In October 2016 when the Health Department started active surveillance in the community for early detection of leprosy cases, it was not expected to throw up any major surprises.
With a prevalence rate of 0.2/10,000 population and with nearly 90% having high immunity against the disease, Kerala has always been one of the low endemic States for leprosy. However, with 44 new child cases of leprosy being detected in the community in the past one year, health officials now say leprosy is still very much in circulation in the community .
Bringing down leprosy prevalence, child cases, and leprosy deformity to prevent active transmission in the community was one of the first programmes launched by the State in October 2016, as one of the health targets to be achieved by 2020, based on UN’s Sustainable Development Goals.
“In October 2016, when we started active surveillance amongst schoolchildren, we intended to survey just 40 blocks in the State. But as more child cases surfaced, we decided to survey all the blocks. The survey is not yet complete. It is a matter of relief that 39 out of the 44 cases we detected are paucibacillary (PB), indicating that these are less infectious cases. On the other hand, there will be few skin lesions in PB cases of leprosy and hence cases are likely to be missed too,” says J. Padmalatha, State Leprosy Officer. In Kerala, about 70% of the leprosy cases used to be multibacillary (MB), which has a high bacterial load and needs longer multi-drug treatment.
Children have lower immunity than adults and hence child cases of leprosy should be considered as index cases. This means that there are many more cases in the community which have not come to surface.
But because the State’s case load has always been low, people here do not even have any basic information about leprosy. Voluntary reporting will improve only if people have the right information about the disease.
“Our priority now is to improve public awareness about leprosy so that people are primed towards early detection and treatment. If you have any hypo-pigmented patches on your skin or any unexplained numbness on your fingers or limbs, you should consider leprosy also as a possibility and seek a dermatologist’s service,” Dr. Padmalatha says.
But following intensive activities, the situation has reversed and more of paucibacillary cases are being reported now. Deformity cases have also gone down. This means that early detection is happening to a certain extent in the State and that Kerala is on the right track for eradication of leprosy by 2020.