Transcript From “Leprosy”

Elimination of Leprosy
Dr. C.R.Revankar
MD, DPH
Public Health Physician & Leprologist
Contact :
3-15-14, Garden view Society,
Bhavani Nagar, Marol, AndheriEast, Mumbai(Bombay) - 400059,
India
Email: [email protected]
& [email protected]
Leprosy : How important for you
Leprosy(Hansen): Easy to
diagnose, treat and cure.
3 million people are with leprosy
related disabilities in the world.
0.76 million new cases were
identified in 2001(WHO 2002)
Objectives
After this lecture one should be
able toDescribe epidemiology of leprosy
disease including disability in
terms of time trends, impact of
leprosy elimination strategies etc
Leprosy (Hansen’s) Disease
Chronic infectious disease caused
by Mycobacterium leprae, affects
nerves, skin and mucosa
Causes nerve damage & disabilities
- leading to social stigma, ostracism
& denial of human rights
Leprosy Case
A patient with active signs of
leprosy- need or is under
MultiDrugTherapy (WHO 1988)
Patients with residual signs are
Inactive and Cured & should not
be included for prevalence rate
Leprosy Elimination
Leprosy Elimination:Reducing
Prevalence Rate (PR) to less than
one active leprosy case per 10,000
population as a Public Health
problem (WHO1991)
Priority:Communicable part of the
disease (Transmission)
Leprosy Eradication/Extinction
Eradication: Absence of disease
agent in nature in a geographic
area after deliberate control
measures (WHO2002)
Extinction: Specific disease agent
no longer exists in nature or
laboratory(WHO 2002)
A World Without Leprosy
Concept encompasses - early
diagnosis, treatment, physical,
socio-economic, psychological and
rehabilitation of leprosy patients
No problems related to Leprosy in
the world (ILA 1998)
Global public health strategy-1
To achieve leprosy elimination
• Adequate, regular MDT
• Leprosy awareness
• Leprosy Elimination campaign
• Special Action Projects for
difficult areas (SAPEL)
Global public health strategy-2
• Action plan, review meetings
• Resource mobilization, technical
support, Capacity building, drug
supply, monitoring, evaluation &
documentation
Transmission
Organism: Mycobacterium leprae
Source: Untreated infectious
patients (Multibacillary type)
Exit: Nasal mucosa, ulcerated skin
Entry: Airborne like TB
Epidemiology-1
• 1%-2% exposed population
develop clinical disease
• Incubation period: 3-5 years,
can occur after several years
• Male:Female ratio: Generally 2:1
Epidemiology-2
Geographic variation
Lepromatous (MB type) -18%
(Tanzania) to 63% (West Malaysia)
Neuritic leprosy-18% in India
Lucio type - Mexico
Epidemiology-3
• Deformities - 80% in Taiwan
7.6% in Cameroon
• Higher rate of Foot drop in
India and wrist drop in Japan
Prevalence rate—varies from
10-2500 per 10000 population
Epidemiology-4
Prevalence rate/10000
Agewise
1-5
5-14
>14
(slums)
47
150
247
slums
119
non-slums
52
schools
66
Global Leprosy Situation-2001
No.of cases registered: 635404
Prevalence rate: 1.4 /10000
New cases detected: 763317
Detection rate: 11.9/100 000
South-East Asia region contributed
76.9% of the global case load
Leprosy: top 6 countries-2001
700000
600000
500000
400000
300000
200000
100000
0
Prevalen
Detection
Leprosy: 6 top countries
•6 top endemic countries: India,
Brazil, Myanmar, Madgascar,
Mozambique, Nepal contribute
85% of global case load:
(69% from India)
• 91% of global case new cases
(81% from India)
Magnitude of Disabilities (1995)
1000000
500000
0
B'desh
Thailand
China
Vietnam
India
Guinea
Indonesia
Nigeria
Diagnosis of Leprosy
More than 95% of cases can be
diagnosed clinically even by
paramedical workers
Skin smears for M.leprae would
assist in suspected infectious cases
Biopsy/PCR may be needed rarely
Diagnosis- infectious leprosy
Detection of 5%-10% skin
smear positive leprosy
patients is more important as
they infect others.
If no smear facility, detect
30%-40% of cases with
multiple skin lesions.
Paucibacillary leprosy(PBL)
From “Leprosy” book by Yawalkar 2002
Multibacillary leprosy(MBL)
From “Leprosy” book by Yawalkar 2002
Classification for Treatment
•Multibacillary(MB) leprosy: >5
skin lesions:39%
•Paucibacillary(PB) leprosy: 2-5
skin lesions:52%
•Single skin lesion PB:9%
(WHO 2002)
Multi Drug Therapy
•Kill all viable bacteria & make a
patient non infectious
•Cure an active leprosy patient
quickly from a public health point
Residual signs of inactivity may
persist including persister bacilli in
the deeper tissues
Impact of MDT Program
Cases cured: 12 million (2002)
Fall in case load: 12 million (1977)
to 0.64 million (2002)
Deformities prevented:1-2 million
Relapse rate: < 1 /1000
(WHO 2002)
Trend of Leprosy :1985-2001
-32 countries (WHO)
4500000
4000000
3500000
3000000
2500000
2000000
1500000
1000000
500000
0
1985 1987 1989 1991 1993 1995 1997 1999 2001
Prevalenc
Detection
Child case /Total new cases
-32 countries: 1985-1997 (WHO)
800000
700000
600000
500000
400000
300000
200000
100000
0
1985
1987
1989
1991
Detection
1993
Children
1995
1997
Disabled among new cases
-32 countries:1985-1997 (WHO)
800000
700000
600000
500000
400000
300000
200000
100000
0
1985
1987
1989
1991
Detection
1993
1995
Disabled
1997
Cumulative disabled leprosy cases
-32 countries-1985-1997
4500000
4000000
3500000
3000000
2500000
2000000
1500000
1000000
500000
0
1985
1987 1989
Prevalenc
1991 1993 1995
Disabled
1997
Urban Leprosy Issues-1
• Leprosy Elimination in urban
areas is challenged by Rapid increase in population,
migration, slum/shanty towns,
density, poor living conditions
and violence
Urban Leprosy Issues-2
• Favorable to maintain reservoir of
infection and transmission
• Difficulty in finding hidden cases,
relapse and treatment completion,
private health care participation
Post-Leprosy Elimination issues-1
• Continued transmission
• Early detection of MB case,
relapse, rifampicin resistance
• Sub clinical infection, carriers
• Eradication model, integration
• Uniform MDT for six months
Post-Leprosy Elimination issues-2
• Early detection & treatment of
reactions in 30%-40% of cases
• Prevention of nerve damage
• Prevention & Care of disabled
Post-Leprosy Elimination issues-3
• Patients dissatisfaction for residual
signs after MDT
• Immunoprophylaxis
• Chemoprophylaxis
• Immunotherapy
Partners in Leprosy Elimination
WHO, Nippon Foundation,
Novartis, World Bank, Danida,
ILEP agencies
National Governments &NGOs
endemic countries