Transcript LEPROSY

DR.I.SELVARAJ I.R.M.S
B.Sc.,M.B.B.S.,D.P.H.,D.I.H.,PGCH&FW/NIHFW/
NEW DELHI
• Senior Divisional Medical
Officer, Railway Hospital,
Chennai Division, Southern
Railway, India.
LEPROSY
It is a chronic infectious disease caused by
M.leprae, an acid fast, rod shaped bacillus. It
mainly affects the skin, peripheral nerves,
and mucosa of the respiratory tract etc., It
has left behind a terrifying image in history
and human memory of mutilation, rejection
and exclusion from society.
Global Leprosy Situation 1998
Leprosy Situation in South East Asia 2001
Country
Bangladesh
Point Prevalence
Cases detected during the
year 2001
Prevalence per 10000
Detection per 100000
8537
10740
0.6
8.2
40
19
0.2
0.9
439782
617993
4.3
60.1
Indonesia
17259
13286
0.8
6.2
Myanmar
8237
9684
1.8
21.0
10657
13830
4.4
56.5
Sri Lanka
1570
2309
0.8
12.1
Thailand
2251
797
0.4
1.3
488333
668658
3.2
43.7
Bhutan
India
Nepal
Total
Global Leprosy Situation in 2001*
Region
Point Prevalence
Cases detected
during the year 2001
Africa
45170
39612
Americas
83101
42830
7007
4758
South East Asia
488333
668658
Western Pacific
7735
4786
38
53
635404
763317
East Mediterranean
Europe
World
* As reported by 106 countries.
Prevalence of Leprosy in SEA Region as of April 2001
GOAL AND OBJECTIVE OF LEPROSY
ERADICATION PROGRAMME
• Goal: elimination of leprosy i.e.to reduce
the prevalence rate to less than I per
10000 population by the year 2000 AD.
• Objective: To arrest disease activity in all
the known cases of leprosy by the year
2000AD
• Strategy: The elimination strategy
CONTROL OF LEPROSY
• It means no longer to be a
public health problem
ERADICATION OF LEPROSY
• It is defined as interruption of
transmission of leprosy to attain a
stage of zero level
ELIMINATION OF LEPROSY
• The elimination of leprosy as a public health
means reducing the prevalence of leprosy to
below on case per 10000 population.
• Elimination of leprosy will be achieved by:
• Making MDT accessible to all communities and
areas.
• Treating all registered cases with MDT
• Diagnosing and promptly treating all new cases
• Improving quality of patient care, including
disability prevention and management
• Ensuring reqularity and completion of treatment
• Enlisting community support for the programme
INCIDENCE OF LEPROSY
Incidence is the number of new
cases (only the new cases) of a
particular disease that occur in a
defined population over a defined
period of time. The time period
used is conventionally one year.
PREVALENCE OF LEPROSY
1. Point Prevalence
2. Period Prevalence
Point prevalence
• The number of persons with a
disease at a specified point in
time in a defined Population
Period prevalence
• The number of persons with a
disease in a defined
population within a specified
period of time
SUSPECT CASE OF LEPROSY
• One or more suggestive skin patches with
normal sensation
• Extensive loss of sensation in the hands or
feet with no other evidence of leprosy
• One or more grossly enlarged peripheral
nerve trunks with no sensory loss or skin
lesion
• Painful nerves with no other evidence of
leprosy
• Painless ulcers on hands and/or feet with no
other evidence of leprosy
• Nodules on the skin with no other evidence
WHO IS LIKELY TO REPORT TO THE HEALTH
CENTRE
• Leprosy cases who were never treated before
• Leprosy cases who had treatment with
dapsone in the past
• Leprosy cases who had treatment with MDT
in the past
• Suspect cases
• With other skin lesions
• Other conditions causing nerve damage
• Contacts of leprosy patients for check up
• Normal individual for information
How to examine for leprosy?
