Dr Tarun Narang, Assistant Professor Dermatology, PGI, Chandigarh said ,”It could be because early detection capacity is not matching the level and intensity of disease occurrence and declining leprosy expertise and interest in health care providers, policy makers& NGOs in the country. Although WHO MDT is highly effective and cure leprosy, In a recent research publication (January 2019) in the American Journal of Tropical Medicine & Hygiene by the Department of Dermatology PGIMER, Chandigarh it was noted that over the last 6 years out of 556 new leprosy cases registered for treatment at Leprosy Clinic, 35 patients (6.3%) did not respond to standard MDT treatment and most of these cases had high bacterial load which means that they were highly infectious and would serve as a reservoir of infection and continue to transmit infection. Authors of this pioneer research work led by Dr Tarun Narang and Professor Sunil Dogra at Dermatology Department PGI, Chandigarh treated these MDT drug resistant cases with new treatment regimen consisting Ofloxacin, Clarithromycin and minocycline along with Immunotherapy (MIP vaccine) with successful outcome and cure in all t The alarming trend is that not only the number of new cases is almost same, but most of the new cases being detected are also multibacillary and have infectious potential, leprosy in children and new cases with grade 2 deformities in India have remained the same over the past 15 years. Leprosy is a mildly infectious disease caused by Mycobacterium Leprae. It starts by damaging the small nerves in the skin resulting in a loss of sensation initially in the patches.latter it progresses to involve the hands or the feet which subsequently leads to deformities and disabilities. Although leprosy was eliminated as a public health problem (prevalence less than 1 per 10,000 population) more than a decade ago, it continues to be a serious challenge to human health worldwide.Every two minutes someone is diagnosed with leprosy. Over 6% of people are diagnosed too late to prevent visible disabilities such as damage to hands and feet and severe eyesight impairment. Leprosy was once considered an incurable disease and people affected with leprosy were ostracized from the society and left die in leper homes or outskirts of the cities. However, the introduction of dapsone and subsequently WHO multidrug therapy (MDT) in 1982 transformed the lives of people suffering from leprosy.Ever since its introduction in India in 1984, MDT has played a pivotal role in achieving the epidemiological target of ‘elimination of leprosy as a public health problem’ and has kept the dream of a leprosy free world alive. Leprosy Elimination was attained at a global level in 2000, whereas India achieved the same in December 2005. Although WHO multidrug therapy (MDT)(an effective cure for leprosy – a combination of three drugs, rifampicin, dapsone and clofazimine) taken daily for 6 to 12 months has been instrumental in our fight against leprosy, with more than 16 million cured leprosy cases and a current world prevalence of 0.23 per 10,000 population; the annual new case detection rate (ANCDR) and the child rate have not decreased significantly in the last decade suggesting unabated active transmission of the disease in the community. A total of 216108 newly diagnosed cases of leprosy worldwide were reported by WHO during 2016 and 18472 involved children, representing almost 9% of all new cases which is a significant number and is an indirect measure of ongoing transmission of the disease. “Children affected by leprosy remain invisible and many cases go undetected. The available data on leprosy-related impairments for children is shamefully high, indicating a failure of the health systems to control leprosy and to protect children from the disease,” Alice Cruz, a UN human rights expert specializing in the disease, said in a statement to mark World Leprosy Day on 27 January. Early diagnosis is of primordial importance in stopping leprosy transmission , the study recommended that these patients can be easily identified by a simple test like slit skin smear, which is simple, cheap and reliable test for diagnosing leprosy and should be restarted in peripheral health centres until we get a better diagnostic and monitoring test. NLEP and Govt of India (GOI) have recently introduced three interventions which will lower the incidence of disease in the population, Leprosy Case Detection Campaign (LCDC) is a unique initiative with the objective early detection of leprosy in affected persons so that they can be saved from physical disability and deformity by providing them timely treatment and thus also halting the transmission of disease at the community level.The GOI has also initiated a pilot study to evaluate the effectiveness of MIP (Mycobacterium indicus pranii)vaccine in preventing leprosy when it is given to the contacts of leprosy patients. In addition to immunoprophylaxis or vaccination, post exposure prophylaxis for close contacts aged more than 2 years of leprosy patients with a single dose of directly observed Rifampicin has been started in India to arrest the transmission of leprosy. We have won the battle but the war against leprosy is still on. With all the remarkable achievements in the fight against leprosy, it is hoped that the disease will be eradicated in the near future with continuous efforts of health authorities, strong political will and community participation. Sustaining the same level of focus and commitment will be a challenge. There is a need to sustain and provide quality leprosy services to all persons through general health system, including good referral system. Efforts need to be made to reduce deformity through early detection, self-care, physiotherapy and reconstructive surgery and developing sound surveillance systems. Worldwide efforts are also being made to end the stigma, discrimination and discriminatory laws against leprosy patients. Recently, a Lok Sabha bill seeking to remove leprosy as a ground for divorce have been passed. It stated that the proposed law would ensure the elimination of discrimination against leprosy patients and would help in their integration into the mainstream of society. In one of its recent reports, law commission of India has also recommended the repeal of laws and provisions which were discriminatory against leprosy affected people. India is a signatory to the UN resolution which calls for the elimination of discrimination against persons suffering from leprosy. Besides all these, if we really want to fulfill our dream of a “ Leprosy Free World” we have to strive to improve the standard of living and some of the experts feel that Leprosy should be a part of poverty alleviating strategies and human rights. More commitments including budget are needed. The government is doing its part we as individual level and society should also come forward and help in whatever capacity we can to eradicate leprosy. This day remind us to understand the real need to fight against the leprosy to eradicate disease which seems to be making a comeback. Mahatma Gandhi’s dream of ‘‘Empowerment of People Affected by Leprosy,’’ can only be fulfilled by removing the stigma associated with leprosy and giving them equal rights and this years theme for leprosy day echoes the same ‘Ending Discrimination, Stigma & Prejudice’. We will not be able to eradicate leprosy unless we remove the prejudice or stigma for leprosy from our minds]]>
