Leprosy is a major public health problem in India and the World. Despite of having many programs to eliminate it, India is sharing a major burden of this disease. To understand this problem and the present measures adopted this presentation has been created.

1. DR BHAVNA JAIN
POST GRADUATE
DEPARTMENT OF
COMMUNITY MEDICINE
LLRM MEDICAL COLLEGE,
MEERUT
1

2. INTRODUCTION
HISTORY
PROBLEM STATEMENT
EPIDEMIOLOGY:
- AGENT
- HOST
- ENVIRONMENT
- INCUBATION PERIOD
- MODE OF SPREAD
CLASSIFICATIONS
CLINICAL SIGNS AND SYMPTOMS
DIAGNOSIS
2

3. LEPROSY CONTROL
TREATMENT
COMPLICATIONS
NLEP
RECENT ADVANCES
SUMMARY
REFERENCES
3

4. Leprosy has afflicted humanity, left behind a terrifying image
in history and human memory of mutilation, rejection and
exclusion from society.
It is the oldest disease of mankind and not a disease of modern
civilization.
Lots of people have suffered its chronic course of incurable
disfigurement and physical disability.
It is health problem, social problem and an economic problem.
4

5. LEPROSY IS A SOCIAL DISEASE
ASSOCIATED WITH A STIGMA 5

6. Leprosy (Hansen’s disease) is a Chronic granulomatous
infectious disease.
Caused by Mycobacterium leprae
Mainly involves the peripheral nerves and skin
Other organs may involve:
 Mucosa of mouth
 Upper respiratory tract
 Eyes, Bones, Lymph nodes, Muscles, other visceras, Testes etc.
Commonly involves every organ except :
 CNS, Ovary and Lungs.
6

7. Word leper comes from Greek word “scaling”.
Also known as Kustha Roga (derived from Sanskrit word
Kushanti meaning eating away) & attributed to punishment
or curse of God.
M. leprae was discovered by Gerhard Henrik Armauer
Hansen in 1873 in Norway. Hence referred to as Hansen’s
disease.
7

8. 1916 - Mitusda described lepromin test
1943 - sulphone drugs used in the treatment
1955 - GOI launched National Leprosy Control Programme
Leprosy control started with the use of chaulmoogra oil and for
the last three decades, MDT has been the main tool against
leprosy.
1981 - Multidrug Therapy (MDT) was introduced for the
treatment.
1983 - NLCP redesigned to National Leprosy Eradication
Program.
1997 NLEP appraised to National Leprosy Elimination Campaign
8

9. WORLD: Prevalence- 1985: 21.1 cases/10,000 population
2015: 0.29 cases/10,000 population
Over the past 20 years, more than 16 million patients have
been cured
Leprosy eliminated in 119 out of 122 countries where the
disease was considered as a public health problem in 1985.
The global burden of leprosy has declined from 5.2 million
cases in 1985 to 174,608 cases in 2015.
Till date there is no resistence to antileprosy medications when
used in MDT.
9

10. SOUTH EAST ASIAN REGION (SEAR):
210,758 new cases of leprosy were detected during 2015. The
number of new cases detected during 2015 in 14 countries
that reported accounted for 95% of all new cases;
In SEAR:
Multibacillary :60.2%
Females : 38.8%
Children (<15yr) : 8.9%
Grade-2 disability: 6.7%
10

11. 11

12. 12

13. 13

14. AGENT FACTOR:
AGENT :
 Caused by M. leprae.
 Acid fast bacilli, stained with ZN staining
 Rod shaped and occur in clumps or bundles (called globi).
 They have affinity for Schwann cells and cells of the reticulo-
endocrine system.
14

15. 15

16.  The bacterial load is the highest in the lepromatous cases
(2 to 7 billion were estimated in one gram of leproma)
 Phenolic glycolipid (PGL) is the specific antigen for M. lepra
 still has not been cultivated on artificial medium or tissue
culture and produces no known toxins, but can grow in:-
 Nude mouse
 Nine banded armadillos (best)
16

17. SOURCE OF INFECTION
 Multibacillary cases important source of infection
 All patients with “active leprosy” must be considered infectious
 Main reservoir : Human being
 Animal reservoirs
9-banded armadillos
Chimpanzees
Mangabey monkeys
Sphagnum moss
17

