EPIDEMIOLOGICAL REVIEW OF
LEPROSY IN THE WESTERN PACIFIC REGION
1983-1997
World Health Organization Regional Office for the Western Pacific Manila, Philippines August 1998
II
Acknowledgements We would like to thank all leprosy programme managers, and statisticians from all the countries and areas of the Western Pacific Region for providing appropriate data for this document.
The designations employed and the presentation of the material in this report do not imply the ex pression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation "country or area" appears, it covers countries, territories, cities or areas.
III
Contents Part I: Leprosy data for the Western Pacific Region 1. Introduction 1
2.
Methods 2.1 The Western Pacific Region 2.2 Indicators 2.3 Sources of data
1
2 3 4
3.
Data collection
4.
Epidemiological review 4.1 Registered prevalence and expansion of MDT services 4.2 Detection of leprosy cases (Tables 3 to 5) 4.3 Time trends in case detection and prevalence rates (Tables 4 to 6)
4 4
5 :;
5.
Programme activities 5.1 Leprosy Elimination Campaign (LEC) 5.2 Special Action Project for the Elimination of Leprosy (SAPEL) 5.3 Special projects 5.4 Classification of countries and areas in the Western Pacific Region according to their current leprosy situation
6 6 6 7
7
IV
Part I Tables Table I. Table 2. Table 3. Table 4. List of countries and areas with socio-economic indicators in the Western Pacific Region Prevalence of registered leprosy cases and coverage with MDT by WHO region at the end of 1996 Latest available data on leprosy by country and area in the Western Pacific Region Time trend of the number of newly detected leprosy cases and case detection rates per 100 000 by country and area in the Western Pacific Region, 1983 to 1996 Time trend of the number of registered leprosy cases and prevalence rates per 10000 by country and area in the Western Pacific Region, 1983 to 1996 Time trend of the number of registered leprosy cases and newly detected cases in the Western Pacific Region, 1983 to 1996 14
9
10 II
12
Table 5.
Table 6.
Part I Figures Figure I. Figure 2. Figure 3. Figure 4. Figure S. Figure 6. Figure 7. Figure 8. Figure 9. The Western Pacific Region Population distribution by country and area in the Western Pacific Region Distribution of the number of registered cases and the prevalence rates in ten countries in the Western Pacific Region (1997) Distribution of registered leprosy cases in the Western Pacific Region (1996) Distribution of detected cases and detection rates in ten countries in the Western Pacific Region (1997) Trends of leprosy case detection rates per 100 000 in five countries in the Western Pacific Region (1983-1997) Trends of leprosy prevalence rates per 10000 population in five countries in the Western Pacific Region, 1983-1996 Leprosy prevalence rates and multidrug therapy coverage in the Western Pacific Region (1988-1997) Number of countries reporting the leprosy essential indicators in the Western Pacific Region (1983-1997) IS
16 16 17 17 18 19 20 21
v
Part II: Leprosy data for each country and area in the Western Pacific Region American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong, China Japan Kiribati Lao People's Democratic Republic Macao Malaysia Northern Mariana Islands Marshall Islands Federated States of Micronesia -Mongolia Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam Wallis and Futuna
24 26 28 30 36 42 44 46 48 50 52 54 56 58 60 62 64
66 68 70 72
74 76 78 80 84 90 94 96 98 100 102 104 106 108 114
VI
Note on data In addition to the references specified under each country, data are obtained from the annual submission of national leprosy data by governments to the WHO Western Pacific Regional Office.
Abbreviations Epidemiology/Programme
GIS IMR LEC LEM MB PAL PB SAPEL Treatment
Geographical Information System Infant mortality rate Leprosy Elimination Campaign Leprosy Elimination Monitoring Multibacillary Person affected by leprosy Paucibacillary Special Action Project for the Elimination of Leprosy
CLO DDS MDT MINO RMP
clofazimine dapsone multidrug therapy minocycline rifampicine
Bacteriology
AFB
acid-fast bacilli
Part I
Part I: Leprosy data for the Western Pacific Region
1. Introduction The prevalence of leprosy has continued to decline in the world in 1997, with the Western Pacific Region reporting considerable progress against the disease. Improvements in programme and multidrug therapy (MDT) coverage have led to improvements in case detection. MDT coverage in the Region has increased from 6% in 1986 to 73% by the end of 1992. and to almost 100% by the end of 1997. Twenty-five out of 36 countries and areas in the Region' have already reached the goal of elimination of leprosy as a public health problem, defined as a prevalence rate of below one case per 10000 population. As a result of the implementation of the elimination strategy at various levels, information collected on the magnitude of leprosy has improved significantly. Statistical information on cases has improved through the extensive use of standardized operational definitions. In some endemic countries, however, leprosy patients are still under-reported and under-registered, and efforts must be made to improve programme coverage, particularly in areas difficult to reach. In other countries where leprosy is no longer a public health problem, available information is often not accurate and is out of date, but this has a negligible influence on the regional figures. The objectives of this report are to present the epidemiological data of leprosy for the period 19831997, and essential information on national leprosy control programmes from each country and area in the Region, and to evaluate and analyse these data. The report consists of two parts: Part II is an overall epidemiological review of leprosy in the region, while Part III deals with data for each country and area in the Region with reference to its national control programme.
2. Methods
2.1 The Western Pacific Region The Western Pacific Region comprises 36 countries and areas (Table I). with a population of approximately 1634 million. Geographically. the countries and areas in the region are scattered in the north, west, central and south Pacific (Figure I). The Region contains some very large, and very small, countries and areas: seven each have a population of more than 10 million (Figure 2), and seven have a popUlation of between I and 10 million. The remaining 22 have a total popUlation of only 3.2 million. Seven Pacific Island countries and areas each have a population of less than 20 000.
I
Pitcairn Islands data arc not included in thIS review.
2
Part I
Several socioeconomic and health indicators for each of the 36 countries and areas are presented in Table 1. The annual population growth rate ranges from 5.6% in the Northern Mariana Islands and 3.8% in the Marshall Islands to small decreases in Niue and Tokelau. Ten countries have an infant mortality rate (IMR) equal to or higher than 40 per 1000 births.
2.2 Indicators The Seventh WHO Expert Committee on Leprosy, which was convened in May-June 1997, concluded that single-lesion paucibacillary (PB) patients can be treated with a single dose of a combination of rifampicine, ofloxacin and minocycline, and that MB patients can be treated with standard MDT for one year instead of two. A large number of the 36 countries and areas of the Western Pacific region are implementing shorter regimens, including Cambodia, Papua New Guinea and the Philippines. Prevalence (registered cases)
The point prevalence rate is defined as the number of cases registered for chemotherapy at the end of the year, divided by the population in which the cases have occurred. This indicator reflects the magnitude of the problem and helps in planning and evaluating control measures. The prevalence is expressed using absolute numbers and the rate per 10 000 population. Detection (newly detected cases)
This is defined as the number of new cases detected during the year divided by the population in which the cases have occurred. This indicator is the most appropriate for estimating the true incidence of the disease in a given population when analysed in conjunction with the proportion of disabled patients (grade 2) among newly detected cases. It is expressed using both absolute numbers and the rate per 100 000 population. Proportion of MB patients among new cases
This is defined as the proportion of MB cases among the total number of newly detected cases during the year. Proportion of patients with grade 2 disability among new cases
This is defined as the proportion of newly detected cases with grade 2 disability among the total number of newly detected cases during the year. This indicator is intended to reflect the effectiveness of the programme in terms of early case-finding and the level of community awareness of the disease. Proportion of children among new cases
This is defined as the proportion of cases aged less than IS years old among the total number of newly detected cases during the year. This indicator reflects the level of transmission of the disease over the last few years. MDT coverage
This is defined as the proportion of cases receiving MDT at any time during the year among the total number of cases appearing on the register during the year. This indicator reflects the programme performance in achieving full MDT coverage. Proportion of patients who have received adequate treatment (cured cases, MDT compLeted)
This is defined as the proportion of patients who have completed adequate MDT treatment among all patients who have completed MDT during the year. Adequate treatment is defined as six months
Part I
3
of chemotherapy completed within nine months for paucibacillary (PB) patients and 24 months of chemotherapy completed within 36 months for MB patients. This operational indicator reflects the efficacy of treatment services. Number of relapsed cases
This comprises only the absolute number of relapsed cases occurring during the year, after the completion of MDT or DDS treatment. Prevalenceldetection ratio
This is the ratio of the prevalence divided by the number of cases detected during that year, expressed as a single number. It reflects the mean duration of registration of leprosy patients. Theoretically, if all patients were MB cases and received their 24 monthly doses of MDT within 36 months, the ratio of prevalence to detection would never exceed 3. A higher value for this ratio indicates that patients are treated longer than necessary, do not receive adequate treatment, or that registers are not updated. In 1997, one-year fixed duration MDT was introduced in the Region. Most countries had adopted this regimen by 1998. A ratio of I is expected where MB patients receive one-year MDT.
