Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It mainly affects the skin, peripheral nerves, and mucosa. The goal of leprosy elimination programs is to reduce the prevalence rate to less than 1 per 10,000 people. Multi drug therapy (MDT) is highly effective in curing leprosy and reducing transmission by interrupting disease activity in all known cases. Integrating leprosy services into general healthcare helps ensure all cases receive timely treatment to prevent disabilities and further transmission. Monitoring prevalence and detection rates is important to assess program progress toward elimination goals.

1. DR.I.SELVARAJ I.R.M.S
B.Sc.,M.B.B.S.,D.P.H.,D.I.H.,PGCH&FW/NIHFW/
NEW DELHI
• Senior Divisional Medical
Officer, Railway Hospital,
Chennai Division, Southern
Railway, India.

2. LEPROSY
It is a chronic infectious disease caused by
M.leprae, an acid fast, rod shaped bacillus. It
mainly affects the skin, peripheral nerves,
and mucosa of the respiratory tract etc., It
has left behind a terrifying image in history
and human memory of mutilation, rejection
and exclusion from society.

3. Global Leprosy Situation 1998

4.
Leprosy Situation in South East Asia 2001
Thailand 2251 797 0.4 1.3
Country Point Prevalence Cases detected during the
year 2001
Prevalence per 10000 Detection per 100000
Bangladesh 8537 10740 0.6 8.2
Bhutan 40 19 0.2 0.9
India 439782 617993 4.3 60.1
Indonesia 17259 13286 0.8 6.2
Myanmar 8237 9684 1.8 21.0
Nepal 10657 13830 4.4 56.5
Sri Lanka 1570 2309 0.8 12.1
Total 488333 668658 3.2 43.7

5.
Global Leprosy Situation in 2001*
Region Point Prevalence Cases detected
during the year 2001
Africa 45170 39612
Americas 83101 42830
East Mediterranean 7007 4758
South East Asia 488333 668658
Western Pacific 7735 4786
Europe 38 53
World 635404 763317
* As reported by 106 countries.

6. Prevalence of Leprosy in SEA Region as of
April 2001

7. GOAL AND OBJECTIVE OF LEPROSY
ERADICATION PROGRAMME
• Goal: elimination of leprosy i.e.to reduce
the prevalence rate to less than I per
10000 population by the year 2000 AD.
• Objective: To arrest disease activity in all
the known cases of leprosy by the year
2000AD
• Strategy: The elimination strategy

8. CONTROL OF LEPROSY
• It means no longer to be a
public health problem

9. ERADICATION OF LEPROSY
• It is defined as interruption of
transmission of leprosy to attain a
stage of zero level

10. ELIMINATION OF LEPROSY
• The elimination of leprosy as a public health
means reducing the prevalence of leprosy to
below on case per 10000 population.
• Elimination of leprosy will be achieved by:
• Making MDT accessible to all communities and
areas.
• Treating all registered cases with MDT
• Diagnosing and promptly treating all new cases
• Improving quality of patient care, including
disability prevention and management
• Ensuring reqularity and completion of treatment
• Enlisting community support for the programme

11. INCIDENCE OF LEPROSY
Incidence is the number of new
cases (only the new cases) of a
particular disease that occur in a
defined population over a defined
period of time. The time period
used is conventionally one year.

12. PREVALENCE OF LEPROSY
1. Point Prevalence
2. Period Prevalence

13. Point prevalence
• The number of persons with a
disease at a specified point in
time in a defined Population

14. Period prevalence
• The number of persons with a
disease in a defined
population within a specified
period of time

15. SUSPECT CASE OF LEPROSY
• One or more suggestive skin patches with
normal sensation
• Extensive loss of sensation in the hands or
feet with no other evidence of leprosy
• One or more grossly enlarged peripheral
nerve trunks with no sensory loss or skin
lesion
• Painful nerves with no other evidence of
leprosy
• Painless ulcers on hands and/or feet with no
other evidence of leprosy
• Nodules on the skin with no other evidence

16. WHO IS LIKELY TO REPORT TO THE HEALTH
CENTRE
• Leprosy cases who were never treated before
• Leprosy cases who had treatment with
dapsone in the past
• Leprosy cases who had treatment with MDT
in the past
• Suspect cases
• With other skin lesions
• Other conditions causing nerve damage
• Contacts of leprosy patients for check up
• Normal individual for information

