7/14/2016 ThepersistingchallengeofleprosyeradicationTheHindu

OPINIONOPENPAGE

February9,2014

Thepersistingchallengeofleprosyeradication
G.Srinivas

TheHindu
WhileIndiacelebratesitsnearvictoryoverpolio,leprosycontinuestohauntit.

TocommemorateMahatmaGandhisselflesseffortstocareforthoseaffectedbyleprosy,January30,thedayofhismartyrdom,isobserved
asAntiLeprosyDay.

Leprosyaffectsclosetoaquartermillionpeople(2,32,857newcasesin2012)acrosstheworld.About58percentofthemareinIndia,where
transmissioncontinuesinspiteofitbeingdeclaredaseliminatedasapublichealthproblemin2005.Indiahastheworldshighestburdenof
thedisease:1,34,752newcasesweredetectedin201213.Onanaverage,everyhourmorethan15newcasesarediagnosedherethataddsup
tosome1,34,000casesayear.Theseinclude13,387children.Importantly,4,650(35percent)ofthesechildrenhavepresentedavisible
disabilityatthetimeofdiagnosis,indicatinglateordelayedpresentation.ThenexthighburdencountryisBrazil,with33,303cases.
Interestingly,ChinainspiteofahigherpopulationascomparedtoIndia,hasreportedonlyabout1,000casesayearsince2005.Soisthecase
withmostAfricancountries.

Leprosyistheworldsoldestrecordeddisease.Itaffectsthenervoussystem,especiallythenervesofthehands,feetandface,andisthe
leadinginfectiouscauseofpermanentdisability.Itiscurable,butleftuntreateditcancausenervedamage,lossoffeeling,paralysisand
blindness.ItisadiseasecausedbythebacteriaMycobacteriumleprae,andisnothereditary.Ithasanincubationperiodrunningupto10
yearsbeforesymptomsappear.Themodeoftransmissionisstillnotconclusivelyproven,althoughpersontopersonspreadvianasal
dropletsisbelievedtobethemainroute.Amajorityofpeoplecontractitthroughcloselongtermcontactwithanuntreatedpatient.Itisnot
transmittedbymeretouch.Healthcareworkersworkforyearswithleprosypatientswithoutcontractingit.

Leprosyisnotverycontagious,andapproximately95percentofthepeoplehavenaturalimmunity.Theearliestsignisapatchontheskin
withlossofsensation.Leftuntreated,itcanprogresstocausedisabilities.Irrespectiveofage,genderandsocialclass,anyonecouldbehit.

Earlydiagnosisandadequatetreatmentareessentialtocurethediseaseandpreventdisabilities.MultiDrugTherapy(MDT),which
combinesthreedrugstokillthebacteriaifusedintheearlystagesofthedisease,canhelpavoiddisabilityanddisfigurement.Globallythere
hasbeenmuchprogresssince1982withtheintroductionofMDT,amiracletreatmentover15millionpeoplehavebeencured.

Inspiteofdeclaringeliminationanepidemiologicaltermdefiningthenumberofleprosycasesasfewerthanoneper10,000population
muchhasremainedthesamewithregardtothenumberofnewcases.Individualswithleprosyarestilldiagnosedlateornottreatedinthe
earlystagesandlandupwithadeformity.Disabilitiesleadtotheirbeingshunned,isolatedandstigmatisedthefearisworsethanthedisease
itself.

TheglobalsituationcontinuestobeinfluencedbytheIndianscene.EffortstakenbyvariousstakeholderstheGovernmentofIndia,State
governments,theInternationalFederationofAntiLeprosyAssociations,nongovernmentalorganisations,Novartis,theWorldHealth

http://www.thehindu.com/opinion/openpage/thepersistingchallengeofleprosyeradication/article5668537.ece 1/2
7/14/2016 ThepersistingchallengeofleprosyeradicationTheHindu
OrganisationandothersinIndiaiscontributingalottoaddressthechallenge.Thegovernmentseffortstoconductspecialcampaignsand
implementactionplansindistrictswithhighburdenin2013and2014help.Butinnovationssuchassystematiccontactsurveys,molecular
diagnostics,andchemoprophylaxisshouldbesteppedup.Heightenedawarenessofsymptomssuggestingleprosy,andofthefactthatleprosy
stillexistsinIndia,shouldhelpcontrolactivities.

WhileIndiacelebratesitsnearvictoryoverpolio,leprosycontinuestohauntit.Concertedeffortsarerequiredtoensuretimelydiagnosisso
thatdisabilitiescanbeprevented,patientsarecuredandthecycleofstigmaanddiscriminationisbroken.

(Dr.G.SrinivasisNationalMedicalAdvisertotheGermanLeprosy&TBReliefAssociation,GLRAIndia,andisbased
inChennai.Email:srinivas@glraindia.org)

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