2.3 Sources of data The main sources of data are: • Officially published reports, including the World Health Statistics Annual (WHO Geneva), Country Health Information Profiles (WHO Regional Office for the Western Pacific), and national reports. • Documents in the WHO Regional Office for the Western Pacific, including the Western Pacific Region data bank on socioeconomic and health indicators. Extensive use was made of the assignment reports to the WHO Regional Office on leprosy in most countries for the period 1983-1997. Annual statistics on leprosy are requested from each country and area in the Region. • Articles in medical journals. The number of relevant papers in international journals is limited. References are given in Part III of this report, under each country profile. • Unpublished reports. Unpublished data on leprosy collected by WHO, particularly during international meetings, have been used and are sometimes the only source of data.
4
Part I
3. Data collection The data on leprosy are a key to the evaluation of the situation of the disease and of control measures. The quantity and quality of the data are directly related to the quality of the reporting system in use; availability of data is itself an indicator of the level attained by the control programme. Information and reporting systems should allow the compilation of the indicators listed above. The major constraint of this study, carried out over a IS-year period (1983-1997), is the availability and consistency of data. In the following tables, a blank entry means that there are no data available. The data most frequently available were the numbers of newly detected cases; data on the numbers of registered cases were less extensive. There is a need to strengthen data reporting and collection for their appraisal nationally and internationally. Each country should be encouraged to report without excessive delay the leprosy indicators listed above. The second major constraint of the present study is the quality of data. Comparison and analysis within and between countries and areas are based on the officially reported figures and on the assumption that these figures are reliable and reflect the actual situation. However, it is very likely that the gap between the actual situation and the data varies with time in a given country, and may vary between countries. A major difficulty, particularly in the context of leprosy elimination, is to assess the proportion of the population covered by the programme. The reported data on detection and prevalence reflect the coverage and quality of the case-finding and registration activities. Inaccuracy in the numbers of registered patients is sometimes an issue, and one may find a large proportion of registered patients that should not be registered for various reasons: death, lost from sight, or maintained on the register after completion of MDT either because they are still being followed-up or are receiving dapsone (DDS) after MDT. In countries where high MDT coverage is seen, this latter situation can easily be assessed by calculating the ratio of prevalence to detection. The difference in diagnostic criteria also affects comparisons between countries, especially for the MB proportion and the disability proportion.
4. Epidemiological review
4.1 Registered prevalence and expansion of MDT services The prevalence of leprosy continued to show a declining trend in 1997, and most of the countries endemic for leprosy have reported considerable progress against the disease. Table 2 shows the prevalence rates and MDT coverage in five WHO regions. The total number of registered cases in the world at the end of 1996 was 920 581 (prevalence rate 1.67 per 10000), of whom 26576 came from the Western Pacific Region (prevalence rate 0.16). The Western Pacific Region recorded the lowest prevalence rate after the European Region (which had an estimated number of cases of less than 1000), and the highest MDT coverage (99% as against 91 % worldwide). The highest prevalence rate are seen in the Marshall Islands and in the Federated States of Micronesia. along with the highest case detection rate (Tables 3 and 4). The highest number of registered cases is in the Philippines (8749), followed by Viet Nam (4676), China (4045) Cambodia (1921), Malaysia (1181) and Papua New Guinea (1004), as shown in Figures 3 and 4. In these countries, leprosy control services have improved dramatically over the last few years, and the national programmes
Part J
5
now cover almost the whole population, In total. 25 of the Region's 36 countries and areas have achieved the WHO target of elimination of leprosy, i.e., less than one registered case per 10 000 population.
4.2 Detection of leprosy cases (Tables 3 to 5) The highest number of newly detected cases in 1997 was 4942 in the Philippines and 2808 in Viet Nam. The leprosy pattern is uneven in Asian countries, with a case detection rate per 100 000 of 22.8 in Cambodia, compared with 0.15 in China. The leprosy case detection rates per 100 000 in the central Pacific countries (Federated States of Micronesia: 112, Kiribati: 98.7 in 1996 and the Marshall Islands: 112) are still very high compared with south Pacific countries, some of which have already eliminated leprosy as a public health problem. The explanation for this is not clear.
4.3 Time trends in case detection and prevalence rates (Tables 4 to 6) The prevalence of leprosy in the world has been reduced by more than 85% in the period 19821997. In the Western Pacific Region, the prevalence rate has fallen from 0.97 per 10000 in 1988 (140 000 registered cases) to 0.15 per 10 000 in 1997 (24339 registered cases), an 85% reduction in ten years. The question that now arises is how to demonstrate whether or not this reduction in prevalence has had an impact on the transmission of the disease. Unfortunately, dependable tools for measuring infection and for monitoring incidence trends in leprosy are not available. Intensification of leprosy control activities through expansion of MDT services to every available health facility is an important step towards elimination. However, the availability of health services and their capacity to implement MDT services for leprosy vary widely. In theory, it' all the cases were to be detected within the first year of onset of disease and treated with MDT. the impact on transmission should be visible within a few years. In practice, the detection of leprosy has slightly increased over the past ten years in contrast to the observed steep reduction in prevalence: in the Region, the case detection rate was 0.71 per 100000 in 1988 (10282 newly detected cases) and 0.83 per 100000 in 1997 (13 567 newly detected cases), The extent to which this can be attributed to the level of transmission. improved case-finding, expansion of health services (particularly in difficult to reach areas). increased population at risk, or a combination of these factors is not clear. From 1988 to 1997, MDT was gradually implemented widely to reach a coverage of 99'7c of all registered cases in the region (Figure 8). As a result of this. the average duration of the disease from diagnosis to cure was reduced to between 2 and 4 years and is now being reduced to between one and two years due to the wide implementation of one-year fixed duration MB MDT. Detection and prevalence are now converging, and it is becoming increasingly obvious that detection. to a large extent, reflects a hidden prevalence which was not very well perceived before, Many of the newly detected cases currently consist of cases accumulated over a period of time. The increase in the case detection rate should not be interpreted as a weakness of the elimination strategy but is rather related to expanding geographical coverage of leprosy services through dynamic national elimination programmes and more recently. introduction of elimination campaigns and special action projects with the specific aim of reaching uncovered areas and underserved populations. If elimination campaigns and community awareness activities continue at their present levels. a reduction in the case detection rate in the next two or three years should be seen.
6
Part I
5. Programme activities The Forty-fourth World Health Assembly, in May 1991, adopted resolution WHA44.9 on the 'elimination of leprosy as a public health problem in the world by the year 2000. The overall elimination strategy is based on: (i) timely case detection; (ii) cure of all diagnosed cases with fixed duration MDT; (iii) simplified case-management; and (iv) monitoring progress through appropriate information systems. The policy of the WHO Regional Office for the Western Pacific addresses the issue of elimination in 11 countries which have not reached the elimination target of less than one case per 10 000 population, and among them, of four countries which still have high prevalence rates. WHO, in collaboration with national programmes, is promoting new initiatives such as Leprosy Elimination Monitoring (LEM) and the use of the GIS with the objective of identifying difficult operational and/or epidemiological situations calling for special intensified efforts. 5.1 Leprosy Elimination Campaign (LEC) The Leprosy Elimination Campaign is a strategy which aims at providing the national programmes with additional external inputs to intensify elimination activities. It is a national activity, implemented by the national personnel with technical cooperation from WHO and other agencies. The main objective of the elimination campaign is to detect leprosy cases, particularly "cases of consequence", defined as "skin-smear positive cases and cases with more than five skin lesions", that have remained undetected in the community and to put them on MDT promptly, Activities carried out include: workshops to improve the diagnostic and treatment services provided by local health workers; orientation courses for volunteers; creating community awareness by using various media and information sessions; and case-finding. mainly through self-reporting and prompt treatment with MDT. The effect of the activities are expected to last beyond the short period of the actual campaign and it is hoped that new patients will continue to self-report. Ten LECs were conducted in Cambodia and the Philippines. They helped to detect 1158 cases in a population of 7.4 million (case detection 15.6 per 100 000). In 1998. 16 LECs are planned in the Philippines, three in Viet Nam, two in Papua New Guinea. and one in Cambodia. 5.2 Special Action Project for the Elimination of Leprosy (SAPEL) A substantial number of patients do not have easy access to diagnosis and treatment of leprosy. Many of them live in such remote areas that they may not even be aware that leprosy is a curable disease. Activities for reaching every village will focus on those patients and populations that so far have not been reached. To do this, WHO headquarters has formulated the Special Action Project for the Elimination of Leprosy aiming at the identification and treatment of patients living in certain conditions. i.e., where it is not possible to implement routine leprosy control programmes. Three basic strategies are being used: (i) lay supervised WHO MDT in which community leaders. or others without formal health training are trained to assist in case detection and supervision of the monthly doses of MDT; (ii) unsupervised MDT (more than a month's supply of MDT drugs is provided to the patients who are then responsible for their own treatment over a period of months); and (iii) use of new drug regimens. Seven SAPELs were implemented in difficult to reach areas in China. Cambodia. the Philippines. and Viet Nam. They helped to detect 455 cases in a total population of 1.5 million inhabitants (case detection 30 per 100 000). In 1998, five SAPELs are planned in Viet Nam. four in China, two in the Philippines. two in Papua New Guinea, and one in Cambodia.