17. How to examine for leprosy?
Examine in a well-lit room
Examine the whole body
Ask since when the patch was noticed
Ask what treatments have been tried
Test for sensation
Look for any visible deformities

18. How to diagnose leprosy
Examine skin
Check for patches
Test for sensation
Count the number of patches
Look for damage to nerves

19. DIAGNOSIS OF LEPROSY
• Hypopigmented or reddish skin lesion(s)
with definite loss of sensation
• Damage to the peripheral nerves, as
demonstated by loss of sensation
• Weakness of the muscles of hands, feet or
face
• Positive skin smear

20. FLOW CHART FOR DIAGNOSIS
AND CLASSIFICATION
O N E S K I N L E S I O N
S L P B le p r o s y
2 - 5 S K I N L E S I O N
P B L E P R O S Y
M o r e t h a n 5 le s io n s
M B L E P R O S Y
S K I N L E S I O N A N D
S E N S O R Y L O S S - L E P R O S Y

21. Leprosy - one of the few diseases
which can be eliminated
Leprosy meets the demanding criteria
for elimination
practical and simple diagnostic tools: can
be diagnosed on clinical signs alone;
the availability of an effective intervention
to interrupt its transmission: multidrug
therapy
a single significant reservoir of infection:
humans.

22. Elimination strategy
• Providing domicillary MDT to all communities
and areas
• Breaking the chain of transmission by intensive
case detection and promptly treatment activities
• Improving quality of patient care, including
disability prevention and management
• Ensuring regularity and completion of treatment
• Encouraging and ensuring community
participation
• Providing rehabilitation to the needy patients
• Organising health education to patients , their
families and community.

23. ADVANTAGES OF MDT
• Highly effective in curing the disease
• Reduces the period of treatment
• Well accepted by patients
• Easy to apply in the field
• Prevents development of drug resistance
• Interrupts transmission of infection
• Reduces risk of relapse
• Prevents disabilities
• Improves community attitude

24. POINTS ON MDT TREATMENT
• Every leprosy patient should receive tratment with
more than one antileprosy drug
• Standard MDT is very safe and effective
• It is available free of charge for leprosy patients
• Standard MDT is for a fixed duration
• At the completion of a full course of MDT the patient is
cured
• Use clinical criteria to classify and decide the
treatment regimen
• If in doupt of classification, give MB treatment regimen
• Active follow-up after completion of treatment is not
necessary
• In case of relapse, re-treat with appropriate standard
MDT regimen

25. Treatment regimens
PB Adult
(6 blister packs) to be taken monthly within a maximum period of 9
months
Rifampicin 600 mg once a month
Dapsone 100 mg every day
MB Adult
(12 blister packs) to be taken monthly within a maximum period of 18
months
Rifampicin 600 mg once a month
Clofazimine 300 mg once a month
Clofazimine 50 mg and dapsone 100 mg every day
SLPB
Single dose ROM
Rifampicin 600 mgm
Ofloxacin 400 mgm
Minocyclin 100 mgm

26. Multi Drug Therapy

27. When treatment is completed
Congratulate the patient
Thank family/friends for their support
Reassure that MDT completely cures leprosy
Any residual lesions will fade away slowly
Show them how to protect anaesthetic areas and/or
disabilities
Encourage to come back in case of any problem
Tell that they are welcome to bring other members
of family or friends for consultation
Remove the patient’s name from the treatment
register

28. ORGANISING MDT
SERVICES
• Updating register
• Screening patients
• Selecting MDT regimen
• Preparing treatment register
• Delivering MDT to patients
• Managing MDT supply
a) estimating MDT requirements
b) procuring
c) storage
d) Shelf life
e) Keeping records

29. ASSESSING PROGRESS WITH MDT
IMPLEMENTATION
• MDT COVERAGE
• Number of patients cured with MDT
• Defaulters
• MDT drug utilisation
• Regular and uninterrupted supply of drugs
is very important for MDT programme

30. PROVISION OF EFFICIENT HEALTH
SERVICES
• Diagnose leprosy and classify the disease clinically
• Recognise and manage the common complications
of the disease
• Identify and refer serious complications
• To ensure regular supply of MDT
• Maintain proper recording and reporting
• Organise convenient locations and timing of the
clinics
• Maintain cardial and friendly relations with all
patients and the local community
• Ensure commitment and motivation to eliminate
leprosy from the area

