Transcript National Leprosy Eradication Program(NLEP)

National Leprosy Eradication Program
(NLEP)
Dr. KANUPRIYA CHATURVEDI
Lesson Objectives



To know about the magnitude of Leprosy
problem in India
To know about the evolution of Leprosy
control/elimination in India
To learn about the goals, objectives and
strategies for leprosy elimination
Disease Burden


The global registered prevalence of leprosy at the beginning of 2006
was 219,826 cases. There are now only six countries that have still to
reach the elimination target of 1 case per 10,000 population, at the
national level.
Based on the reports received from all the states and UTs in India for
the year of 2008-09 current leprosy situation in the country has been
observed as below.
 A total of 1.34 lakh new cases were detected during the year 200809, which gives Annual New Case Detection Rate (ANCDR) of 11.19
per 100,000 population. This shows ANCDR reduction of 4.36%
from 11.70 during 2007-08.
 A total of 0.86 lakh cases are on record as on 1st April 2009 giving
a Prevalence rate (PR) of 0.72 leprosy cases per 10,000 population.
 Detailed information on new leprosy cases detected during 2008-09
indicates the proportion of MB (48.4), Female (35.2), Child (10.1),
Visible Deformity (2.8),
Trend of Leprosy Prevalence & Annual New
Case Detection (ANCD) Rates in India
Prevalence & ANCDR
30
25
20
15
10
5
0
25.9
PR
ANCDR
20.0
13.7
10.9
8.9
8.4 5.9 5.8
5.5
6.4
5.9 6.2
5.7 4.9 4.6 5.1 5.6
7.0
5.3 5.3
5.5 5.9
4.4
3.3
3.7 4.2 3.2 2.4
2
0.84
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year (March End)
Situation of States as per Prevalence2001 Vs 2006
Year
Number of States having a PR
of
<1 1 – 2 2 – 5 5 - 10 >10
2001
13
3
6
3
1
2006
25
8
1
Nil
Nil
National Leprosy Eradication Program





Started in 1955 as NLCP with the objective of early
detection of cases and treatment with Dapsone
monotherapy
It was made a centrally sponsored programme in 1980
With the advent of Multi Drug Therapy (MDT) for
leprosy the cure rates increased
It was changed into eradication programme in 1983
with the objective of eradicating the disease by the
end of 2000
The ‘elimination’ was defined as attaining a prevalence
Rate (PR) of less than 1 case per 10,000 population
Milestones of leprosy Eradication










1955 national leprosy control program
1983 leprosy eradication program ( MDT started)
1991 World Health Assembly resolution to eradicate
leprosy by 2000 AD.
1993 world bank supported MDT program phase I
1997 mid term appraisal
1998-2004 modified leprosy elimination campaign
2001-2004 NLEP project phase II
2002 simplified information system
Nationwide evaluation of Project II
NRHM covers NLEP
What does elimination as a public
health problem mean?

Reducing the case load to less than 1 case
per 10,000 inhabitants



by detecting and curing all cases of leprosy
leading to a reduction in the source of infection and
the disease burden in communities
so that leprosy is likely to disappear naturally as it
already has from many countries
Leprosy - one of the few diseases
which can be eliminated

Leprosy meets the demanding criteria
for elimination



practical and simple diagnostic tools: can
be diagnosed on clinical signs alone;
the availability of an effective intervention
to interrupt its transmission: multidrug
therapy
a single significant reservoir of infection:
humans.
Rationale for eliminating leprosy






Technically feasible
Prevents patients going on a downward spiral to
poverty and destitution due to leprosy related
disabilities
Enhances the credibility of and confidence in
local health services
Puts into place structures which can be used for
other diseases
Releases resources to manage other diseases
Will consign leprosy to history
Highly effective cure available

Multidrug therapy (MDT)
 Is a combination of 2 / 3 drugs (clofazimine,
rifampicin, dapsone)
 Cures patients in 6 months / 12 months
depending on form of leprosy
 Kills the leprosy bacilli and stops its
transmission
 Can be delivered under field conditions
without special staff and institutions
 Is available free of charge from WHO
Project phase II 2001 onwards



Part A: National Plan setting out the project
design for the country
Part B: Plan for 8 high endemic states (
Madhya Pradesh, Orissa, Bihar, UP, West
Bengal, Uttranchal, Chattisgarh and
Jharkhand.
Part C: Plan for remaining 27 states and
union territories
Objectives



To achieve elimination of leprosy at
national level by the end of the project
To accomplish integration of leprosy
services with general health services in the
27 low endemic states
To proceed with integration of services as
rapidly as possible in the 8 high endemic
states
Elimination strategy

To eliminate the following strategy adopted:


Modified leprosy elimination campaigns ( MLEC):
organizing camps for 1 or 2 weeks duration for
case detection, treatment and referral
Special action projects for the elimination of
leprosy ( SAPEL): initiative for providing MDT
services in special difficult to access areas or to
neglected population groups
Activities