Part I
7
5.3 Special projects The Federated States of Micronesia, with 30 cases per 10 000 population, had the highest prevalence of leprosy in the region in 1995. A survey of selected villages conducted in 1995 reported a new case detection rate of 680 per 100000 in Chuuk and 560 per 100000 in Pohnpei. These alarming figures prompted the Government and WHO to launch a special leprosy elimination project in March 1996, in order to accelerate and achieve the leprosy elimination goal by the year 2000. The project was of two years duration with two rounds of screening of the entire population in order to: (i) detect, treat and cure all the existing cases using the WHO MDT regimen; and (ii) administer preventive therapy to all healthy people to prevent the development of the disease In those infected. The preventive therapy consisted of a combination of rifampicine, ofloxacin and minocycline (ROM) for adults and rifampicine alone for children aged less than 15 years old. Drugs were administered twice in a single dose, a dose during each round of the project. Regimen and doses for preventive therapy were discussed and agreed upon during a technical meeting held in November 1995 in the Regional Office which convened international experts on chemotherapy. The first round ended in June 1997. The second round started in March 1997 and was completed by the end of May 1998. During the first round, 71 % of the population was screened and 68% received preventive therapy. In total, 258 new leprosy cases were detected while 59 other cases self-reported. As at the end of January 1998, 71 % of the population received preventive therapy, 45 new leprosy cases were detected while 35 cases self-reported. In total, 83% of the population received at least one dose, and 53% received two doses of preventive therapy. The number of newly detected cases is expected to reach 9S by the end of the second round. This represents a reduction in case detection from the first to the second round of 70%, mostly attributable to the large proportion of backlog cases detected during the first round. A mass screening of the population with MDT treatment of newly detected leprosy cases started in May 1997 in Kiribati. The screening covered 91% of the population. Out of a total of 64704 individuals examined, 128 leprosy cases (13% MB) were detected.
5.4 Classification of countries and areas in the Western Pacific Region according to their current leprosy situation Countries and areas in the Western Pacific Region may be divided into four groups, according to their current leprosy situation. Group 1. Comprises 2S countries and areas which have reached the elimination target of less than one case per 10 000 population. These countries are Australia, Brunei Darussalam, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong, China, Japan, Macao, Malaysia, Mongolia, New Caledonia, New Zealand, Niue. Northern Mariana Islands, Republic of Korea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu. Vanuatu, Viet Nam. and Wallis and Futuna. Group 2. Comprises two countries and one area that have very small populations and fewer than ten cases of leprosy: American Samoa, Nauru and Palau. Group 3. Comprises four countries that have not reached the elimination target but, with sustained efforts, should reach it by the end of 1998. These are: Cambodia, Lao People's Democratic RepUblic, Philippines and Singapore.
8
Part I
Group 4. Comprises four countries that still have high prevalence rates: Kiribati, Federated States of Micronesia, Marshall Islands and Papua New Guinea.
Part I
9
Table 1.
Socioeconomic indicators by country and area in the Western Pacific Region Population (OOOs) Year Annual pop. growth rate %
Country/Area
Year
IMR'
American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong, China Japan Kiribati Lao P.D.R. Macao Malaysia N. Mariana Islands Marshall Islands Micronesia, F.S. Mongolia Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam Wallis and Futuna
56 18289 296 10 702 1 223890 19 796 220 158 6311 124299 79 4575 416 21 168 59 56 122 2400 11
185 3614 2 17 4226 70247 45248 166 3 185 394 2 98 10 169 76700 14
1995 1996 1995 1996 1996 1995 1996 1995 1997 1996 1995 1996 1995 1996 1996 1995 1995 1995 1996 1995 1995 1996 1995 1995 1995 1995 1996 1996 1997 1995 1996 1995 1996 1995 1997 1994
1.9 1.3
3.0 2.6 1.0 1.1
1.5 2.1 0.8 2.5 0.2 1.4 2.6 0.2 2.3 5.6 3.8 3.5 1.5 1.4 1.8 1.2 -0.2 3.2 2.3 2.4 0.9 0.3 2.0 3.5 -1.3
0.5 1.7
2.4 2.0 1.1
1995 1995-96 1995 1996 1995 1995 1996 1995 1991 1995 1995 1995 1995 1996 1995 1996 1994 1994 1996 1994 1995 1995 1996 1996 1995 1995 1995 1994 1996 1994 1992 1995 1995 1996 1996 1995
13 I
8 90 36 4 21 12 9 4 4 54 104 5 12 7 26 25 40 26 14 7 0 20 82 49 9 20 4 26 16 6 49 41 45 40
I Gross national product. , Infant mortality rate per 1000 births. J Gross domestic product (GOP). Source: Western Pacific Region data bank on socioeconomic and health indicators.
10
Part 1
Table 2.
Prevalence of registered leprosy cases and coverage with MDT by WHO Region (1996) Registered cases 95901 123 537 23005 651 562 26576 920581 Prevalence rate per 10000 1.77 1.64 0.54 4.72 0.16 1.67 Estimated prevalence rate 3.2 2.2 1.0 6.0 0.3 MDT coverage %
WHO Region
Cured with MDT (cumulative) 443610 225450 52784 7059925 206635 7 9RB 404
Newly detected cases 46489 43483 5761 457 921 13 027 566 fiR I
Detection rale per 100 000
Africa Americas Eastern Mediterranean South-East Asia Western Pacitic
91.5 75.3 83.0 93.7 99.0 91.0
7H 5.59 1.25
32.4 O.R ')X4
Total
2
Source: WHO, Wkly Epidem. Rec., 1997, 72: 165-172.
Table 3.
Latest available data on leprosy by country and area in the Western Pacific Region (detection rates per 100000 population, prevalence rates per 10 000 population) Year Population (OOOs) 55 18088 305 IO 706 I 236000 19 796 220 158 6502 125095 79 4846 500 21665 64 61 110 2400 11 181 3696 2 19 4533 71 389 45991 167 3185 425 2 98 IO 173 76900 14 Newly detected cases Rate MB Disability Children 5.46 0.05 0.66 22.8 0.15 0 0.75 2.27 4 0.17 0.01 98.7 5.28 0 1.28 7.84 112 112 0 18 3.87 0.05 0 5.3 12.1 6.92 0.Q7 7.78 0.3 4.94 0 1.02 IO 3.47 3.65 0 2 2 1263 1508 0 3 I 4 3 0 418 394 0 0 0 ()
Country/Area
Total 3 9 2 2438 1854 0 6 5 6 11 8 78 256 0 277 5 68 123 0 2 7 2 0 1 547 4942 34 13 10 21 0 I 1 6 2808 0
Treated MDT 15
MDT completed R
Relapse
Registered end of year 7 10 6 1921 4045 0 17 13 20 54 200 42 533 0 1181 4 163 163 0 4 13 2 0 2 1004 8749 707 16 44 42 0 1 1 8 4676 0
Prevalence rate 1.27 0.01 0.19 1.79 0.03 0 0.21 0.59 1.26 0.08 0.02 5.32 1.1 0 0.54 0.63 26.8 14.8 0 3.6 0.72 0.005 0 1.1 2.2 1.22 0.15 0.95 0.15 0.99 0 0.1 I 0.5 0.61 0
Prevalence! detection 2.3 1.1 3 0.8 2.2 -
American Samoa Australia Brunei Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong. China Japan Kiribati Lao P.D.R. Macao Malaysia N. Mariana Islands Marshall Islands Micronesia. F.S. Mongolia Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Total
1996 1995 1997 1997 1997 1997 1996 1997 1997 1997 1993 1996 1997 1997 1997 1997 1997 1997 1997 1996 1995 1997 1997 1997 1997 1997 1997 1997 1997 1997 1995 1997 1996 1997 1997 1994
0
0
0 0 268 80 0 0 0 I 0
5519 6028 0 19
2 3364 2 160 0 12 6 II
0 188 0 0 0 0
169 0 188 3
63 0 9 I
<)
27 35 0 0 5 0 0 2
0 15 0 25 54 0 0 I 0 ()
811 0 14 230 490 0 25 0
278 0 237 10 61 315 0
0 0 0 1 0 0 0 0 0 0 I 21 0 0 I 0 0 0 0 0 17 0
2.8 2.6 3.3 4.9 25 0.5 2.1
4.3 0.8 2.4 1.3
2 1.9 1
12 0 5 672 3513 399 15 210 5 0 0
0 0 309 3983 27 7 4 10 0 1 I 4 I 798 0
0 0 65 252 I 0 0 I 0 0 0 I 854 0
2 1.8 1.8 21 1.2 4.4 2 -
8 1676 12916 I 106 31 38 ()
178 393 0 I 0 7 0 0 0 I 159 0
I 4
3 17 2669 0
1 1
25 7349 0
J.3 1.7
1634465
13 544
0.83
23648
0.15
1.8
:::;
2'
12
Part 1
Table 4.
Time trend of the number of newly detected leprosy cases and case detection rates per 100 000 population by country and area in the Western Pacific Region (1983-1997) 1983 15 44.1 28 0.18 1984 1985 9 25.7
Country! Area
1986 II 30.6 27 0.17 I 0.44 549 6.5 4945 0.47
1987 13 35.1 30 0.19
1988 7 18.9 20 0.12
1989 6 16.2
1990 9 19.6 16 0.09 0 0 574 7.03 3345 0.3 0 0 26 3.51 8 4.08 2 1.59
1991 9 19.2
1992 7 14.6
1993 4
1994
1995 4
1996 3 5.46
1997
Am. Samoa Australia
S 0 0 6 2.1 1644 18.3 2096 0.17 0 0
7.41 9
38 0.24
Brunei
Cambodia China Cook Islands Fiji
704 8.6
545 6.4 4042 0.38
French Polynesia Guam
36 5.37 24 15.3 3 2.65
25 3.57 12 7.5
22 3.1 II 6.88
20 2.77 14 7.82 4 3.28
19 2.53 19 10.6 3 2.4
706 8.1 3837 0.35 6 35.3 17 2.34 10 5.29 4 3.23
789 8.8 3303 0.3
16 2.16 3 1.56
Hong Kong, China Japan
30 0.03
42 0.03
42 0.03
15 0.01
Kiribati Lao P.O.R.
