would like to share some reflections on the importance of making leprosy a compulsory notifiable disease and the implications this could have in our fight against the disease.

First, it is very important that leprosy becomes a notifiable disease across India. In fact, I only recently learned about this and was quite impressed. I had the impression that mandatory notification of leprosy was already a common practice in most countries, as it is in Brazil, where it has been mandatory for decades. Does the mandatory notification in Brazil contribute to our being in second place in the world in terms of case numbers? And will the mandatory notification in India lead to a significant increase in new cases? These questions deserve careful consideration.

Regarding the elimination of leprosy in Jordan, or in other countries, corroborated by the World Health Organization, I have some questions that perhaps cannot be fully answered here, but I believe are important. Besides the more refined clinical semiology now used for the detection of new cases—such as active case finding within families and communities by hansenologists—sensitive laboratory tools like the anti-PGL-I IgM serology, the RLEP quantitative Polymerase Chain Reaction (qPCR RLEP), and complementary examinations such as ultrasonography of peripheral nerves should be part of the investigation routine. I imagine that, in countries that claimed elimination, clinical examinations on the field by hansenologists, laboratory tests, and ultrasonography were rarely used or even neglected, which could explain the discrepancy between epidemiological data and the reality on the ground.

We need to remember that several countries that were considered to have eliminated leprosy as a public health problem, even without the use of these tools, are now facing a significant increase in new cases. Furthermore, the World Health Organization has been promoting a tool to declare the interruption of transmission of Mycobacterium leprae, twenty-five years after the declaration of "elimination" of leprosy as a public health problem, which is based solely on the review of notified epidemiological data, as recently done in the state of Alagoas (Lima LV, Pavinati G, Silva RGTD, et al. Leprosy elimination phase in Alagoas, 2001-2022: an ecological study. Epidemiol Serv Saude. 2025;34:e20240255. Published 2025 Apr 11. doi:10.1590/S2237-96222024v34e20240255.en). In the case of Alagoas, we would very much like the results to be consistent with the reality on the ground, but local colleagues report that the situation does not match in many places. The main reason for this? The global elimination of leprosy diagnosis, which warrants a broader and more in-depth discussion, especially in this forum we have here. How many cases, for example, of fibromyalgia or rheumatoid arthritis with intense pain could actually be leprosy? Or even just pain, with no diagnosis? How many cases of feet with sensory alterations, labeled as diabetes, could in fact be leprosy?

In Brazil, the training of new leprosy specialists has been virtually nonexistent for over forty years. The recent training of new specialists in the state of Mato Grosso by the Brazilian Hansen's Disease Society (SBH) together with the Mato Grosso School of Public Health (ESP-MT) has significantly increased the number of cases detected, making it the state with the highest detection rate in the country. This happens in all places where leprosy specialists are working.

Beyond mandatory notification, in which countries do we have specialists working in the diagnosis of patients not only in reference centers, waiting for patients, but actively in the field—going to homes, schools, prisons, and places where people gather? At some point, someone wrote that diagnosing leprosy was easy. It is not. And we have to face this now. We all know that poor data leads to poor conclusions; in places with diagnostic difficulties, it is impossible to draw reliable conclusions about elimination or the interruption of transmission, whatever that may mean.

Regards,

Claudio

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Claudio Guedes Salgado, MD, PhD

Full Professor

Institute of Biological Sciences
Pará Federal University

Former President of Brazil Hansen's Disease Society (SBH), 2018-2023

International relations advisor for the SBH

Dermato-Immunology Lab

Av. João Paulo II, 113
Bairro: Dom Aristides
Marituba - Pará - Brasil
CEP: 67200-000
Phone: +55-91-3201-7033

Cell phone: +55-91-991465641
E-mails: csalgado@ufpa.br and claudioguedessalgado@gmail.com

Lattes CV (Brazil format): http://lattes.cnpq.br/2310734509396125