1. DR. I. SELVARAJ I. R. M. S B. Sc. ,M. B. B. S. ,D. P. H. ,D. I. H
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
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
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
12.1
Total
488333
668658
3.2
43.7

5. Global Leprosy Situation in 2001*
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 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 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. Point Prevalence Period Prevalence
PREVALENCE OF LEPROSY
Point Prevalence
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

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
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
estimating MDT requirements
procuring
storage
Shelf life
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
MLEC-2 WAS CONDUCTED IN
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