307 8.56
426 11.5
702 18.3
33 0.03 28 4D.6 168 4.25
26 0.02 63 88.7 264 6.48
12 0.01 28 38.3 371 8.83
Macao Malaysia
N. Mariana Islands
Marshall Islands
3 17.7 2 6.06
2 10.5 5 14.3
3 15 7 25
313 2.0 2 10 13 44.8
Micronesia, ES. Mongolia
348 2.08 4 I 1.1 10 33.3 177 188
311 1.83 3 7.89 19 44.2 87 89.7
329 1.9 I 2.63 24 60 96 101
296 1.69 3 6.82 26 56.5 80 79.2
415 4.96 3400 0.3 2 11.8 6 0.8 5 2.49 5 3.94 26 0.44 17 0.01 59 79.7 340 8.1 2 0.43 315 1.79 8 17.8 32 68.1 84 80.8
617 7.19 2728 0.23 0 0 II 1.46 12 5.83 7 5 20 0.33 15 0.01 33 44 317 7.27 2 0.41 220 1.22 4 8.7 21 42.9 90 84.1
3 1.05 945 10.5 2191 0.19 0 0 7 0.91 7 3.38 4 2.8
0.05 0 0.68 2219 21.65 I 895 0.16 I
0 0 2404 23.02 1845 0.15
~
0.66 2438 22.g I 854 0.15 (I (I
9 1.17 9 4.25 6 4.2
5.26 6 0.77 6 2.71 6 4
6 0.75 6
2.73
5 2.27 6 4 II 0.17
8
0.01 41 54 234 5.23 I 0.2
17 22.1 304 6.62
16 2D.25 298 (1.1 0 Il
78 98.73 270 5.53
256 5."8 (I
II
3 6 20 37 220 202
Nauru
New Caledonia New Zealand Niue Palau Papua N. Guinea Philippines
I 12.5 23 15.9
I 12.5 20 13.2
3 37.5 20 13.3
0 0 32 21.6
3 37.5
22 14.3
3 37.5 14 8.75
2 22.2 I) 9.38
Republic of Korea Samoa
7 50 912 26 1730 3.32 345 0.86 51 31.6
2 154 683 21 1726 3.23 293 0.72 15 9.38
2 16.7 773 23 I 139 2.08 195 0.47 15 938
I 7.14 568 16.6 2 185 3.9 142 0.34 16 10.1
3 214 579 16.2 2748 4.68 131 0.31 19 11.8
3 21.4 652 18.2 2442 4.11 157 0.37 II 6.83
I 8.33 544 13.9 4 163 6.93
18 10.6
Singapore Solomon 1~land~
21 7.34
23 7.96
24 7.84
14 4.38
Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna
0 0
I 104
0 0
2 2.06
0 0
2 2.08
I 1.02
31 25 2021 3.74
28 22.1 2103 3.77
21 16.2 2062 3.59
15 11.3 2292 3.88
II 8.09 2 183 3.61
II 7.91 1847 2.98
7 4.93 2073 3.26
7 77.7 16 9.76 I 0.03 0 0 5 41.7 512 13.7 5725 9.31 157 0.36 13 8.02 36 1.33 19 5.97 0 0 I 1.03 0 0 10 6.85 1995 3.47
2 22.2 13 7.78 4 0.12 0
2 22.2 10 5.85
3 30 10 5.75
330 1.74 I 1.75 8 14.3 95 84.8 0 0 2 20 9
293 1.45 6
273 1.29 6 9.6X
277 1./:'-; )
0 6 50 519 13.6 7 169 11.4
10 6.13 13 048 21 6.36 I 50 I 1.03 0 0 7 4.79 2500 3.69
0 0 2 16.7 219 5.61 5896 9.16 136 0.31 9 5.52 41 1.48 I)
4.4 I 'i0 0 0 0 0 17 II 3142 4.53 0 0
4 26.7 519 13.6 3442 5.29 130 0.3 5 301 24 084 8 2.25
4.86 I 0.03 0 0 6 35.3 345 8.51 4450 6.85 113 0.25 10 6.17
12.77 18 32.73 206 169 0 0 2 18.IS 7 3.87 I 0.1n (I
112 219.6
7.S4 7D 114.9 123 112 (I
0 II 2
(I
18.18
10 0.27 0 ()
2
0.0) (I
0 <)
()
4
52.94 231 5.:17 3988 5.9
:.U 699 l6.')
I S.l 547 12.1
:W
0.0<) 13 7.6 1? 1.16 <)
4051 5.8 19 (1.09 13 7.78
4942 6.(-.P
34 0.07 13 7.g 10 0 ..1 21 4.94
10 2.64
24 'i.86
2.20 0 0 () (I
0 0 2 22.2 14 8.7 3 185 4.38
I I I 10 7 4.0 2883 3.83
3 23.09 3 1.83 3173 4.29 ()
14 8.28 2576 3.42
6 3.5 2808 3.6)
0 0
0
Above: number of newly detected cases: below: case detection rates per 100000 population.
Part I
13
TableS.
Time trend of the number of registered leprosy cases and prevalence rates per 10 000 population by country and area in the Western Pacific Region (1983-1997) 1983 70 20.6 2661 1.7 ]
Country!Area Am. Samoa Australia Brunei
1984
1985
1986
1987
1988
1989
1990
1991 49 10.4
1992
1993 21 4.2
1994
1995 IJ
1996 7 t .27
1997
2.41 10 0.01 10 0.01 6
62 0.Q4 ] ]
0.1]
0.12 1742 2.0 70000 0.66 1]]4 1.5 55240 0.5 I 170
0.1 1669 1.99 20003 0.17 2 1.18 86 1.15 1627 1.9 8470 0.07 0 0 49 0.65 18 0.87 23 1.64 47 008 200 2038 2.26 6055 0.05 0 0 J9 0.51 18 0.87 24 1.68
6 0.2 2461 2.73 5655 0.05 0 0 J9 0.51 II 0.52 10 07
Cambodia China Cook lslands 26 15.] 455 6.79 29.5 17.7 444 6.34
649 0.8 100000 1.0
742 0.9
1.1 40000 0.]6
I 156 1.42 ]0000 0.26 0 0
0.2 2886 2.82 48JJ 0.04 I 0.5] 24 0.31 12
1 0.1 2960 2.83 4474 004
[,
0.2 I 92 J 1.79 4-04.") 0.03 () ()
15 7.5 367 5.17
16 9.41 24J 1.24 204 2.81 147 1.99
Fiji French Polynesia Guam Hong Kong, China Japan Kiribati
2H3 J.91
109 1.47
17 0.21 14 0.6413 0.59
9 0.45 34 2.8 20 1.57 65 0.11 884 0.1 768 0.06 J] 4.5
0.55 8 0.53
20 1.2()
16]8 2.9
54(Un
0.02 80 9.5 I ]9] 3.32 18 0.39 46 5.97 967 2.11
118 19 2988 8.3
13 lAO;;
42 ') 12 574 I 18 '::;,1
Ll0 P.D.R. Macao Malaysia N. Mariana Islands Marshall Islands Microne.~ia.
:1 152 8.79
:'> 381
2353 6.14
9.1:
1955 4.94
I 376 3.38
2529 0.02
I ]61 3.12 15 0.21
1085 2.43 11 0.26
694 1.42
I I () ()
96 2.8
7 0.17 1823
:'i 730 3.6
6373 3.81
;) 723
.') 031 2,9
3.37
4- 149 2.36
3439 1.%
0.96 4 0.87 1.58 20 ]7 ]49
I 561 0.78
"
,
I :1 1-1 0,62
I lSI 0.::;4-
1.49
II 1.77
50 10.6 851
'8 1.43 290 25.9 0
46 8.36
x5 16.67
4 iJ.«' Ihh 277
ES.
90.5 Mongolia Nauru
782 80.6
658 69.~
628 62.2
501 48.2
32.6
:n.2
362
.168 30.16 0 0 X 7 :!.7 13 0.72 I 0 0 4 4
16_' I-I-.~
0 40 .17.1 163 25 42 46.7 14 15.6 48 2.87 0 0 8
II 0 4 \(13
8
New Caledonia New Zealand Niue P<]lau P"pua N. Guinea Philippine~
JJ4 .22
liS 21
:126 11
])9
:IS]
"
11
70 4.38
90 5.49 .1
64 3.74
22 I 26
27 IA6 I 0
, (l.OOS () ()
0.01
0 0
0 0 16
0 0 I' 1.06
II
0 ~
,
0 2
9752 27.8 .17323 7.17
8715 26.8 )7377 7
8203 24.4 38814 7.1
7581 22.2 )8570 6.89
7465 20.H 35281 6.01
163 12.H .16972 6.22
~
:'i
I~S
I.U :I 19-1-7 .'U2
Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna
274 17 2145 8.)