18. PORTAL OF EXIT
 Nose (nasal mucosa) is a major portal of exit.
 Can also exit through ulcerated or broken skin of
bacteriologically positive cases of leprosy.
INFECTIVITY
 Highly infectious but of low pathogenicity
 Can be rendered non – infectious by treatment with dapsone
for 90 days or with rifampicin for 3 weeks
 Local application of rifampicin (drops or spray) can destroy
bacilli within 8 days
18

19. ATTACK RATES
Among household contacts of lepromatous cases, 4.4% to 12%
is expected to show signs of leprosy within 5 years.
HOST FACTORS:
AGE
 Infection can take place at any time depending upon the
opportunity for exposure.
 Incidence rates peak between 10 and 20 years of age and then
fall.
 A high prevalence of infection among children means that the
disease is active and spreading
19

20. SEX
 Incidence and prevalence higher in males than in females.
MIGRATION
 Mostly a rural problem due to migration it is causing a problem
in urban areas also.
PREVALENCE POOL
 Constant flux resulting from inflow and outflow.
 Inflow: new cases, relapse, immigration.
 Outflow: cure, inactivation, death, emigration.
20

21. INACTIVATION OF DISEASE
 Even in the absence of specific treatment a majority of patients
particularly of tuberculoid and intermediate type tend to get
cured spontaneously.
IMMUNITY
 Cell Mediated Immunity is responsible for resistance to
infection with M.leprae. In lepromatous leprosy there is
complete breakdown of CMI.
 antibodies are more pronounced at lepromatous end.
 similarly an increase of immunoglobulins IgG and IgM is noted
towards lepromatous end
21

22. GENETIC
 Human lymphocyte antigen (HLA) linked genes influence the
type of immune response that develops
ENVIRONMENTAL FACTORS:
 Humidity favours survival of M.leprae
 Can remain viable in dried nasal secretion at least 9 days
 In moist soil at room temp. for 46 days
SOCIAL FACTORS:
poverty
Overcrowding, lack of ventilation
poor housing
lack of personal hygiene
22

23. INCUBATION PERIOD:
 long incubation period of 3 to 5 years or more for lepromatous
cases.
 Tubercoloid leprosy has a shorter IP.
MODES OF TRANSMISSION:
Droplet infection : Aerosols containing M. leprae
Contact transmission
 Person to person by close contact (direct or indirect)
Other routes
 Insect vectors : mosquitoes, bedbugs
 Tattooing needles
23

24. Classifications are based on clinical, bacteriological,
immunological and histological status of patient.
Types:
 Indian classification
 Madrid classification
 Ridley Jopling classification
 WHO classification
24

25. INDIAN CLASSIFICATION
 Indeterminate type
 Tuberculoid type
 Borderline type
 Lepromatus type
 Pure neuritic type
MADRID CLASSIFICATION
 Indeterminate type
 Tuberculoid type
 Borderline type
 Lepromatus type
25

26. RIDLY AND JOPLING CLASSIFICATION
 Indeterminate type
 Tuberculoid type
 Borderline type
 Lepromatus type
 Pure neuritic type
WHO CLASSIFICATION(1981,87,93)
PAUCIBACILLARY
LEPROSY
MULTI BACILLARY
LEPROSY
1 to 5 skin lesion More than 5 skin lesion
Asymmetrical
distribution
Symmetrical distribution
Definite loss of
sensation
Loss of sensation
may or may not be present
BI <2 at all sites in the
initial skin smear
BI >= 2 at any site in the
initial skin smear
26

27. W H O CLASSIFICATION (FOR
CHEMOTHERAPY – M. LEPRAE)
PAUCIBACILLARY
LEPROSY
MULTI BACILLARY
LEPROSY
Indeterminate (I) Mild borderline (BB)
Borderline tuberculoid (BT) Borderline lepromatous (BL)
Polar tuberculoid (TT) Lepromatous (LL)
27

28. 28

29. The indian classification (1981) is the official classification of the
Indian Leprosy Association( Hind Kusht Nivaran Sangh). It is a
clinic-bacterial classification.
Features are:
INDETERMINATE TYPE:
 Earliest & transitory stage
 One or two vague hypo pigmented macule with definite sensory
impairment.
 These lesions are bacteriologically negative (SSS –ve)
29