Early detection of leprosy cases
Intensified health education and public
awareness campaigns
Regular treatment of leprosy cases
providing multi- drug therapy( MDT) at
fixed centres near the patient
Disability prevention and medical
rehabilitation
Early detection of leprosy cases

For the field purpose :


Multi-bacillary leprosy is labeled when there
are 6 or more skin patches and/or 2 or more
nerves affected. Skin smear is positive.
Paubacillary leprosy is labeled when there 5
or less than 5 skin lesions and/or 1 more
nerve affected. Skin smear do not show
bacilli
Treatment



Rifampicin is given once a month. No toxic effects have
been reported in the case of monthly administration. The
urine may be coloured slightly reddish for a few hours after
its intake, this should be explained to the patient while
starting MDT.
Clofazimine is most active when administered daily. The
drug is well tolerated and virtually non-toxic in the dosage
used for MDT. The drug causes brownish black
discoloration and dryness of skin. However, this disappears
within few months after stopping treatment. This should be
explained to patients starting MDT regimen for MB leprosy.
Dapsone :This drug is very safe in the dosage used in MDT
and side effects are rare. The main side effect is allergic
reaction, causing itchy skin rashes and exfoliative
dermatitis. Patients known to be allergic to any of the
sulpha drugs should not be given dapsone.
Treatment contd.



Multibacillary (MB) leprosy
 For adults the standard regimen is: Rifampicin:
600 mg once a month Dapsone: 100 mg daily
Clofazimine: 300 mg once a month and 50 mg
daily Duration= 12 months.
Paucibacillary (PB) leprosy
 For adults the standard regimen is: Rifampicin:
600 mg once a month Dapsone: 100 mg daily
Duration= six months
Single Skin Lesion Paucibacillary leprosy
 For adults the standard regimen is a single dose
of: Rifampicin: 600 mg Ofloxacin: 400 mg
Minocycline: 100 mg
MDT Dose for Multi-bacillary Leprosy
Adult
Child 10-14 yrs.
Child 6-9 yrs.
Day 1
Day 1
Day 1
Supervised monthly
treatment
Supervised monthly
treatment
Supervised monthly
treatment
Rifampicin 600mg
Rifampicin 450mg
Rifampicin 300mg
Clofazimine 300mg
Clofazimine 150mg
Clofazimine 100mg
Depsone 100mg
Depsone 50mg
Depsone 25mg
Day 2-28
Day 2-28
Day 2-28
Daily Clofazimine 50 mg
Clofazimine 50 mg
Clofazimine 50 mg
Depsone
Depsone
Daily Depsone 100mg
50mg
25mg
Regimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12
months; first dose of each month to be given in presence of HW.
Multi- drug therapy( MDT) for
paubacillary leprosy
Adult
Child 10-14 yrs.
Child 6-9 yrs.
Day 1
Day 1
Day 1
Supervised monthly
treatment
Supervised monthly
treatment
Supervised monthly
treatment
Rifampicin 600mg
Rifampicin 450mg
Rifampicin 300mg
Dapsone
Dapsone
Dapsone
100mg
Day 2-28
Day 2-28
Daily Dapsone 100mg
Dapsone
50mg
25mg
Day 2-28
50mg
Dapsone
25mg
Regimen of two drugs – Rifampicin and Dapsone for 6 months provided in blister packs
Disability prevention and medical
rehabilitation plan
Objectives of the rehabilitation plan:
1.
2.
3.
Persons with lepra reactions are adequately
managed so as to prevent occurrence of
disabilities.
Persons with disabilities due to leprosy are assisted
with care and support to prevent worsening of their
existing disabilities
Persons with deformities suitable for correction are
provided reconstructive surgery services through
specialized centers managed by government and
voluntary organizations.
Monitoring and evaluation

The implementation of elimination plans in the most
endemic countries is closely monitored so as to
detect potential problems that might impede its
progress and to identify rapid, yet feasible solutions:




promotion of research in the epidemiology of the disease,
including modeling
development of computerized databases on leprosy,
including data collection, reports and analysis, estimates and
predictions of leprosy problem trends
costing and drug requirements for the elimination of the
disease
development of simplified tools for data collection, including
guidelines and training material, on essential information for
the control of leprosy in the most endemic countries
Problems..




Late detection of patients, many with visible
deformities
Poor treatment completion and cure
Fear, prejudice and stigma surrounding leprosy
Limited community awareness and involvement
…but some challenges remain







Leprosy remains a public health problem in 9
States
Poor coverage with MDT services in some difficult
to reach areas
Hidden cases who continue to spread the infection
Late detection of patients, many with visible
deformities
Poor treatment completion and cure
Fear, prejudice and stigma surrounding leprosy
Limited community awareness and involvement