31. MONITORING INDICATORS
• Point Prevalence Rate – Indicator of magnitude of the
problem
• Monthly&Annual New Case detection rate –Indicator
of impact of the programme
• Proportion of children among new cases – Indicator
of early detection
• Proportion of new cases with deformity – Indicator of
effectiveness of programme implementation
• Proportion of MB among new cases – Indicator of late
detection
• Prevalence discharge ratio – Indicator of progress of
the programme related to cure
• Clinic attendance –Indicator of regularity of
treatment

32. Why integrate leprosy into the general
health services?
Integration means to provide “comprehensive”
essential services from one service point
to improve patients’ access to leprosy services and
thereby ensure timely treatment
to remove the “special” status of leprosy as a
complicated and terrible disease
to consolidate substantial gains made
to ensure that all future cases receive timely and
correct treatment
to ensure that leprosy is treated as a simple disease

33. Why coverage is important?
Good coverage means that:
health facilities are easily accessible to every
member of the community
health services are provided on a daily basis
health workers are able to diagnose, cure and
provide basic information about the disease
health facilities are distributed equally in all
areas
urban/rural, male/female, poor/rich, tribal/others, etc.

34. Advantages of Integrating
Leprosy Services
Transmission of infection interrupted early
Stigma reduced further
Development of deformities prevented
Patients treated early
Patients detected early

35. Why disabilities occur?
Disabilities such as loss of sensation and
deformities of hands/feet/eyes occur because:
Late diagnosis and late treatment with MDT
Advanced disease (MB leprosy)
Leprosy reactions which involve nerves
Lack of information on how to protect insensitive
parts

36. Disabilities can be prevented
The best way to prevent disabilities is:
early diagnosis and prompt treatment with MDT
Inform patients (specially MB) about common
signs/symptoms of reactions
Ask them to come to the centre
Start treatment for reaction Inform them how to
protect insensitive hands/ feet /eyes
Involve family members in helping patients

37. MORE FACTS ABOUT LEPROSY-1
• NATIONAL LEPROSY CONTROL PROGRAMME WAS STARTED
IN 1955
• NATIONAL LEPROSY ERADICATION PROGRAMME WAS
RENAMED IN 1983
• PREVALENCE OF LEPROSY IN INDIA WAS 57/10000 IN 1981
• AFTER MDT INTERVENTION, IT WAS REDUCED TO 5.07/10000 IN
MARCH,2000
• A TOTAL OF 8.84 MILLION PATIENTS CURED WITH MDT
• 19 STATES HAVE ACHIEVED ELIMINATION BY 2000
• 8 STATES ARE LIKELY TO ACHIEVE BY 2002
• 5 STATES BY 2005
• CURRENT STRATEGY IS (MLEC) COMPAIGN IN 30 STATES
• MLEC-1 WAS LAUNCHED IN 1997-1998
• MLEC-2 WAS CONDUCTED IN 1999-2000
• ABOUT 2,20,000 WERE DETECTED WHICH ARE NOW BEING
TREATED
• 3,76,000 PARAMEDICAL PERSONNEL INCLUDING DOCTORS AND
3,78,000 VOLUNTEERS WERE TRAINED
• SAPEL PROGRAMME IN INACCESSIBLE AREAS

38. MORE FACTS ABOUT LEPROSY-2
• FOUR LEPROSY VACCINES ARE CURRENTLY IN
TRAIL
• 1)BCG –34.1% PROTECTION
• 2)BCG+KILLED M.LEPRAE – 64.0%
• 3)M.W – 25.7%
• 4)ICRC – 65.5%
• 70% LAI are concentrated in the states of
Bihar,UP,WB,Orissa,and MP.Bihar alone is having
32% recorded cases of LAI IN INDIA
• The prevalence of leprosy in PUNJAB,NAGALAND,and
HARYANA is 1 per 10000
• 7 CONTROLLED TRAILS AND 9 CASE –CONTROL
STUDIES EVALUATING THE ROLE OF BCG IN
PREVENTION OF LEPROSY WERE CARRIED OUT
AROUND THE WORLD