30. Indeterminate leprosy :Hypopigmented patch, sensation normal,
.no palpable peripheral nerve and slit skin smear negative
30

31. TUBERCULOID TYPE:
One or two well defined lesions
Asymmetrically distributed on trunk and limbs
Well defined lesions which may be flat or raised
Erythematous or hypo pigmented, and are anaesthetic.
One or two nerves may be enlarged near the skin lesion
Bacteriologically Negative (SSS –ve).
Lepromin test may be strongly positive
31

32. Tuberculoid leprosy: Two hypo
pigmented patches, hypoasthetic
.well defined borders, palpable
peripheral nerve and SSS
negative
Tuberculoid Leprosy: Annular,
erythematous, anaesthetic patch
with well defined and raised
borders and SSS Negative
32

33. BORDERLINE TYPE (BB, BT, BL): 33

34. Borderline Tuberculoid Leprosy: Well-
defined large anaesthetic patches
with satellite lesions. SSS Negative
Borderline Borderline Leprosy: Less
defined, asymmetrically distributed
hypoaesthetic patches. SSS positive
Borderline Lepromatous Leprosy:
Numerous, hypoaesthetic almost
symmetrically distributed patches . SSS
positive
34

35. LEPROMATOUS LEPROSY:
Very numerous ill defined lesions.
(macules, patches, papules, and nodules).
Symmetrically distributed all-over the body
Loss of eyebrows and eyelashes.
Leonina facies.
No sensory impairments in lesions .
Peripheral nerves symmetrically enlarged.
Slit skin smear always positive.
35

36. 36

37. Those cases which show nerve involvement but
no skin lesions.
Bacteriologically negative.
37

38. CARDINAL FEATURES
 Hypo-pigmented patches
 Partial or total loss of cutaneous sensation in the affected
area (light touch is the earliest sensation to be lost)
 Presence of thickened nerves
 Presence of acid-fast bacilli in the skin or nasal smear
38

39. SIGNS OF ADVANCED DISEASE:
 Lumps or nodules in the skin of the face and ears
 Plantar ulcers
 Loss of fingers or toes
 Nasal depression
 Foot drop and claw toes
 Other deformities
39

40. DONE BY:
History & Clinical examination
Bacteriological examination:
By: skin smears, nasal smears or blows, nasal scrappings
Foot pad culture
Histamine test
Biopsy
Immunological test:
By: (a) tests for detecting Cell Mediated Immunity
Lepromin test
Lymphocyte transformation test (LTT) and Leucocyte migration inhibition
test(LMIT)
(b) tests for humoral response to M.leprae
Flourescent leprosy antibody absorption test (FLA-ABS)
Monoclonal antibodies
ELISA
Phenolic glycolipid antigen (PGL)
40

41. HISTORY:
 Patients Bio data : name, age, sex, address
 Presenting complaints
 Family history of leprosy
 Contact with leprosy cases
 Previous history of treatment for leprosy, if any
CLINICAL EXAMINATION:
 A thorough inspection of the body surface(skin).
 Palpation of commonly involved superficial nerves:
41

42.  Ulnar N. near the medial epicondyle.
 2.Greater Auricular N as it turns over SCM muscle.
 3.Lateral Popliteal N.
 4.Dorsal branch of Radial N.
TESTING FOR :
 1.Loss of sensation : heat, cold, pain, touch .
 2.Paresis or paralysis of muscles of hands and feet.
42

43. Nerve palpation 43

44. BACTERIOLOGICAL EXAMINATION:
Skin Smears :
 Simple and valuable test.
 It is needed for diagnosis.
 Monitor the progress of the treatment
 Pinch the site tight, Incise, Scrape & collect material
 Smear on a slide, Air dry & fix, Stain (Z-N method)
 Sites are: Ear lobe, Forehead, Gluteal region,Active edge of
patch.
44

