Click HERE to view online article on THE HINDU from Feb 9, 2013
The persisting challenge of leprosy eradication
To commemorate Mahatma Gandhi’s selfless efforts to care for those affected by leprosy, January 30, the day of his martyrdom, is observed as Anti-Leprosy Day.
Leprosy affects close to a quarter million people (2,32,857 new cases in 2012) across the world. About 58 per cent of them are in India, where transmission continues in spite of it being declared as eliminated as a public health problem in 2005. India has the world’s highest burden of the disease: 1,34,752 new cases were detected in 2012-13. On an average, every hour more than 15 new cases are diagnosed here; that adds up to some 1,34,000 cases a year. These include 13,387 children. Importantly, 4,650 (35 per cent) of these children have presented a visible disability at the time of diagnosis, indicating late or delayed presentation. The next high-burden country is Brazil, with 33,303 cases. Interestingly, China in spite of a higher population as compared to India, has reported only about 1,000 cases a year since 2005. So is the case with most African countries.
Leprosy is the world’s oldest recorded disease. It affects the nervous system, especially the nerves of the hands, feet and face, and is the leading infectious cause of permanent disability. It is curable, but left untreated it can cause nerve damage, loss of feeling, paralysis and blindness. It is a disease caused by the bacteria Mycobacterium leprae, and is not hereditary. It has an incubation period running up to 10 years before symptoms appear. The mode of transmission is still not conclusively proven, although person-to-person spread via nasal droplets is believed to be the main route. A majority of people contract it through close long-term contact with an untreated patient. It is not transmitted by mere touch. Health care workers work for years with leprosy patients without contracting it.
Leprosy is not very contagious, and approximately 95 per cent of the people have natural immunity. The earliest sign is a patch on the skin with loss of sensation. Left untreated, it can progress to cause disabilities. Irrespective of age, gender and social class, anyone could be hit.
Early diagnosis and adequate treatment are essential to cure the disease and prevent disabilities. Multi-Drug Therapy (MDT), which combines three drugs to kill the bacteria if used in the early stages of the disease, can help avoid disability and disfigurement. Globally there has been much progress since 1982 with the introduction of MDT, a miracle treatment; over 15 million people have been cured.
In spite of declaring elimination — an epidemiological term defining the number of leprosy cases as fewer than one per 10,000 population — much has remained the same with regard to the number of new cases. Individuals with leprosy are still diagnosed late or not treated in the early stages and land up with a deformity. Disabilities lead to their being shunned, isolated and stigmatised; the fear is worse than the disease itself.
The global situation continues to be influenced by the Indian scene. Efforts taken by various stakeholders — the Government of India, State governments, the International Federation of Anti-Leprosy Associations, non-governmental organisations, Novartis, the World Health Organisation and others in India is contributing a lot to address the challenge. The government’s efforts to conduct special campaigns and implement action plans in districts with high burden in 2013 and 2014 help. But innovations such as systematic contact surveys, molecular diagnostics, and chemoprophylaxis should be stepped up. Heightened awareness of symptoms suggesting leprosy, and of the fact that leprosy still exists in India, should help control activities.
While India celebrates its near-victory over polio, leprosy continues to haunt it. Concerted efforts are required to ensure timely diagnosis so that disabilities can be prevented, patients are cured and the cycle of stigma and discrimination is broken.
(Dr. G. Srinivas is National Medical Adviser to the German Leprosy & TB Relief Association, GLRA India, and is based in Chennai. E-mail: email@example.com )