LB 8.2
2762 0.67 118 7
-I- .\.'() 11.6 20280 U I 637
1.\ ..' ~ 964 7.75
-I- 71 I 318 HI6 11 67.J.
::.9
~ I 004 --
2755 J.D5
2167 5.3-1-
I 105 2.6
' ,
17 :1-1-7 2.76
72 4.4
75 4.6
52 3.2
50 .1.1
O.3S 36 2.22
34 2.09 1406 5.14
15 :117 2..18 1 -169 O.J.J. 25 1.5.1 I 171 -+.23
15 -1-41 2..17 I 309 0 . .1 14 0.84 106:'-
16.J.86 2.5-1I 209 (L~7
l.n I 126 0.25 21 1. '") 1 747 2.62
8664 1.24 I on 0.24 23 1.38
X 1-1-9 1.22 707 0.15 1(, O.l)5 44 0.1')
20 1 '.I
3.7 66 1.86 40 1.06
700 11.7
115
).48 0 0 I 0.1 0 0
II 1.1
140 -1-.24 I 5 2 0.21 ()
24 O.6i (I
26 0.6-+
4' O.l)l)
I 5 I 0.1 2 2.22
!)
I 01 2 2.21 .1 .1.:13 1(, 0.98 7419 I 0
2 O.:? I I :?O I 15
I 0.1
JO 14.] 226 17.7
0 15 1.()3 18342 2.71 0 0
13 1.49 9449 1.:16 0 0
29 1.8
20 1.18
s 0 . ."
36616 6.78
34240 6.14
10750 5.36
28240 4.79
26750 4.42
24150 ).9
D46J 3.69
20997 165
7 :no 101 0 0
SIll
0.68
-I-N? 0.6?-
-+ h7(, (l.61
0
Above: number of registered cases; below: prevalence rates per 10 000 population.
14
Part /
Table 6.
Time trend of the number of registered leprosy cases and the number of newly detected cases in the Western Pacific Region (1988-1997) Regional
Reuis(ered cases
Year 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
population (OOOs) I 446939 1468180 1497093 1515579 1537199 I 560521 I 580357 1610291 1 628600 1 634465
Number 140000 113000 88545 69804 45845 39835 40085 30812 26576 23648
Rate per 10 000 (0.97) (0.77) (059) (0.46) (0.30) (0.26) (0.25) (0.19) (0.16) (0.15)
Newly detected cases Rate per 100 000 Number (0.71 ) 10282 (O.SO) I I 768 (0.89) 13294 (1.00) 15164 (0.89) 13610 to.71) I 1052 (0.81 ) 12730 (0.74) 11941 (0.80) 13027 13544 (0.83)
Note: standard case definition has heen applied throughout the table (Expert Committee on Leprosy, Sixth report. WHO Technical Series 1988; 76&).
,.....-..
--"---->.---~----"-.--.-----'---
... ,---".-.--.- _. __ .__._- .,---
-.-~-----
.. -.-.---
Wortd Health Organization RegiOnal Office for the Western Pacific
PqIe, AIpdbIoofQlna
D . '
.~ Korea ' i Rep\IbIi:.
pJapan
CCO
8) ~
Figure 1.
.'. " "
, Hongkoog
Leprosy Situation in the Western Pacific Region N!if1hem MIrianB Is,
PhUlpplno
April 1998 "-' ,';,',"'1
VlaIHtwn
,1 ,- .
,
Guam
~:::;r-
~."
';i.
-.
VtIIUtJ/IJ ~".
New Caledonia
,:-
OF,
...
Tokelau
Co!* I8Iands
W·L~ TC111g8
.. F~ PcIyneIia
NU
Legend
~ . ,
Less 1han 1 Case per 10 000 (25 COtlI1Uies ) less 1han 10 Cases (3 COIIIIIries ) 1-2 cases per 10 000 (4 oounIries l GrealBr than 2 Cases per 10 000 (4 00IIl1ries )
1bI detfg IIIi:iuwi mapdo AOlImfaly the ........ of ... _ ... IJo poII<l1Jo RogiooaI DhcIof -.iIIu'" <1 _ _.... ......., .. IOnIIooy ...... 1IcIoI-.<I 1'tC_<l_noIlo_ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ . _ _ _ . _ _ _ _ _ _ _ _ ~ ~ . _
on"
o
)ja~
I i
(l
HOff; _ _ _ _ IIoW'HOc"""'"
......
L - _ _ ._ _ _ _ ._ _
--
16
Part 1 Population distribution by country and area in the Western Pacific Region
Figure 2.
Japan 8%
VietNam
Philippines 4%
Republic of Korea Others 50/0
5%
China 75%
Figure 3.
Distribution of the number of registered cases and the prevalence' rates per 10 000 population in ten countries in the Western Pacific Region (1997) Cambodia China Kinbati Lao P.D.R. Malaysia
Micronesia, F.S. Papua New Guinea Philippines Marshall Islands
Viet Nam 10
5 o Registered cases (000s)
5
10
15
20
25
30
Prevalence rate per 10 000 population
Part f
17
Figure 4.
Distribution of registered leprosy cases in the Western Pacific Region (1996)
Others 14%
Viet Nam 19%
Malaysia 5%
Cambodia 7%
China 17%
Papua New Guinea 4%
Philippines 34%
Figure 5.
Distribution of detected cases and detection rates per 100000 in ten countries in the Western Pacific Region (1997) I 'T' *,:L;-~
I
Cambodia China Kiribati Lao P.D.R. Malaysia Micronesia, F.S.
,
"'.;.•:.... 11
I I ,
I
t -"""
I , I ,
!
I
I
i
I •
;'·\~!;j:h";'~iill~~.t%~;;
\;rH
I
:;~:~j: "'''?~HP9t 1
I
I i
I
il I
~ I !
! I !
I
i
I
i
I
I
I
I
I
1
I
~i;iHi,;;'
i I
i
I , ~~Af:
I ':h;;iVittm-i;;'~~ !
.
Papua New Guinea Philippines Marshall Islands Viet Nam 55 I
':1 ! I _+H ::::.
I
t ~ , •
! , ! !
I I :
! I I
I ! ' :,:,;;,,,,,;,;~
i I
I
I "";,,;;;
I I '''iii;;;
F
I
I 45
" .
I I
i
I 55
j
I
35
25
15
5
5
15
25
35
45
65
75
85
95 105 115 125
Detected cases (hundreds)
Detection rate per 100000
18
Part I
Figure 6.
Trends of leprosy case detection rates per 100000 population in five countries in the Western Pacific Region (1983-1997)
1000
100
\ , , 'A _ - ,0.,
I\A A ., '/),.- - 6- - 6
~Micronesia,
F.S. 0 0 0 0 0 ~
--"-Cambodia
Q; Q.
" '" II: ~
.
:II. - - 6 - -
10 -- _.
A
----.,./ ./ ,/
::1 . /
.... 11, /),.
- - -tr - - Papua New Guinea
_ _ Philippines
/'
/ ~
"" ~
.. Il.
\.
.~
"-/
Y
~
./'" ..",
E--lI::
~ /
..:x:
V 1 ~
"""'" M "
~
7'0
~VietNam
~
M
M
M
~
00 Year
~
~
~
~
~
~
"
Part I
19
Figure 7.
Trends of leprosy prevalence rates per 10 000 population in five countries in the Western Pacific Region (1983-1997)
100
-. -t:. ... 4 -·-I1".A , .
'"
-'" " , ,
".---.
10 ~
o
o o
o
~
~
--
A. -. to..
'¥""'"". • Micronesia,
,
,
-.
.
'x
..... ''
F.S.
.'\ ~
~
~ cr !co
/,'Y ~
\'-
....-~
.. .
.~
.
. - . 6· _. Papua New Guinea
~
•
Cambodia
•
Philippines
u
VietNam
0.1 ~
M
~
00
~
~
~
00 Year
~
~
~
~
~
~
~
20
Part I
Figure 8.
Leprosy prevalence rates and multidrug therapy coverage in the Western Pacific Region (1988-) 997)
1.6 1.4
100 90 80 70 60 50 (%j
c :::0
0
S 1.2 ::s a. 0 a.
.. ~
C> C> C> C>
0.8 a. S f! 0.6 c iii 0.4 > 0..
.. .. u
40 30 20 10 0 88 89 90 91 92 Year
l!!
0.2 0 93 94 95 96 97
-+-- Prevalence rate -o-MDT coverage
Part I
21
Figure 9.
Number of countries reporting the leprosy indicators in the Western Pacific Region ( 11)83-1997)
35 30
.. .. .'" to § .. ... ... .. . .. ... 1:: ~
25
...-...- Prevalence ~Detection
20
- - 5 indicators
v.; 10
= :z:
B
5 0 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97'
Year
Five indicators: Case detection rate, prevalence rate, deformity rate, child rate, and MDT completed.
*1997: Data available as at April 1998.