45. Nasal Smears or blows :
 Nasal smears can be best prepared from early morning mucus
material.
Nasal Scrapings :
 After going in 4.5 cm the blade is rotated towards the septum
and scrapped a few times and withdrawn.
BACTERIAL INDEX:
 It is the only objective way of monitoring benefit of treatment.
 It indicates the density of leprosy bacilli in smears and
includes both living (solid staining) and dead (fragmented or
granular) bacilli.
45

46. According To Ridley’ Logarithmic Scale It Ranges From 0 To
6+ and is based on the no. of bacilli seen in an average
microscopic field.
B 0 stands for no bacilli in any of 100 oil immersion field.
46

47. 47

48. MORPHOLOGICAL INDEX:
 The MI is calculated after examining 200 pink-stained free
standing bacilli.
 The percentage of solid staining bacilli in a stained smear is
referred to as MI.
 It is a valuable indicator of the patient’s response to treatment
during the first few months and helps to signal drug resistance.
SOLID FRAGMENTED GRANULAR(SFG) PERCENTAGE:
 It gives a better picture as solid fragmented and granular
bacilli are mentioned separately. It is similar to MI but a more
sensitive indicator of the patient’s response to treatment.
48

49. FOOT-PAD CULTURE:
 Only certain way of identifying M. Leprae is to inoculate the
material into foot pads of mice and demonstrate its
multiplication
 10 times more sensitive at detecting the bacilli than slit skin
smear.
 Time consuming : requires 6 to 9 months.
 Used for :
 1. Detecting drug resistance.
 2. Evaluating the potency of anti-leprosy drugs.
 3. Detecting the viability of bacilli during treatment.
49

50. HISTAMINE TEST:
 Reliable test for detecting at an early stage peripheral nerve
damage due to leprosy.
 Method : carried out by injecting 0.1ml of a 1:1000 solution of
histamine phosphate into hypopigmented patches or in areas
of anesthesia.
 Result : in normal person it gives rise to a wheal surrounded
by erythematous flare(Lewis triple response). In case of
leprosy where the nerve supply is
 destroyed, flare response is lost.
 Particularly useful in cases of indeterminate leprosy.
50

51. BIOPSY:
 Usually resorted to when there is high clinical suspicion but
the other test are unyielding. It also gives information about
the bacterial content of skin.
IMMUNOLOGICAL TESTS:
 LEPROMIN TEST
 test of cell mediated immunity
 METHOD : it is performed by injecting 0.1ml of lepromin into
inner aspect of the forearm. The reaction is read at 48 hours
and 21 days. Two types of reaction have been described :
51

52.  ANTIGENS USED:
 Dharmendra antigen
 Mitusda antigen
 EARLY REACTION(FERNANDEZ REACTION) :
 an inflammatory reaction develops within 24 to 48 hours and
this tends to disappear in 3 to 4 days. If the diameter of the red
area is more than 10mm the test is considered positive.
 It is a delayed type hypersensitivity reaction indicating prior
exposure or infection to soluble constituents of lepra bacilli.
 Superior to late reaction
52

53. LATE REACTION(MITSUDA REACTION) :
 It is characterized by the appearance of a nodule which
becomes apparent in 7 to 10 days and reaches its maximum in
3 to 4 weeks.
 The test is read at 21 days. If the nodule is more than 5 mm it
is considered positive.
 It is induced by the bacillary component and indicates cell
 mediated immunity.
 In the first six months of life most children are lepromin
negative. BCG vaccination is capable of converting lepra
reaction from negative to positive.
53

54.  VALUE OF LEPROMIN TEST :
 evaluating the immune status of leprosy patients.
 Aid to classify the type of disease.
 Estimating the prognosis
 Strongly positive in a typical tuberculoid case and getting
weaker towards the lepromatous end, the typical lepromatous
case being lepromin negative indicating failure of CMI.
 The greatest drawback being:-
 Positive in non cases
 Negative in lepromatous cases
 hence not used as a diagnostic test.
54

55. LTT & LMIT :
 Newer in in vitro tests such as lymphocyte transformation test
and leucocyte migration inhibition test has been developed
 They give a measure of CMI
 Used to detect sub clinical infection
FLA-ABS TEST :
 Tests for humoral antibodies(serological tests)
 used for detecting subclinical infections. 92.3 percent sensitive
and 100 percent specific in detecting specific antibodies in all
types leprosy irrespective of type and duration of disease.
55

