Eradication a distant goal as new leprosy infections loom
Aditi Tandon
New Delhi, January 27
New infections continue to loom in India making leprosy eradication a distant goal.In 2017, the national leprosy programme detected more than the average annual number of new cases, mainly on account of active house-to-house detection involving physical examination of people in 173 districts of 20 states.
On an average, India has been reporting more than one lakh new leprosy cases annually since 2005.While World Leprosy Day was observed today, the Ministry of Health attributed the spurt in new cases (1,35,000 in 2016-2017) to a mass leprosy surveillance campaign undertaken in 2016-2017 after evidence of rising disability due to the disease.
The government data showed that disability rate due to leprosy doubled between 2005 and 2015, indicating a huge hidden burden of the disease which the government is now tracking in mission mode.
Dr Anil Kumar, Deputy Director General, Leprosy, Government of India, said the high case detection should not cause panic and low case detection should not be seen as a cause of relief.
“It’s a complicated sector. India declared national-level leprosy elimination in 2005. But strangely, between 2005 and 2015 the average annual number of new case detections remained static at a little over one lakh whereas ideally this number should have decreased. On investigation, we found that disability due to the disease had risen two-fold in the decade ending 2015. At the end of 2014-2015, the disability rate due to leprosy was 4.6 persons per 10,000 persons. This indicated a massive hidden burden of the disease. The ministry then started detecting leprosy in mission mode starting 2016-2017, besides expanding treatment networks. The result was — disability rate from leprosy came down to 2.8 per 10,000 persons ending 2017,” added Dr Kumar.
The WHO defines leprosy elimination as the presence of less than one leprosy case per 10,000 persons. Although India had declared national-level elimination of the disease in 2005 and state-level elimination (barring Chhattisgarh and Dadra and Nagar Haveli) in 2012, district-level elimination has not been achieved. The government had committed year 2018 as the deadline for elimination. Eradication, defined as zero case in the community, is even more challenging.
As of now, there are over 110 leprosy endemic districts in India with the prevalence being more than one case per 10,000 persons. The principally affected states are Chhattisgarh, Gujarat, Maharashtra, Bihar, Odisha, Jharkhand and UP. This year the government will consider expanding the indigenous anti-leprosy vaccine to all affected people in endemic districts.
The vaccine has been piloted in Gujarat by the Indian Council of Medical Research and will now be introduced in Chhattisgarh. The ICMR has asked the ministry for a national rollout with India still contributing the most to the global leprosy burden.
Leprosy is caused by the slow multiplying bacillus Mycobacterium leprae and mainly affects the skin, peripheral nerves, mucosa of the upper respiratory tract and eyes. The challenge with leprosy management is its five-year incubation period and the fact that symptoms can take 20 years to appear.
In the interval, unaware carriers can transmit the disease to others adding to the burden. “This makes case detection the key. Earlier the detection, faster the treatment,” says Dr Sripad Patil, Director, ICMR’s Jalma Institute for Leprosy and Other Mycobacterial Diseases.
The Jalma Institute for Leprosy and Other Mycobacterial Diseases recently found ‘live’ leprosy bacteria in muddy water samples from Ghatanpur, Kanpur, the first discovery of ‘live and viable Mycobacterium leprae in the atmosphere’.
Focus on early detection
- India declared national-level leprosy elimination in 2005. But average annual number of new case detections remained static at over one lakh between 2005 and 2015
- Disability rate due to leprosy doubled between 2005 and 2015. But disability rate of 4.6 persons per 10,000 persons in 2015 came down to 2.8 per 10,000 persons in 2017 due to detection of disease in mission mode
- The principally affected states are Chhattisgarh, Gujarat, Maharashtra, Bihar, Odisha, Jharkhand and UP
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