Leprosy, a treatable disease, needs to be addressed early

At a recent event, Dr Harsh Vardhan brought attention to the intensification of government efforts to eliminate leprosy in India. This recent focus has been a welcome step, especially as it has been observed that, since 2005, when India achieved elimination of leprosy as a public health concern, the number of new cases has remained stagnant.

Even today, although leprosy numbers are small in comparison to those of other diseases such as malaria, tuberculosis etc, India has not won a decisive battle against the disease. Classified amongst the least infectious of diseases by the WHO, leprosy is now fully curable through antibiotics treatment. Yet its elimination remains a challenge for India.

The need to urgently address this challenge stands out even more sharply if we consider the share of India in the global burden of leprosy. Of the total annual number of new cases worldwide, 2,08,619, India accounts for 1,20,334 new cases resulting in the country being host to nearly 58 per cent of the total world population of leprosy affected people.

In recent years, India has shaken itself out of the complacence into which it had fallen after 2005 when it achieved the WHO defined elimination rate, i.e. less than one new case per 10,000 population. It has given a significant push towards early detection and treatment which is critical to both preventing disability as well as interrupting the transmission of the disease. These efforts are in line with the country's and the WHO's target of zero disability cases and zero child cases. India has undertaken and continues to undertake intensive leprosy detection campaigns in endemic areas where ASHA workers have been given the responsibility of going from house-tohouse to find out early signs of leprosy and for bringing the suspected cases into the public health network.

Additionally, the National

Leprosy Eradication

Program (NLEP) has introduced an anti-leprosy vaccine, Mycobacterium

Indicus Pranii (MIP), in

Gujarat on a pilot mode.

NLEP is also trying to introduce this vaccine in Chhattisgarh, again on a pilot mode.

Another innovative approach has been to introduce a prophylactic dose of rifampicin in the contact population of new cases. It has been observed that most cases occur among the contact population of those affected by leprosy, even though the disease is not easily transmitted. There are however differences among experts whether a single dose would really be effective or whether it could lead to a resistance to rifampicin which is also used for treating TB.

The National Leprosy Eradication Program has also undertaken awareness programs in the endemic areas — breaking myths that surround leprosy and educating people that it is a bacterial disease. The success of the medical program depends on the social perception and understanding of leprosy. The recognition that leprosy is a treatable disease and needs to be addressed early to avoid disability; that those affected become noninfective within 24 hours of starting treatment; of making isolation and exclusion unnecessary and unwarranted; all this will convert leprosy into just another disease in public perception.

Although laudable, government’s efforts are likely to fall short in bringing about a radical change in the incidence of leprosy soon. Leprosy has a long gestation period and the bacteria can lie dormant for as many as seven years or more before the disease manifests itself. The answer, therefore, lies in combining current efforts with awareness building even in the non-endemic areas.

Subsequently, it is important for the government to mount a nationwide campaign to spread awareness about leprosy. The success of an initiative such as this is clear from the learning that in the eighties, the government made a major effort to spread awareness about TB, which helped to change the public perception of the need for isolation in remote areas to provide care within homes.

Finally, there is need to involve civil society and use new technology in this fight. Teachers, students, artists, doctors, corporates, celebrities and other NGOs can help by spreading the word. Realtime data, social media, apps, twitter can all be used to reach out to the remote corners of the country. The battle against leprosy can be won.

Dr Vineeta Shanker

◗ The National Leprosy Eradication Program has also undertaken awareness programs in the endemic areas — breaking myths and educating people that leprosy is a bacterial disease

The article is attributed by Dr Vineeta Shanker, executive director, Sasakawa-India Leprosy Foundation