India’s fight against leprosy — 16 years after being eliminated globally as a public health issue — is far from over. The World Health Organization (WHO) asked South-East Asian countries, including India which accounted for 60% per cent of such cases worldwide in 2015, to focus on preventing disabilities in children.
According to WHO, leprosy affected 2,12,000 people globally in 2015. India alone reported 1,27,326 new cases, accounting for 60% of new cases globally. The other high-burden countries were Brazil and Indonesia. Of the new cases, 8.9% were children and 6.7% presented with visible deformities. The remaining 10,286 new cases (5%) were reported by 92 countries. Thirty countries reported zero new cases.
‘Unacceptable numbers’
India is among the 22 countries considered as having a “high burden for leprosy” along with high transmission by WHO. “Despite being eliminated globally as a public health problem in 2000, leprosy continues to mar the lives of individuals, and impacts families and communities. Though present numbers are a fraction of what was reported a decade ago, they are unacceptable, as an effective treatment for leprosy — multidrug therapy, or MDT — has been available since the 1980s and can fully cure leprosy,” says Dr. Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.
The number of new cases indicates the degree of continued transmission of infection. Global statistics show that 1,99,992 (94%) of new cases were reported from 14 countries reporting more than 1,000 new cases each. Only 6% of new cases were reported from the rest of the world.
How it spreads
While the mode of transmission of leprosy is not known, the most widely held belief is that the disease was transmitted by contact between those with leprosy and healthy persons. More recently, the possibility of transmission by the respiratory route is gaining ground. There are also other possibilities such as transmission through insects which cannot be completely ruled out. Although leprosy affects both sexes, in most parts of the world males are affected more frequently than females, often in the ratio of 2:1, according to WHO’s Global Leprosy Report.
World Leprosy Day is observed on the last Sunday of January since 1954. Dr. Singh says that “to effectively combat stigma, a multi-sectoral approach is needed. Health authorities need to reach out to and include leprosy-affected persons and communities in their programming. Laws or regulations that sanction or abet discrimination against persons suffering from leprosy should be repealed. A concert of voices should be mobilised to counter harmful social attitudes. Non-governmental and civil society organisations should be included in campaigns to challenge leprosy-related stigma, and to address discrimination against affected persons and their family members.”
In 2016, WHO launched the Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world, with the aim of reinvigorating efforts to control leprosy and avert disabilities, especially among children still affected by the disease in endemic countries.
India, which is among the endemic countries, has been advised to include strategic interventions in national plans to meet the new targets, such as screening all close contacts of persons affected by leprosy; promoting a shorter and uniform treatment regimen, and incorporating specific interventions against stigmatisation and discrimination.
vidya.krishnan@thehindu.co.in
