National Leprosy Eradication Programme

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae. Official figures (WHO) show that more than 213 000 people mainly in Asia and Africa are infected, with approximately 249 000 new cases reported in 2008. M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear. Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern.

Treatment of Leprosy

Some drugs such as rifampicin, clofazimine, and dapsone are used to treat Leprosy. In 1993, the WHO had recommended two types of standard MDT regimen be adopted. One was a 24-month treatment for multibacillary (MB or lepromatous) cases using rifampicin, clofazimine, and dapsone. Another was a six-month treatment for paucibacillary (PB or tuberculoid) cases, using rifampicin and dapsone.

Leprosy in India

In 2007, India was contributing to about 54% of new cases detected globally during the year 2007, and this trend was supposed to continue for some more years. The National Leprosy Control Programme was launched by the Government of India in 1955. Multi Drug Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was launched in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population, at the National level in the month of December 2005 as set by the National Health Policy, 2002. Here is the current position : (Source Ministry of Health, data is of January 2009)

• 29 states/UTs have achieved leprosy elimination status
• 6 States/UTs viz. Bihar, Chhattisgarh, West Bengal, Jharkhand, Chandigarh and D&N Haveli are yet to achieve elimination.
• With 87,206 leprosy cases on record at end of March 2008, the prevalence rate was 0.74/10,000 population.
• During 2007-08, a total of 1.38 lakhs new leprosy cases were detected giving Annual New Case Detection Rate of 11.70 per lakh population. All the newly detected cases were put under treatment.
• During 2008-09 (upto November 2008), 94,794 new leprosy cases were detected and put under treatment.
• 1353 reconstructive operations were performed for correction of disability among leprosy affected persons during April to November 2008.
• Out of 85,176 cases discharged during April to November 2008, 78808 cases (92.5%) were released as cured after completing treatment.

National Leprosy Eradication Programme

• Government of India had launched the National Leprosy Control Programme in 1955 based on “Daps one” immunotherapy.
• Then the Multi Drug Therapy (MDT) came into wide use from 1982 and the Programme was re-designated the National Leprosy Eradication Programme (NLEP) in 1983.
• The programme was expanded with World Bank assistance and the 1st phase of the World Bank supported National Leprosy Elimination Project started from 1993-94 and ended in March 2000.
• The 2nd phase of World Bank supported National Leprosy Elimination Project started from April 2001 and ended successfully in December 2004.
• During the 2nd phase, NLEP was decentralized to States/Districts and Leprosy Services were integrated with the General Health Care System.
• Since then, free Multi Drug Therapy (MDT) is available at all Sub-Centre’s, PHCs and Government Hospitals and Dispensaries on all working days.
• The programme has been integrated with NRHM. The state & district leprosy societies have been merged with the state and district health societies.
• The National Health Policy, 2002 had set the goal of elimination of leprosy (i.e., to reduce the number of cases to <1/10,000 population) by the year 2005. India has achieved this goal of elimination of leprosy as a public health problem at the national level in the month of December 2005, when the recorded Prevalence Rate (PR) in the country was 0.95/10,000 population.
• By March 2007, the prevalence rate of leprosy in the country had declined to 0.72 per 10,000 population.

Current Position

The above narrative comes from the India Year Book and clearly says that India achieved the elimination of leprosy 7 years ago. But, according to World Health Organization, India still records the highest number of fresh cases globally. As per WHO, 65% of all new cases of leprosy globally are from India. The health ministry’s latest data shows between April 2010 and March 2011, India recorded 1, 26,800 fresh cases of leprosy, of which 12,463 were children under the age of 15. Around 4,000 of these patients had disabilities due to leprosy.

In this context, the Health Ministry recently called up a meeting and discussed these high numbers. Most of states of India eliminated the disease in 2005 (elimination is less than 1 case per 10,000), but it has been quoted that as many as 209 districts still record more than 10 cases per 10,000 which is tremendously high. These districts are mainly in Bihar, Chhattisgarh and Dadar & Nagar Haveli. Now, India’s leprosy prevalence rate stands at 0.69 cases per 10,000.

Under the 12th five-year plan, starting from 2012, India intends to start WHO’s child-to-child policy under which school students will be taught to identify patches on the skin of their classmates. Although there is no vaccine, leprosy is curable with multi-drug therapy (MDT). Within a day of starting MDT, there is no risk of the disease infecting another person.