56. MONOCLONALANTIBODIES
 These against M. leprae antigens have been produced
 If antibodies against specific antigens are found, they will
become reagent of choice for identifying M. leprae
ELISA TEST
BASED ON A PHENOLIC GLYCOLIPID (PGL) ANTIGEN
56

57. MEDICAL MEASURES
ESTIMATION OF THE PROBLEM
EARLY CASE DETECTION
MULTIDRUG THERAPY
SURVEILLANCE
IMMUNOPROPHYLAXIS
CHEMOPROPHYLAXIS
DEFORMITIES
REHABILITATION
HEALTH EDUCATION
SOCIAL SUPPORT
PROGRAMME MANAGEMENT
EVALUATION
57

58. MULTIDRUG CHEMOTHERAPY
In the absence of effective of primary prevention by a leprosy
vaccine leprosy control is based on effective multidrug
chemotherapy(secondary prevention).
OBJECTIVES :
To interrupt transmission of infection
Early detection and treatment of cases to prevent deformities
To prevent drug resistance
58

59. In multidrug regimens only bactericidal drugs are used :
First line drugs : rifampicin, dapsone, clofazimine,
ethionamide and protionamide.
Second line drugs : quinolones, minocycline, clarithromycin.
WHO RECOMMENDED REGIMENS :
MULTIBACILLARY LEPROSY
Rifampicin : 600mg once monthly under supervision
Dapsone : 100mg daily self administered
clofazimine : 300mg once monthly under supervision,50mg
daily self-administered
59

60. Where clofazimine is unacceptable due skin coloration it may
be substituted by 250 to 375mg daily dose of ethionamide or
protionamide.
The above regimen needs to taken for 12 months within 18
months.
PAUCIBACILLARY LEPROSY :
Rifampicin : 600 mg once a month, supervised
Dapsone : 100 mg daily, self administered
The above regimen needs to be taken for 6months within 9
months
60

61. TREATMENT REGIMEN FOR CHILDREN 10-14 YEARS :
MULTIBACILLARY LEPROSY
Rifampicin : 450mg once monthly under supervision
Dapsone : 50mg daily self administered
clofazimine : 150mg once monthly under supervision 50mg
every other day self-administered
PAUCIBACILLARY LEPROSY
Rifampicin : 450mg once a month under supervision
Dapsone : 50mg daily self administered.
61

62. 62

63. 63

64. IMPORTANT POINTS :
 MDT is not contraindicated in patients with HIV infection.
 MDT is safe during pregnancy.
 Drugs are excreted in breast milk but no reports of adverse
reaction except for mild discoloration of infants skin by
clofazimine
 Leprosy is exacerbated during pregnancy, it is important that
MDT is continued
64

65. SURVEILLANCE:
 Paucibacillary leprosy-recomended to be examined clinically
atleast once a year for minimum 2 years
 Multibaccilary leprosy-leprosy-recommended to be examined
clinically at least once a year for minimum 5 years.
IMMUNOPROPHYLAXIS:
 BCG can provide some protection against leprosy
 Several alternative vaccines are under development
65

66. DEFORMITIES:
 It is due to damage of peripheral nerve trunks or injury from
infection to hand and feet's
 Approx. 25 percent of cases who are not properly treated at an
early stage develop deformities of hands and feet.
DEFORMITIES PREVENTION:
 Measures include care of dry and denervated skin of palms and
soles.
 Treating wounds, ulcers, and cracks in palms & soles
 Use of protective gloves and footwear
66

67.  Prevent joint stiffness in case of paralysis
 Protection of eyes
 Periodic check up for progression of disease.
 use of prosthesis and orthopaedic devices, including corrective
splints as well as by corrective surgery.
REHABILITATION
 Rehabilitation includes all the measures used for reducing the
impact of disability for an individual, enabling him/her to
achieve independence, social integration, a better quality of life
and self actualization.
67

68. 68

69. HEALTH EDUCATION
 Health education aims at helping people to avoid this type of
diseases
 It should be direct towards the patient and his/her family
 It should educate people on the true facts about leprosy and
removes superstation and the social stigma associated with
leprosy.
SOCIAL SUPPORT
 Chemotherapy alone is not likely to solve this problem
 It needs social support also
69

