Leprosy : Epidemiology and

Control
Introduction

• Hansens disease

• Chronic
• Infectious
• Mycobacterial

• Affects nerves > skin > eyes, muscles, bones, testes and internal
organs
Epidemiology : problem statement

• < 1 case per 10,000 in India (India achieved elimination in 2005)

• ANCDR < 1 /1000

• Except Chhatisgarh and Dadra and Nagar Haveli

Epidemiology : Agent

• Mycobacterium Leprae

• Acid Fast Bacillus

• Intra as well as extra cellular

• Affinity for Schwann cells > Macrophages

• High infectivity and low pathogenicity

Epidemiology : Host

• Human

• Peaks at 20-30 yrs

• More common in males

• If there is high prevalence among children It indicates active

transmission

• Cell Mediated Inmmunity

Epidemiology : Environment

• Warm and humid

• Survives in dried nasal secretions for 9 days

• Survives in moist soil for 46 days

• Response to treatment
• Dapsone – 90 days
• Rifampicin – 3 weeks
Epidemiology : Transmission

• All active cases can transmit disease

Lepromatous Leprosy > Indeterminate > tuberculoid

• Transmissible bacteria are found in high numbers in nasal discharge

of patients

• Discharge from open ulcers

• Droplet infection > direct contact> fomite

• Low incubation period 3-5 years as long as 20 years

Epidemiology : Pathophysiology

• M Leprae

• Transient bacteriemia

• Schwann cells of peripheral nerves (Face or Limb)

Strong immunity
Weak immunity

Pure Neural
lepromatous
Healing spontaneously
multibacillary
Paucibacillary leprosy
Classification

• Indian • Madrid

Indeterminate Indeterminate
Tuberculoid Tuberculoid
Lepromatous Lepromatous
Borderline Borderline
Pure neuritic

Used in field in leprosy programs

Classification

Ridley Jopling

Tuberculoid TT
Borderline tuberculoid BT
Borderline BB
Borderline lepromatous BL
Lepromatous LL

Used in Research
Classification

Characteristic Pauci-bacillary Multi-bacillary

Skin lesion 1-5 >6
Nerve <= 1 1
Skin smear All sites negative 1 or more sites
positive
Control : Aim

• Aim : prevalence <1 /10,000

• Goals :
• Interrupt transmission
• Cure and rehabilitation
• Deformity prevention
Control : Measure

• Estimation of Problem : epidemiological survey to study

transmission by examining school age children (total
prevalence 4 times)
• Early case detection
• Contact Survey : areas where prevalence is < 1/1000
• Group Survey : areas where prevalence is about 1/1000 or
more
• Mass survey : areas with prevalence 10 or more /1000
 Control : Measure
• Epidemiological indicators

• ANCDR = [New Cases (never treated Before)/ population of the area as

on 31 march] x 100,000

• Rate of New cases with Garde -2 disability =

[New cases with Garde 2 disability]/ population of the area as on 31 march]
x 100,000

• Proportion of Child among new cases =

[new case <14 years/total new cases]x 100

• Child Rate = [New Leprosy Cases <14 years/population of the area as on

31 march] x 100,000
 Control : Measure
• Epidemiological indicators

• ANCDR = [New Cases (never treated Before)/ population of the area as

on 31 march] x 100,000

• Rate of New cases with Garde -2 disability =

[New cases with Garde 2 disability]/ population of the area as on 31 march]
x 100,000

• Proportion of Child among new cases =

[new case <14 years/total new cases]x 100

• Child Rate = [New Leprosy Cases <14 years/population of the area as on

31 march] x 100,000
Control : Measure

• MDT
Objective : interrupt transmission
early treatment
prevent drug resistance

Case : clinical signs and symptoms with or without bacteriological

confirmation who has not completed treatment with MDT

Adequate treatment : completion of treatment within reasonable period

of time
9 months for paucibacillary & 18 months for multi bacillary
Control : Measure
• MDT
Objective : interrupt transmission
early treatment
prevent drug resistance

Case : clinical signs and symptoms with or without bacteriological

confirmation who has not completed treatment with MDT

Adequate treatment : completion of treatment within reasonable period

of time
9 months for paucibacillary & 18 months for multi bacillary

Regular treatment : completed at least 2/3 of months of treatment

without break.
Control

• Surveillance : 2 years for pauci and 5 years for multi

• Immunoprophylaxis : under trials

• Chemoprophylaxis : given to close contacts of leprosy

Household contacts
&
Social contacts
Control : Disabilities
Part examined WHO grade Sensory Voluntary
Muscle
Hand 0 Sensation + Normal power
1 Sensation + Normal power
2 Sensation - Weak
Feet 0 Sensation + Normal power
1 Sensation + Normal power
2 Sensation - Weak
Eyes 0 Vision normal No lid gap
blinking +
2 Cannot count Lid gap blinking
finger at 6 m -
Control

• Rehabilitation : correction of physical deformity

social and vocational
opportunities

• Health education :
• Patient and Family – adherence to treatment
• Society – enabling environment inclusion

• Social Support : Assistance in travel, accessible buildings,

vocational opportunities , financial aids
Control : NLEP
• Started in 1955 as National Leprosy Control Program
• Treatment with dapsone (monodrug)

• In 1982 renamed to NLEP with the aim to reduce case load to

<1/10,000

• Components:
• Integrated leprosy services
• Capacity Building
• IEC
• DPMR
• Intensified monitoring and supervision
Control : NLEP

• Involvement of ASHA : incentives

• Case Detection = Rs 250/-
• Completion of MDT course = Rs 400/- for Pauci and Rs
600/- for Multi
• Early Case detection = Rs 250/-
• New case with deformity = Rs 200/-
 Control : NLEP

• DPMR

• Standard Treatment as per National Guidelines for Lepra reactions,

Ulcers, Physiotherapy, MCR shoes Recon surgery
• Convergence of NLEP services under various departments and
integration in NHM facilities
• Referral system
primary level : PHC, CHC, Sub div
hospital
Secondary : District HQ Hospital,
District Nucleus
Tertiary : CLTRI, ICMR JALMA,
ILEP supported hospitals, PMR
 Control : NLEP

• Sprash Leprosy Awareness Campaign: 2017-18 implemented through

Gram Sabha

• SET scheme : encouraging involvement of NGOS

• Incentive to Patient : Rs 8000/- for undergoing major Recon Surgery

irrespective of income

• Nikushth : Real Time Leprosy Reporting software