Part II
23
Part II: Leprosy data for each country and area in the Western Pacific Region
24
Part II
American Samoa 1996 Prevalence New cases Cured Relapsed
Population: 55 000 Epidemiology: The case detection rate has decreased steadily since 1983. Programme: Vertical. The leprosy unit is part of the Department of Health which has implemented the leprosy control programme. Several health centres contribute to screening and referring suspected cascs to the leprosy unit. Case-finding: Mainly passive. Contacts of active cases are listed for systematic examination but compliance with systematic examinations of contacts is partial. Diagnosis: Mainly based on clinical examination of patients. Laboratory: Until 1993, reports the absence or presence of AFB. There is no quality testing. Skin biopsies are sent to Carville, Los Angeles or Hawaii. Treatment: MDT was implemented in 1986. Prevalence/detection ratio: 2.3 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: References: Farrugia R. (WHO). Report on a field visit to American Samoa, April 1994. Farrugia R. (WHO), Report on a field visit to American Samoa, September 1996. Farrugia R. (WHO), Report on a field visit to American Samoa, May 1997. Lynch MJ. (WHO), Report on laboratory diagnosis of leprosy and tuberculosis in American Samoa, April 1994.
Part 1/
25
Leprosy indicators in American Samoa (1983-1996): Year Population Registered Prevalence per 10 000 (000s) cases New New cases cases per 100000 MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
34 35 35 36 37 37 37 46 47 48 50 52 54 55
70
20.6
15 9 11 13 7 6 9 9 7 4 4 3
44.12 25.71 30.56 35.14 18.92 16.22 19.57 19.15 14.58 8.00 7.41 5.46
60 56 45 31 83 89 89 29 100 50 66
0 22 0 8 33 0 0 0
20 11 27 23 0 11 0 14 0 0
49 21 13 7
10.43 4.20 2.41 1.27
0 0
Rate per 10 000
Leprosy prewlence and case detection rates per IO 000 (1983 - 1996)
25~---------------------------------------------,
20~~------------------------------------------~
15+-----------~~c_----------------------------~
_ _ Prev. rate - 0 - Detee. rate
10+-------------------------~
__- - - - - - - - - - - - - - - - _ i
5~--------------------------~~--------~
Year
26
Pan Il
Australia 1995 Prevalence per 10 000 Grade 2 Cured cases Relapsed cases
Population: 18 088 000 Epidemiology: Leprosy is unevenly distributed in the country. It has been present over the past IS years in the Northern Territory and Western Australia, and, to a lesser extent, in Queensland. At-risk groups comprise migrants in New South Wales and Victoria, and the Aboriginal population in the Northern Territory, in whom detection rates have fallen since the early 1950s from 270 to 15 per 100 000 population. Programme: There is no national standardized control policy, and no national register. Case-finding: Mainly passive, with occasional community surveys in endemic pockets, and contact surveys. Diagnosis: Based on clinical and bacteriological examination. Laboratory: Biopsies are sent to University College, London where mouse foot pad inoculation performed. Treatment: All cases receive MDT, which was implemented in 1982. Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Australia. References: Ree G.H. Pattern ofleprosy in Queensland, Australia, 1955-1990. Lepr Rev. 1991; 62: 420-430. Information from Communicable Disease and International Health Branch, Canberra, September 1991. Ree G.H. Country Report: Leprosy in Australia, June 1992. Information from Specialized Health Services, Brisbane, August 1991. IS
Part /I
27
Leprosy indicators in Australia (1983-1995); Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence (OOOs) cases per 10000 15379 15519 15859 16018 16100 16358 16833 16873 17143 17417 17630 17843 18088 18289 New cases 28 38 27 30 20 16 New cases per 100 000 0.18 0.24 0.17 0.19 0.12 0.09
MB %
Disability %
Child %
2661
1.7
62
0.04
10
0.01
0 9
0.00 0.05
0
Rate
PeT 10000 0.045 0.04 0.035 0.03 0.025 0.02 0.015 0.01 0.005 c(
Leprosy prevalence and case detection (";~~ rates per 10 000 (1983 - 1995) 17
------- "\ /\ ~
\
\
--+- Prevo rate
\
- 0 - Detec. rate
h~
\
~ 00 Year
~
o ~ ~
'-:-../ ~ ~ ~
M
~
U
$
91
%
%
~
28
Part 1/
Brunei Darussalam 1997
New cases
Cured
Relapsed
Population: 305 100 Epidemiology: Programme: Case-finding: Diagnosis: Laboratory: Treatment: MDT was implemented in 1985, and every newly detected case receives MDT. Prevalence/detection ratio: 3 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Aehievements: Leprosy as a public health problem has been eliminated from Brunei Darussalam. References: Information from the Ministry of Health. Brunei Darussalam, January 1992.
Part /I
29
Leprosy indicators in Brunei Darussalam (1983-1997): Year Population Registered Prevalence per 10 000 (000s) cases New New cases cases per 100000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
250 269 224 226 235 241 248 256 264 272 285 285 296 314 305
3
0.13
1
0.44
3
0.12
0
0.00
3 6 6 3
6
0.10 0.21 0.2 0.1 0.2
3
6 2 0
1.05 2.1 0.68 0
67 67 50 -
100 100 -
0 0 -
2
0.66
100
0
0
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
0.25,--------------------_
0.2
t - - - - - - - - - - - - - - - - - - I : r -.......---+ -+- Prevo rate --fr- Detee. rate
0.15 t-----------------+~\____\-..J_
0.1
t--------------="""J:}.---\---¥--
0.05 t-----r~-------rL_-----+-_I_
Year
30
Part /I
Cambodia 1997 Cured Relapsed
Population: 10 706 000 Epidemiology: The increase in case detection and prevalence rates from 1991 to 1997 can be attributed to the increasing coverage of the leprosy programme, and to the notification of many previously unregistered leprosy cases. The programme is still detecting a large number of backlog cases. Programme: Leprosy control started again in 1984 in Phnom Penh. There is a National Centre of Dermatology and Leprology and the national leprosy control programme was redesigned and strengthened in 1994, after implementation of a plan of action in 1992, with a document for the programme, technical standards and operations, and a plan of action. The Director of the national tuberculosis programme was made responsible for the national leprosy programme in April 1996. The programme is supported to a considerable extent by the CrOMAL (French Order of Malta). LEC and SAPEL projects cover a population of about 3.8 million. A LEM was conducted in 1997. Case-finding: Mainly passive. Intensified activities to detect hidden cases started in 1996. Diagnosis: Based on clinical grounds. Bacteriological examination is not performed on a regular basis. Laboratory: Treatment: MDT since 1984. Treatment is delivered at the district level. Drug supply is integrated into the general system of drug supply for the provinces, with a buffer stock of three months kept at the district level. Prevalence/detection ratio: 0.8 Rehabilitation: Carried out in collaboration with Handicap International. Surgery is performed in Phnom Penh (Hopitai des Bonzes). Retreatment of cases previously treated with DDS and discharged: Achievements: MDT coverage is 100%. References: Blanc L. (WHO), Report on a field visit to Cambodia, May 1992. Blanc L. (WHO), Report on a field visit to Cambodia, June 1995. Blanc L. (WHO), Report on a lield visit to Cambodia, April 1996. Blanc L. (WHO), Report on a field visit to Cambodia, November 1996. Jl.ao P.S. (WHO), Strengthening the leprosy control programme in Cambodia, April-May 1996. R'ao P.S. (WHO), Leprosy Elimination Campaign, Cambodia, June 1996. Rao P.S. (WHO), Leprosy Elimination Campaign, Cambodia, September-November 1996. Rao P.S. (WHO), Leprosy Elimination Campaign. Cambodia. January-May 1997. Rao P.S. (WHO), Review of Leprosy Elimination Campaigns and SAPEL in Cambodia. October-December 1997. Rao P.S. (WHO). Review of Leprosy Elimination Campaigns and Special Action Projects for the Elimination of Leprosy in the Western Pacific Region, June-September 1997. Tin K. (WHO). Evaluation of the leprosy elimination programme using the Leprosy Elimination Monitoring protocol. April-May 1997.
ParT /I
31
Leprosy indicators in Cambodia (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence (OOOs) per 10000 cases 7087 7219 0.8 7439 649 742 0.9 7624 1742 2.0 7837 1334 7939 1.5 1 170 1.3 8046 1 156 1.42 8168 1669 8372 1.99 8582 1 627 1.90 9000 2038 2.26 2.73 9000 2461 10251 2886 2.82 10442 2.83 2960 1921 1.79 10 706 New cases New cases per 100 000
MB %
Disability %
Child %
704 549 545 706 789 574 415 617 945 1644 2219 2404 2438
8.6 6.5 6.4 8.1 8.8 7.03 4.96 7.19 10.50 IR.27 21.65 23.02 22.8
0 0 77 17 ') ()
0 72 64
62 65 55 54 50 52
14 13 11 25 21 21 16 17
')
7 18 () <)
10 11 11
Rate per 10000
Leprosy prevalence and case detection rates per 10000 (1983 - 1997)
3,--------------------------------------------2.5+---------------------------------7L-------~-
2+-----·------·~----------~~~L-----~------~
1.5+---
-+- Prevo rate - 0 - Detee. rate
0.5 +---------------------------'t:F-------------------
Year
32
Part II
Leprosy indicators by province in Cambodia (1995): Province Banteay Meanchey Battambang Kampong Cham Kampong Chhnang Kampong Speu Kampong Thorn Kampot Kandal Kep Koh Kong Kratie Mondulkiri Preah Vihear Prey Vcng Pursat Rattanakiri Rubber Plantation Siem Reap Sihanoukville Steung Treng Svay Rieng Takeo Phnom Penh National Centre Total Population 1995 (OOOs) 507 725 1542 359 520 572 510 986 28 84 235 24 104 1015 330 85 90 687 126 77 476 768 856 Registered cases 21 72 527 146 174 150 42 57 3 14 40 4 26 248 33 45 46 71 '1 ~
Prevalence per 10000 0.41 0.99 3.4 4.1 3.3 2.6 0.82 0.58 1.1 I.7 1.7 I.7
New cases 36 93 576 198 192 152 82 68 5 23 48 6 17 314 40 97 39 200 2 5 43 122 8
New cases per 100000 7.1 13 38 55 37 27 16 6.9 18 27 20 25 16
Prevalence! detection I.7
1.3
1.1 1.4 1.1 I
2 1.2 1.7
1.6 1.2 1.5 0.7 1.3 1.2 2.2 O,l{
4.4 2.4 I
31 12 114 43 29 1.6 6,5 9 16 0.93
5.3 5,1 I
2.8 I
0,16 0.39 0,44 1.35 0,093
3 21 104 8 72
I.7 2 1.2 I
43
0,6
10706
1921
1.79
2438
22.8
1.3
Kir'f'\
WESTERN PACIFIC REGION
CAMBODIA
WESTERN PACIFIC REGION
CAMBODIA Distribution of leprosy cases registered for treatment (1997)
1 dot • 5 cases
Dots are randomly distrlbutad within provinces
Part /I
35
(This page intentionally left blank.)