70. ANTI-LEPROSY ACTIVITIES IN INDIA
 1874-Mission To Leprosy was found by Baily at Chamba in the
Himachal Pradesh. (now in Purulia in West Bengal)
 After that a lot of organizations are established
 Hindu Kusth Nivaran Sangha
 Gandhi Memorial Leprosy Foundation
 National Leprosy organization(1965)
 German Leprosy Relief Association
 Damien Foundation
 Danish save the child foundation
 National Leprosy Control Program(1954) was converted in to
Eradication Programme(1983)
70

71. Reactions.
Complications of peripheral nerves.
Complications of eyes
Complication of bones
71

72. During the course of leprosy, immunological mediated
episodes of acute or subacute inflammation known as
reaction may occur.
There are two types of reactions :
Type 1 or Reversal reaction
Type 2 or erythema nodosum leprosum
Both types can occur before the start of MDT, during
treatment or after completion of treatment.
72

73. REVERSAL REACTION
the leprosy skin lesions themselves become inflamed red,
swollen and painful.
It is type of delayed type of hypersensitivity.
Occurs in both PB and MB
Nerves may be enlarged, tender and painful with loss of
function.
General symptoms are uncommon
Do not affect other organs.
73

74. ERYTHEMA NODOSUM LEPROSUM
In ENL new inflamed, red nodules appear under the skin,
while the original lesions remain same.
Commonly on face, arm and legs & bilaterally symmetrical.
subside within few days even without treatment
It is antigen antibody reaction.
Seen in MB cases only.
Nerves may be affected but is uncommon
Other organs like testis, eye, kidney may be affected
General symptoms of fever, joint pain, red eyes and watering
may be associated.
74

75. 75

76. TREATMENT:
Because of high risk of permanent nerve damage reversal
reaction needs to be promptly diagnosed and treated
adequately
Standard 12 wk. regimen of prednisolone is the treatment of
choice.
Treatment also includes bed rest, splinting of affected nerves,
analgesics and prednisolone.
76

77. 77

78. For pregnant women prednisolone should be started at 30mg
dose instead of 40mg and limit the course for 10weeks in PB
cases and 20 weeks for MB cases.
For children dose should be started at 1mg/kg of body wt. per
day.
clofazimine is the drug of choice for the management of
chronic, recurrent ENL reactions. Another drug claimed to be
useful in ENL is pentoxyfylline.
78

79. 79

80. 80

81. Ulnar Median
Radial
Lateral (common) Popliteal Posterior Tibial
81

82. 82

83. 83

84. Complications Of Bones
Bone damage in Leprosy is confined to bones of hand , feet & skull.
84

85. 85

86. NERVE INVOLVEMENT:
 leads to muscle weakness, muscle atrophy, severe neuritic pain,
and contractures of the hands and feet.
 Ulnar nerve is most commonly involved , least common is radial.
 Most common cranial nerve involved is Trigeminal.
 First sensation to go is thermal (cold>fine touch).
Proprioception is usually preserved.
86

87. 87

88. 88

89. 89

90. 90

91. STRATEGIES
 Integrated leprosy services through general health care system
 Early detection and complete treatment of new leprosy cases
 Carrying out household contact survey
 Involvement of ASHA
 Strengthening of Disability prevention and medical
rehabilitation (DPMR) services
 Information Education and Communication (IEC) activities to
improve self reporting and reduction of stigma
 Intensive monitoring and supervision
91

92. MAJOR INITIATIVE :
New case detection : main indicator of programme monitor
Treatment completion rate •
DPMR (Disability Prevention & Medical Rehabilitation) facilities
Dressing material, supporting medicine, ulcer kit to leprosy affected
person
Microcellular rubber footwear
NGOs, Medical Colleges strengthen for Reconstructive surgery for
correction of disability
Amount of 5000/- for leprosy affected person from BPL family
undergoing Reconstructive Surgery
Support to Govt. Institution in form of 5000/-per reconstructive surgery
conducted
92

93. Involvement of ASHA, in bringing out suspected leprosy cases
and follow up of confirmed cases
Provision of self settled colonies for leprosy affected person
Intensive IEC campaign “Towards leprosy free India”
Reduce leprosy burden
Reduce stigma and discrimination
93

