The World Health Organisation (WHO) aiming a ‘world free of leprosy’ by 2020, has launched a global strategy to combat the disease, a move critical for India which is among the three countries that account for more than 80 per cent of newly diagnosed leprosy cases. WHO has called for strong commitments and accelerated efforts to stop the disease transmission and end associated discrimination and stigma to achieve the target. According to World Health Body, the new global strategy is guided by the principles of initiating action, ensuring accountability and promoting inclusivity and so, these principles must be embedded in all aspects of leprosy control efforts.
The strategy aims to, by 2020, reduce to zero the number of children diagnosed with leprosy and related physical deformities, reduce the rate of newly diagnosed leprosy patients with visible deformities to less than one per million… and ensure that all legislations that allow for discrimination on the basis of leprosy is overturned. Besides several key proposals, a special focus is on children as a way to reduce disabilities and minimise transmission. Interventions should also target detection among higher risk groups through campaigns in highly endemic areas or communities and improving health care coverage and access for marginalized population, WHO insisted.
According to available information, leprosy is a widespread, chronic disease of humans that affects chiefly the skin, eyes, mucous membranes of the nose and throat, certain peripheral nerves and the testes in males. It is caused by ‘Mycobacterium leprae’, an acid-fast bacillus that is similar to the bacillus that causes tuberculosis (TB). Once infected, the skin and peripheral nerves are the principal loci of the disease. The mucous membranes are frequently involved by the disease producing agents, resulting in marked changes in voice quality. The disease is characterized by long duration and slow progress, which may be interspersed with acute episodes of what is probably hypersensitive reaction. Following an acute exacerbation, the course of the disease may be radically altered, followed by either improvement or intensification of symptoms.
‘Mycobacterium leprae’ is a straight or slightly curved rod ranging from 1 to 8 microns in length and from 0.2 to 0.5 microns in width. It is known as an ‘acid-fast’ organism because of its ability to absorb certain dyestuffs and resist decolorisation with weak mineral acid in the same manner as does ‘Mycobacterium tuberculosis’. In the body, the organism frequently occurs in masses termed ‘globi’, which have the appearance of bundles of sticks. ‘Mycobacterium leprae’ is sometimes called Hansen’s bacillus after its discoverer, G. Armauer Hansen, who first described the organism after seeing it in microscopic sections taken from biopsies of patients in 1874.
One of the most marked manifestations of the disease is the loss of thermal and tactile sense. Such anesthesia is due to destruction of peripheral nervous tissue in the affected area. Neural destruction results frequently in atrophy and may lead to marked deformities of the extremities, such as claw hand. In untreated cases, bone damage may result in disfiguring auto amputation of the extremities. As a result of the anesthesia, the patient will often unwittingly injure or burn the anesthetic area, resulting in marked ulcerations that are then subject to infection with pyogenic micro-organism. The disease is rarely fatal in itself, and death is usually due to superimposed infection from a more virulent organism that overwhelms the patient because of his weakened condition. Tuberculosis, intestinal infection are among the major causes of death in leprosy patient.
It is estimated that 9 million to 12 million persons are infected with the disease at any one time in the early 1960s. The greatest number of cases were concentrated in South China, India and Central Africa. South and Central America, the Malayan Peninsula and the islands of South Pacific are also areas of high incidence of leprosy. Although leprosy occurs most frequently in damp, tropical climates, the disease also occurs in sub-tropical areas. In temperate zones such as Crete and Japan, and even within sub-Arctic zones in Norway and Iceland and the cold Northern islands of Japan.
However, a latest WHO report said leprosy is on the verge of elimination globally since 2000, with the disease prevalence rate dropping to below 1 per 10,000 population. Though almost all countries have achieved this rate at the national level, at the sub-national level, it remains an unfinished agenda. Out of the 2,13,899 new leprosy cases in 2014, 94 per cent were reported from 13 countries – Bangladesh, Brazil, Congo, Ethiopia, India, Indonesia, Madagascar, Myanmar, Nepal, Nigeria, Philippines, Sri Lanka and Tanzania. India, Brazil and Indonesia account for 81 per cent of the newly diagnosed and reported cases globally.
According to WHO, leprosy continues to afflict the vulnerable, causing life-long disabilities in many patients, subjecting them to discrimination, stigma and a life marred with social and economic hardships. The delay in detection of new patients and persisting discrimination against people affected by leprosy have ensured continued transmission of the disease. Several leprosy-affected countries still have legislation in place that allow discrimination against people suffering from leprosy. Social stigma impedes early detection of the disease, particularly in children, and increase disabilities.
WHO emphasised that screening all close contacts of leprosy affected persons, promoting a shorter and uniform treatment regime and incorporating specific interventions against stigma and discrimination are the important strategic measures that endemic countries need to include in their national plans to meet the new challenges enumerated in the recently announced leprosy control strategy which has been developed in consultation with various national leprosy programmes, technical agencies and NGOs, as well as patients and communities affected by the disease. ‘The strategy focuses on equity and universal health coverage which will contribute to reaching sustainable development goal on health,” WHO said.
(The writer is a freelance journalist)