36
Part II
China 1997 Cured Relapsed
Population: 1 236 000 000 Epidemiology: There were 4045 registered leprosy cases in 1997, as compared to an estimated 500 000 cases in 1950. The WHO criteria for elimination of leprosy as a public health problem were met in all 30 provinces, direct municipalities and autonomous regions in 1992. Furthermore. leprosy as a public health problem has been eliminated in 97.2% of all counties and cities (there are more than 2500 counties and cities in the country), as compared to 78.5% in 1989. Around 70 counties remain with a leprosy prevalence rate of more than one case per 10000 population, with most cases living in difficult to reach areas. An estimated 70% of all leprosy cases come from the mountainous south-western provinccs. Programme: Vertical. All activities related to leprosy are performed by the country leprosy doctors. A SAPEL was implemented in Yunnan in 1996. Case-finding: Mainly passive with intensive health education activities. In some areas, the programme uses a policy of rewarding a health worker who reports a case of leprosy. Diagnosis: According to clinical findings, bacteriology and histopathology tests. Laboratory: Available at the provincial level. Treatment: MDT was implemented in 1982 in Yangzhou Prefecture, Sichuan and Yunnan Provinces. WHO MDT was introduced in 1985 and nationwide implementation began in 1987. Fixed duration treatment is used, but in some areas, MDT is given until skin smears are negative. Prevalence/detection ratio: 2.2 Rehabilitation: The rehabilitation programme does not cover all the country. There are no facilities for vocational rehabilitation training of leprosy patients. There are an estimated 120000 disabled people. Retreatment of cases previously treated with DDS and discharged: An increasing number of patients notified as relapsed cases come from the group of patients treated with DDS and declared cured. Achievements: MDT coverage is more than 99% in mainland China. Leprosy as a public health problem has been eliminated from China. However, the following provinces still have pockets of high endemicity: Guizhou, Sichuan, Yunnan and Tibet Autonomous Province. References: Blanc L. (WHO), Report on a field visit to Yunnan province, China, December 1996. Blanc L. (WHO), Report on a lield visit to Sichuan province, China, November 1996. Blanc L., Farrugia R., Jakeman P., Yuasa Y. (WHO), Report on the third evaluation survey of MDT implementation and leprosy control programme in China: Anhui, Gansu, Jiang"i and Shanx.i Provinces, September 1994. Dai Z-c., "Leprosy control in China", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHF/MDT Series 2, 1991, 1-10. Glaziou P. (WHO). Report on a field visit to Anhui and Jiangsu provinces, China, May 1997. WHO, Wkly Epidem. Rec., 1995.25.185-188. Glaziou P .• Tin K.• Loprang F .• Jacobson R. (WHO), Fourth Evaluation of the Leprosy Elimination Programme in China. October-November 1997.
Part II
37
Leprosy indicators in China (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered (000s) cases 1024950 1051551 1059521 1 053970 1060013 1096140 1 111 910 1 133682 1 149000 1 165467 1 182 195 1 198744 1 221 462 1235940 1236000 70000 55240 40000 30000 20003 8470 6055 5655 4833 4474 4045 0.66 0.50 0.36 0.26 0.17 0.07 0.05 0.05 0.04 0.04 0.033 100 000 0.94 4945 4042 3837 3303 3345 3400 2728 2191 2096 1 895 1 845 1854 0.47 0.38 0.35 0.30 0.30 0.30 0.23 0.19 0.17 0.16 0.15 0.15 57 60 74 63 53 57 66 66 69 68 69 81 24 24 21 22 22 21 3 3 3 3 3 3 3 4 3 Prevalence per 10 000 New cases New cases per 100000
MB %
Disability %
Child %
Rate per 10000
0.9 0.8 0.7 0.6
,
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
'""" n-
0.5 0.4 0.3 0.2 0.1
" 87
\.
-+- Prevo rate -{}- Detee. rate
"'" "-~ 88 89 90 Year
o 83 84 85
86
'" 91
~
92
93
94
95
96
97
Leprosy indicators by province in China (1997): Province Beijing Tianjin Hebei Shanxi Neimengbu
<..,; 00
Population (OOOs) 65660 9 000 62250 31 330 20310 40830 25920 37520 n 050 21800 44000 64 450 32000 41500 88400 98000 57950 64000 69290 46330 7430 83 000 32000 34730 38940 2500 35130 24670 4960 540 17 170 6502 21440 1236000
Total I I
Rate
Newly detected cases Disabilitv Children MB I I
Treated MDT 4 7
MDT comDleted 0 2
Relapse
Registered end of vear 4 6
Prevalence rate
Prevalence! detection
;0 :::: :::t
O.DII
0 I
0.002
0 0
0 I
0.004 0.009
4.0 6.0
Liaoning Jilin Heilongjiang
0 I
Shanghai liangsu
2 2 73 II
Zhejiang Anhui Fujian Jiangxl Shandong Henan Hunan Hubei Guangdong Guangxi Hainan Sichuan
Chongqing Guizhou Yunnan Tibet Shaanxi Gansu
Qinghai Ningxia Xingjiang Hong Kong! Taiwan Total
40 106 73 66 9 20 109 121 66 20 221 21 242 485 52 30 35 4 0 43 II
0 0.039 0005 0.015 0.102 0.025 0.062 0.331 0.176 0.075 0.009 0.035 0.170 0.175 0.142 0.249 0.266 0.066 0.697 1.246 2.060 0.085 0.142 0.081 0 0.250 0.17 0.15
0 I
2 2 68 9 30 61 62 59 7 13 99 81 48 18 203 21 211 399 26 30 34 3 0 19 3 1508
0 0 2 I
32 4 4
15 9
13 I
5 15 II
0 0 0 0 0 0 0 5 0 2 4 2 2 8 I
3 2 55 6 53 131 6 6 2 2 0 15 0 394
3 6 0 4 26 I
0 I I
0 14 0 80
23 5 26 10 240 67 97 342 195 242 33 100 349 589 183 76 712 99 795 1377 145 133 55 32 0 92
4 2 3 5 98 33 34 253 48 63 9 35 121 157 50 18 244 26 260 534 71 40 5 19 0 26 II
0 0 I
0 6 5 2 8 5 12 0 4 15 23 4 8 18 I
19 3 9 5 142 36 64 243 142 180 24 72
20 40 0 7 7 0 0 I
0 188
2]3 432 134 55 483 77 541 848 73 88 46 20 0 66 54 4045
0.005 0.001 0.002 0.004 0.065 0.008 0.010 0.076 0.034 0.020 0.002 0.012 0.036 0.062 0.029 0.074 0.058 0.024 0.156 0.218 0.292 0025 0.019 0.040 0 0.038 0.08 0.033
3.0 4.5 2.5 1.9 3.3 1.6 2.3 1.9 2.7 2.7
3.6 2.1 3.6 2.0 2.8 2.2
3.7 2.2 1.7 1.4 2.9 1.3 5.0
1.5 4.9 2.2
1854
6028
2160
Leprosy data not included in the total (see Hong Kong, China section)
WESTERN PACIFIC REGION
Leprosy Surveillance Programme Heilongjiang
~ ,:~ ~ ~..:: II ~
0 • 1-. -
~
Nei Mongol Zizhiqu Jilin Xinjiang Uygur liaoning c. c
-'f,
Gansu Shanxi
Beijing
/j ~' . . .
i
~1{ ,;.~ ~,- :--"
Hebei "' c
"c
Ningxia
Tianjin' ~"" "', "
CHINA leprosy prevalence rates per 10,000 (1997) .0.1 to OJ , 10.05 to 0.049 . 0.01 to 0.049 0.0001 to 0.009
--~.
S handon,g'" Qinghai ,
."
'., Jiangsu
'Anhui'
... ,~:",>
Shanghai , Cc
~
>Zhejianllj" Hunan
o
,i"c Jiangxi' .. ; ( c
" Fujian,J.
ltI
<
.; •. '\ ,
,~
~~' ~ .p'l'
",
.