94. DISABILITY PREVENTION & MEDICAL
REHABILITATION (DPMR)
Main activities carried out under DPMR are as follows :
Implementation of DPMR activities as per guidelines and
reporting outcome e.g. t/t of leprosy reaction, ulcer,
physiotherapy, reconstructive surgery and providing
Microcellular footwear
Integrating DPMR services with NRHM (National Rural Health
Mission) facilities
To develop a referral system
94

95. 95

96. ASHA INVOLVEMENT :
To bring out suspected cases from village for diagnosis and treatment
Receive incentives
At confirmation and diagnosis -250/-
On completion of full treatment – additional 400/-(PB) additional 600/-
(MB)
An early case before onset of any visible deformity- 250/-
A new case with visible deformity in hands, feet or eye – 200/-
Activities to be performed by ASHA
Search for suspected case
Follow up all cases
Advice and motivate, self care practices • Spreading awareness
96

97. IEC :INFORMATION EDUCATION & COMMUNICATION
FOCUS ON – LEPROSY FREE INDIA
Behaviour change in community against stigma and
discrimination against leprosy affected person
Making the public aware about the
Availability of MDT
Correction of deformity through surgery
Leprosy affected person can live a normal life with family
97

98. 98

99. 99

100. NEWER INITIATIVE UNDER NLEP
1) FOCUSSED LEPROSY ELIMINATION PLAN (2005):
Priority areas : prevalence > 3 per 10000
Increased efforts on IEC, training and integrated service
delivery
Week long Leprosy awareness campaign
2) SAPELAND LEC:
Special action projects for elimination of Leprosy (SAPEL) in
rural areas and Leprosy elimination campaign (LEC) for urban
areas: to cover population residing in difficult/inaccessible
areas, which were not covered by regular programme activities.
100

101. 3) ACCOMPANIED MDT:
If patient is unable to come and collect his/her MDT from clinic
then any responsible person from family or village can collect it.
Designed to help patients who interrupt their treatment due to
avoidable reasons.
4) LEPROSY CASE DETECTION CAMPAIGN:
LCDC on line with pulse polio campaign has been introduced
specifically for high endemic districts by the central leprosy
division
It is mainly used to detect untreated/hidden leprosy cases.
101

102. THE GLOBAL LEPROSY STRATEGY 2016-2020:
ACCELERATING TOWARDS A LEPROSY FREE WORLD
Was released in April 2016
VISION:
zero disease
Zero transmission of leprosy infection
Zero disability due to leprosy
Zero stigma and discrimination
Goal :
Further reduce the global and local leprosy burden
102

103. Targets :
Number of children diagnosed with leprosy and visible deformities :
zero
Rate of newly diagnosed leprosy patients with visible deformities : <
1 per million
Number of countries with legislation allowing discrimination on
basis of leprosy : zero
103

104. Leprosy or Hansen’s disease or Kusth rog is a chronic infectious
disease caused by M.leprae
Probably the oldest disease known to mankind
Mainly affect peripheral nerves, also affects the skin, muscles,
eyes, bones , testes and internal organs
Leprosy is often known as a “social disease”. Social stigma is
attached to it. Stigma is coupled with physical deformity leads to
social isolation and depression.
104

105. In the absence of effective of primary prevention by a leprosy
vaccine leprosy control is based on effective multidrug
chemotherapy(secondary prevention).
Anti leprosy day in India is celebrated on death anniversary
of freedom fighter Mahatama Gandhi on 30th January of
every year.
World leprosy day is celebrated on the last Sunday of
January every year.
The theme for 2018 was “ Zero Disabilities in Girls and
Boys”
105

106. Park’s Textbook of Preventive and Social Medicine , K.Park, 24th
edition.
Community Medicine with Recent Advances , A H Suryakantha , 4th
edition.
Review of Preventive And Preventive and Social Medicine , Vivek Jain,
9th edition.
National Health Programs of India , Jugal Kishore, 12th edition.
National Leprosy Eradication Program from NHM, www.nlep.nic.in
Leprosy Elimination from WHO, www.who.int/lep/en/
106

107. 107