Leprosy
Key facts
- Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae.
- Official figures show that almost 182 000 people, mainly in Asia and Africa, were affected at the beginning of 2012, with approximately 219 000 new cases reported during 2011.
- M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear.
- Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.
- Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes.
- Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes.
Leprosy is curable and treatment provided in the early stages averts disability.
Multidrug therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.
Leprosy today
Leprosy control has improved significantly due to national and subnational campaigns in most endemic countries. Integration of primary leprosy services into existing general health services has made diagnosis and treatment of the disease easy. The implementation of the global leprosy strategy 2011–2015 national leprosy programmes now focus more on underserved populations and inaccessible areas to improve access and coverage. Since control strategies are limited, national programmes actively improve case holding, contact tracing, monitoring, referrals and record management.
According to official reports received from 105 countries and territories, the global registered prevalence of leprosy at the beginning of 2012 stood at 181 941 cases. The number of cases detected during 2011 was 219 075 compared with 228 474 in 2010.
Pockets of high endemicity still remain in some areas of Brazil, Indonesia, Philippines, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. All endemic countries remain highly committed to eliminating the disease, and continue to intensify their leprosy control activities.
Brief history - disease and treatment
Leprosy was recognized in the ancient civilizations of China, Egypt and India. The first known written mention of leprosy is dated 600 BC. Throughout history, the afflicted have often been ostracized by their communities and families.
Although leprosy was treated differently in the past, the first breakthrough occurred in the 1940s with the development of the drug dapsone, which arrested the disease. But the duration of the treatment was many years, even a lifetime, making it difficult for patients to follow. In the 1960s, M. leprae started to develop resistance to dapsone, the world’s only known anti-leprosy drug at that time. In the early 1960s, rifampicin and clofazimine, the other two components of recommended multidrug therapy (MDT), were discovered.
In 1981, a WHO Study Group recommended MDT. MDT consists of 3 drugs: dapsone, rifampicin and clofazimine and this drug combination kills the pathogen and cures the patient.
Since 1995, WHO provides free MDT for all patients in the world, initially through the drug fund provided by the Nippon Foundation and since 2000, through the MDT donation provided by Novartis and the Novartis Foundation for Sustainable Development.
Elimination of leprosy as a public health problem
In 1991 WHO's governing body, the World Health Assembly (WHA) passed a resolution to eliminate leprosy by the year 2000. Elimination of leprosy is defined as a prevalence rate of less than 1 case per 10 000 persons. The target was achieved on time and the widespread use of MDT reduced the disease burden dramatically.
- Over the past 20 years, more than 14 million leprosy patients have been cured, about 4 million since 2000.
- The prevalence rate of the disease has dropped by 90% – from 21.1 per 10 000 inhabitants to less than 1 per 10 000 inhabitants in 2000.
- Dramatic decrease in the global disease burden: from 5.2 million in 1985 to 805 000 in 1995 to 753 000 at the end of 1999 to 181 941 cases at the end of 2011.
- Leprosy has been eliminated from 119 countries out of 122 countries where the disease was considered as a public health problem in 1985.
- So far, there has been no resistance to antileprosy treatment when used as MDT.
- Efforts currently focus on eliminating leprosy at a national level in the remaining endemic countries and at a sub-national level from the others.
Actions and resources required
In order to reach all patients, leprosy treatment needs to be fully integrated into general health services. Moreover, political commitment needs to be sustained in countries where leprosy remains a public health problem. Partners in leprosy elimination also need to continue to ensure that human and financial resources are available.
The age-old stigma associated with the disease remains an obstacle to self-reporting and early treatment. The image of leprosy has to be changed at the global, national and local levels. A new environment, in which patients will not hesitate to come forward for diagnosis and treatment at any health facility, must be created.
WHO response
The WHO Strategy for leprosy elimination contains the following:
- ensuring accessible and uninterrupted MDT services available to all patients through flexible and patient-friendly drug delivery systems;
- ensuring the sustainability of MDT services by integrating leprosy services into the general health services and building the ability of general health workers to treat leprosy;
- encouraging self-reporting and early treatment by promoting community awareness and changing the image of leprosy;
- monitoring the performance of MDT services, the quality of patients’ care and the progress being made towards elimination through national disease surveillance systems.
Sustained and committed efforts by the national programmes along with the continued support from national and international partners have led to a decline in the global burden of leprosy. Increased empowerment of people affected by the disease, together with their greater involvement in services and community, will bring us closer to a world without leprosy.