WHO in action: eliminating leprosy

30 WHO in action Eliminating leprosy In 1991, WHO's Member States pledged their commitment to eliminating leprosy as a public health problem by the year 2000. World Health interviewed Dr S. K. Noordeen, Chief of the Leprosy Unit at WHO headquarters in Geneva, about the progress being made. What makes WHO so confident that this is now possible? There is no lingering doubt today that we can bring about a drastic reduction in the prevalence of this disease by treating patients with multidrug therapy (MDT). So, provided there is effective disease control, it can be reduced within the space of six or seven years to a level where leprosy is no longer a public health problem. We define this as reducing the proportion of leprosy patients in a given community to less than one case per 10 000 population. What do you mean by multidrug therapy? Until I 980, leprosy control programmes employed only a single drug, dapsone, which was capable of killing the bacterium Mycobacterium leprae in the infected person. This showed great promise, but then dapsone-resistant strains developed. Fortunately, two A disease that blinds, a disease that mutilates. other powerful anti leprosy drugs became available- rifampicin and clofazimine - so that when they are used together there is very little chance of the bacterium developing resistance to all three. Over the years, MDT - as recommended by WHO- has proved to be highly effective in curing leprosy and is also quite acceptable to the patients. Provided there is very high MDT coverage, the pool of infectious sources should be wiped out in the course of time, and transmission of infection with M.leprae will cease. Of course, any physical damage that has been done cannot be easily restored. Even after leprosy is eliminated, many thousands of patients will still need physical rehabilitation. How many victims of leprosy are there in the world today, and how many new cases occur every year? There are an estimated total of 2.4 million existing cases, and 87 World Health • 47th Year, No.2, March-Aprill994 countries have significant numbers of cases. Of these, 95% live in 25 countries, while just five countries- Brazil, India, Indonesia, Myanmar and Nigeria - account for 81% of the cases. About 650 000 new cases are still being detected each year, but these are expected to decline steadily. What progress has been made so far? What remains to be done? And how much will the task cost? After eight years of treating cases with MDT, some 5.6 million patients had been cured by late 1993, and over one million patients were still being treated. The total of registered cases has fallen from 5.4 million in 1985 to 1.76 million in 1993. Between 1993 and the year 2000, we will have to treat some 5.0 million patients with MDT, at a cost estimated at between US$ 400 million and $ 600 million, of which about 25% will be required for the drugs. World Health • 47th Year, No.2, March-April l994 31 efforts and resources of various agencies, including the World Bank, the Sasakawa Foundation and such major nongovernmental organizations as the International Federation of Anti-Leprosy Associations (ILEP), the International Leprosy Association (ILA) and the International Leprosy Union (ILU). The mull/drug therapy is highly effective, and quite acceptable to the patients Is there not a risk of people becoming over-optimistic about eliminating this disease, and pulling less effort into leprosy control and leprosy research? Certainly the international health community should not become complacent. The challenge is still formidable, and initial success should in no way dilute the support for leprosy control or research. We have no doubt that this goal can be reached, but it will call for concerted and coordinated efforts by all concerned. • How does a person become infected? Leprosy is not easy to "catch." Merely touching an infected ·rt person's hand does not transmit the disease. But people living in close physical contact with an infected person are at high risk of infection. The average incubation period is three to five years, but can be as long as two decades . Will new cases of leprosy continue to occur beyond the year 2000? If so, how can they be explained? Yes, a few new cases wi II continue to occur because of the long incubation time. But the continued application of MDT will steadily reduce the number of new cases. Different WHO regions will reach elimination levels at different times: in the Eastern Mediterranean region it might be as early as 1997, in the In the next issue A n impo rta nt intern a tiona l conference on Population and Development is to take place in Ca iro in September . The M ay- June issue looks at the interacti ons of demog raph ic factors a nd the hea lth status of different population groups, and at efforts to ensure the qua lity of li fe of al l people . • African region by 1998, and in the South-East Asia region by the year 2000. We can expect the total eradication of leprosy some time early in the next century. What are the essential requirements for eliminating this disease? The most essential thing is to maintain high coverage with MDT - in the region of 95% -as well as high levels of patients complying with and completing the treatment. There has to be very effective case- detection, and all the endemic countries must constantly monitor the progress they are making. Governments, donor agencies - and of course WHO- need to remain politically committed to the goal of elimination and not relax their quest for the necessary resources . WHO's particular role is to coordinate the Did you enjoy this issue? 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