Examine
in a well-lit room
Examine
the whole body
Ask
since when the patch was noticed
Ask
what treatments have been tried
Test
for sensation
Look
for any visible deformities
How to diagnose leprosy
Examine
Check
Test
skin
for patches
for sensation
Count
Look
the number of patches
for damage to nerves
DIAGNOSIS OF LEPROSY
• Hypopigmented or reddish skin lesion(s)
with definite loss of sensation
• Damage to the peripheral nerves, as
demonstated by loss of sensation
• Weakness of the muscles of hands, feet or
face
• Positive skin smear
FLOW CHART FOR DIAGNOSIS
AND CLASSIFICATION
SKIN LESION AND
SENSORY LOSS - LEPROSY
ONE SKIN LESION
SLPB leprosy
2-5 SKIN LESION
PB LEPROSY
More than 5 lesions
MB LEPROSY
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.
Elimination strategy
• Providing domicillary MDT to all communities
and areas
• Breaking the chain of transmission by intensive
case detection and promptly treatment activities
• Improving quality of patient care, including
disability prevention and management
• Ensuring regularity and completion of treatment
• Encouraging and ensuring community
participation
• Providing rehabilitation to the needy patients
• Organising health education to patients , their
families and community.
ADVANTAGES OF MDT
•
•
•
•
•
•
•
•
•
Highly effective in curing the disease
Reduces the period of treatment
Well accepted by patients
Easy to apply in the field
Prevents development of drug resistance
Interrupts transmission of infection
Reduces risk of relapse
Prevents disabilities
Improves community attitude
POINTS ON MDT TREATMENT
• Every leprosy patient should receive tratment with more than one antileprosy
drug
• Standard MDT is very safe and effective
• It is available free of charge for leprosy patients
• Standard MDT is for a fixed duration
• At the completion of a full course of MDT the patient is cured
• Use clinical criteria to classify and decide the treatment regimen
• If in doupt of classification, give MB treatment regimen
• Active follow-up after completion of treatment is not necessary
• In case of relapse, re-treat with appropriate standard MDT regimen
Treatment regimens
PB
Adult
(6 blister packs) to be taken monthly within a maximum period of 9
months
Rifampicin
Dapsone
MB
600 mg once a month
100 mg every day
Adult
(12 blister packs) to be taken monthly within a maximum period of 18
months
Rifampicin
600 mg once a month
Clofazimine
300 mg once a month
Clofazimine
50 mg and dapsone 100 mg every day
SLPB
Single
dose ROM
Rifampicin
Ofloxacin
600 mgm
400 mgm
Minocyclin
100 mgm
Multi Drug Therapy
When treatment is completed
Congratulate
Thank
family/friends for their support
Reassure
Any
the patient
that MDT completely cures leprosy
residual lesions will fade away slowly
Show
them how to protect anaesthetic areas and/or
disabilities
Encourage
to come back in case of any problem
Tell
that they are welcome to bring other members
of family or friends for consultation
Remove
register
the patient’s name from the treatment
ORGANISING MDT
SERVICES
•
•
•
•
•
•
a)
b)
c)
d)
e)
Updating register
Screening patients
Selecting MDT regimen
Preparing treatment register
Delivering MDT to patients
Managing MDT supply
estimating MDT requirements
procuring
storage
Shelf life
Keeping records
ASSESSING PROGRESS WITH MDT
IMPLEMENTATION
•
•
•
•
•
MDT COVERAGE
Number of patients cured with MDT
Defaulters
MDT drug utilisation
Regular and uninterrupted supply of drugs
is very important for MDT programme
PROVISION OF EFFICIENT HEALTH
SERVICES
• Diagnose leprosy and classify the disease clinically
• Recognise and manage the common complications
of the disease
• Identify and refer serious complications
• To ensure regular supply of MDT
• Maintain proper recording and reporting
• Organise convenient locations and timing of the
clinics
• Maintain cardial and friendly relations with all
patients and the local community
• Ensure commitment and motivation to eliminate
leprosy from the area
MONITORING INDICATORS
• Point Prevalence Rate – Indicator of magnitude of the
problem
• Monthly&Annual New Case detection rate –Indicator
of impact of the programme
• Proportion of children among new cases – Indicator
of early detection
• Proportion of new cases with deformity – Indicator of
effectiveness of programme implementation
• Proportion of MB among new cases – Indicator of late
detection
• Prevalence discharge ratio – Indicator of progress of
the programme related to cure
• Clinic attendance –Indicator of regularity of
treatment
Why integrate leprosy into the general
health services?
Integration
means to provide “comprehensive”
essential services from one service point
to
improve patients’ access to leprosy services and
thereby ensure timely treatment
to
remove the “special” status of leprosy as a
complicated and terrible disease
to
consolidate substantial gains made
to
ensure that all future cases receive timely and
correct treatment
to
ensure that leprosy is treated as a simple disease
Why coverage is important?
Good
coverage means that:
health
facilities are easily accessible to every
member of the community
health
services are provided on a daily basis
health
workers are able to diagnose, cure and
provide basic information about the disease
health
facilities are distributed equally in all
areas
urban/rural,
male/female, poor/rich, tribal/others, etc.
Advantages of Integrating
Leprosy Services
Transmission
of infection interrupted early
Stigma reduced further
Development of deformities prevented
Patients treated early
Patients detected early
Why disabilities occur?
Disabilities
such as loss of sensation and
deformities of hands/feet/eyes occur because:
Late
diagnosis and late treatment with MDT
Advanced
Leprosy
Lack
parts
disease (MB leprosy)
reactions which involve nerves
of information on how to protect insensitive
Disabilities can be prevented
The
best way to prevent disabilities is:
early
diagnosis and prompt treatment with MDT
Inform
patients (specially MB) about common
signs/symptoms of reactions
Ask
them to come to the centre
Start
treatment for reaction Inform them how to
protect insensitive hands/ feet /eyes
Involve
family members in helping patients
MORE FACTS ABOUT LEPROSY-1
• NATIONAL LEPROSY CONTROL PROGRAMME WAS STARTED IN
1955
• NATIONAL LEPROSY ERADICATION PROGRAMME WAS
RENAMED IN 1983
• PREVALENCE OF LEPROSY IN INDIA WAS 57/10000 IN 1981
• AFTER MDT INTERVENTION, IT WAS REDUCED TO 5.07/10000 IN
MARCH,2000
• A TOTAL OF 8.84 MILLION PATIENTS CURED WITH MDT
• 19 STATES HAVE ACHIEVED ELIMINATION BY 2000
• 8 STATES ARE LIKELY TO ACHIEVE BY 2002
• 5 STATES BY 2005
• CURRENT STRATEGY IS (MLEC) COMPAIGN IN 30 STATES
• MLEC-1 WAS LAUNCHED IN 1997-1998
• MLEC-2 WAS CONDUCTED IN 1999-2000
• ABOUT 2,20,000 WERE DETECTED WHICH ARE NOW BEING
TREATED
• 3,76,000 PARAMEDICAL PERSONNEL INCLUDING DOCTORS AND
3,78,000 VOLUNTEERS WERE TRAINED
• SAPEL PROGRAMME IN INACCESSIBLE AREAS
MORE FACTS ABOUT LEPROSY-2
• FOUR LEPROSY VACCINES ARE CURRENTLY IN
TRAIL
• 1)BCG –34.1% PROTECTION
• 2)BCG+KILLED M.LEPRAE – 64.0%
• 3)M.W – 25.7%
• 4)ICRC – 65.5%
• 70% LAI are concentrated in the states of
Bihar,UP,WB,Orissa,and MP.Bihar alone is having 32%
recorded cases of LAI IN INDIA
• The prevalence of leprosy in PUNJAB,NAGALAND,and
HARYANA is 1 per 10000
• 7 CONTROLLED TRAILS AND 9 CASE –CONTROL
STUDIES EVALUATING THE ROLE OF BCG IN
PREVENTION OF LEPROSY WERE CARRIED OUT
AROUND THE WORLD