·Guangdong.. . . . ' c' .,JJ:i:.' Hongkong Island .......... ::...'L. , ...,..'fI--,jj . \( Macau L ~4'''''''''~'
Hainan ~~
..,.,-.
WESTERN PACIFIC REGION
Leprosy Surveillance Programme
~
•--
. I . ,-
CHINA Distribution of leprosy cases registered for treatment (1997)
1 dot=S cases
Dots are randomly distributed within provinces.
Part /I
41
(This page intentionally left blank.)
42
Part
[f
Cook Islands 1997 Prevalence New cases Cured Relapsed
Population: 19 000 Epidemiology: Leprosy cases have occurred sporadically since 1990. Programme: Fully integrated, no vertical component, no central leprosy unit. Case-finding: Passive and through school surveys. Diagnosis: Based on clinical findings and bacteriological examinations. Laboratory: There is no quality testing. Treatment: MDT started in 1986. Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from the Cook Islands. References: Jesudasan K.. Glaziou P. (WHO). Report on a held visit to Cook Islands, May 1994.
Part II
43
Leprosy indicators in the Cook Islands (1983-1997); Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence New cases (000s) per 10 000 cases 18 19 20 20 17 17 17 17
New cases per 100 000
MB %
Disability Child % %
26
15.3
15 16
7.50 9.41 6 35.29 0.00 11.76 0.00 0.00 0.00 5.26 0 0 0 0 0 (]
0 2 0 0 0 1
0.00 1.18 0.00 0.00 0.00 0.53
0 2 0 0 0 1
17 18 19 19 19 19 19 0
0
0
0.00
0
0
0
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983·1997)
18 16 14 12 10
r"\.
~
~
8 6 4 2
~A ...
-+-- Prevo rate -0-- Detee. rate
o 83 84 85 86 87
'" '''' '\ 88 89
~~ 90 Year
..n. 93 94 95 96 97
91
92
44
Part fI
Fiji 1996 Prevalence New cases Relapsed
Population: 796 000 Epidemiology: The prevalence rates decreased from 6.8 per 10 000 in 1983 to 0.21 per 10 000 in 1996. The detection rates per 100000 decreased from 6.1 in 1982 to 0.75 in 1996 (6 newly detected cases). Programme: Integrated, with a central unit, including a clinic for leprosy cases at Twomey Memorial Hospital, which is a regional training centre in leprosy for the South Pacific Region. Case-finding: School surveys are carried out on a regular basis. Diagnosis: Based on clinical findings and systematic bacteriological examinations. Laboratory: There is a well-equipped centralized laboratory. Treatment: WHO MDT was implemented in 1983. Prevalence/detection ratio: 2.8 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Old cases are retreated when signs of relapse occur. Achievements: Fiji has reached the goal of elimination of leprosy as a public health problem at country level. The Eastern region had a prevalence rate of 1.1 per 10 000 in 1993 while the prevalence rate of leprosy in the other regions was below 1 per 10 000. The MDT coverage is 100%. References: Jesudasan K. (WHO), Report on a field visit to Fiji, November 1994.
Part 1/
45
Leprosy indicators in Fiji (1983-1996): Year Population Registered Prevalence (OOOs) cases per 10000 New cases New cases per 100000 MB % Disability Child % %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
670 700 710 723 750 727 740 740 747 754 770 771 784 796
455 444 367 283 243 204 147 109 86 49 39 39 24 17
6.79 6.34 5.17 3.91 3.24 2.81 1.99 1.47 1.15 0.65 0.51 0.51 0.31 0.21
36 25 22 20 19 17 16 26 6 11 7 9 6 6
5.37 3.57 3.10 2.77 2.53 2.34 2.16 3.51 0.80 1.46 0.91 1.17 0.77 0.75
47 52 55 20 68 71 81 73 50 55 57 56 33
17 8 14 20 16 24
78 0
0 0 11 0
50
Rate per 10 000
Leprosy prevalence and case detection rates per 10 000 (1983 -1996)
8 7
6 5 4
~
~
3 2
'"
- - Prevo rate - 0 - Delee. rate
~
1-
a
'"
~ --... ...0..
Year
46
Part Il
French Polynesia 1997 Cured Relapsed
Population: 220000 . Epidemiology: The prevalence rate per to 000 decreased from 24 in 1946 to 0.59 in 1997 (13 registered cases). The case detection rate was 7.3 per 100000 in 1968 and 2.27 per 100000 in 1997 (5 newly detected cases). Programme: Mainly vertical. There is a central leprosy unit. Case-finding: Mainly passive. Active case-finding is systematically performed in contacts of known cases. Diagnosis: Based on clinical, bacteriological and histological findings. Laboratory: Quality control measures are undertaken at the central laboratory and skin biopsies are sent to the Pasteur Institute in Paris. Treatment: Modified WHO MDT was implemented in 1982. Rifampicine is given on a daily basis to both PB and MB patients. Treatment has been of fixed duration since 1982 (two-year MDT for MB patients). Prevalence/detection ratio: 2.6 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Most old cases are retreated with
MDT. Achievements: The MDT coverage is 100%. French Polynesia has reached the goal of elimination of leprosy as a public health problem. References: Cartel lL., Boutin J.P., Plichart R., Roux l, Grosset lH., Leprosy in the French Polynesian archipelagos from 1967 to 1987,Bul/ Soc Pathol &ot, 1988; 81, 819-826. Farrugia R. (WHO), Report on a field visit to French Polynesia, April 1992. Infonnation from the Institut Malarde, Papeete, French Polynesia, October 1994.
Part II
47
Leprosy indicators in French Polynesia (1983-1997): Year Population Registered Prevalence (000s) cases per 10 000 New cases New cases per 100 000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
157 160 160 179 180 189 192 196 201 206 207 212 220 220 220
295
17.7
24 12 11 14 19 10
9 18 18 11
12 14 13
0.45 0.87 0.87 0.52 0.55 0.64 0.59
3 8 5 12 7 9 6 6 5
15.29 7.50 6.88 7.82 10.56 5.29 1.56 4.08 2.49 5.83 3.38 4.25 2.73 2.73 2.27
38 33 0 43 26 60 0 38 60 33 43 56 83 100
13 8 0 7 II
10
20
33 25 60 8 29 0 0 0 0
13 17 27 21 42 20 0 13 0 33 14 22 33 33 0
Rate per 10000 20
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
18 16 14 12 10
~
'"."" ~
8 6
"""" J"1..
-+-- Prevo rate - 0 - Detec. rate
4 2
o
"" "" 88 89
83
84
85
86
87
"" 90
~" 91 92 93 94 95 96 97
Year
48
Part /I
Guam 1997 Prevalence New cases Grade 2 Cured Relapsed
Population: 150 000 Epidemiology: The main at-risk group is migrants, an increasing proportion of whom come from the high endemic Federated States of Micronesia. Programme: Integrated. Case-finding: Mainly passive, but contacts of known leprosy cases are screened systematically. Diagnosis: Based on clinical, bacteriological and histological examinations. Laboratory: There are quality testing measures. Biopsies are sent to Carville, USA. Treatment: MDT started in 1988. MDT is given until skin smears are negative. Prevalence/detection ratio: 3.3 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: All old cases under DDS mono therapy have been retreated. Achievements: The MDT coverage has reached 100%. Leprosy as a public health problem has been eliminated from Guam. References: Blanc L., (WHO), Report on a field visit to Guam. November 1994. Blanc L., (WHO), Review of leprosy elimination campaigns and special action projects for elimination of leprosy in the Western Pacific Region, June-September 1997. Information from the Department of Public Health and Social Services. Guam. October 1994.
Part lJ
49
Leprosy indicators in Guam (1983-1997): Year Population Registered Prevalence (ooos) cases per 10 000 New cases New cases per 100000
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
113 119 120 122 125 124 126 126 127 140 143 143 150 158
3
2.65
33
33
0
34
2.8
4 3 4 2 5 7 4 6 6 6
3.28 2.40 3.23 1.59 3.94 5.00 2.80 4.20 4.00 3.78
50 67 75 100 80 71 100 83 100 67
0 0 0 0 0 0 25 17 0
0 0
0 0 0 14 25 0 17
20 23 24 10
8 20
1.57 1.64 1.68 0.70 0.53 1.26
Rate per 10000
Leprosy prevalence and case detection rates per 10000 (1983 -1997)
3~---------------------------------------------
2.5+-------------~~-------------------------------
~
2~----------~~----------------
1.5
-\ +------------'----'----\-\--, ~ ~
-+- Prevo rate --0- Detee. rate
0.5
t----------;:;----=...n..:---Lt~~_::::::o=~~~ -cr
~
I
O+--+--~~~-r--+--+--~~--~--~-+--+-~--~
Year
50
Part II
Hong Kong, China 1997 Cured Relapsed
Population: 6 502 000 Epidemiology: Programme: Part of the Social Hygiene Service of the Department of Health. There is a central inpatient leprosy unit. Case-finding: Diagnosis: Laboratory: Treatment: WHO MDT was implemented in 1983, but different multidrug regimens have been in use since 1977. Patients receive treatments of extended duration. Prevalence/detection ratio: 4.9 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Hong Kong, China. References: WHO. Wkly Epidem. Rec. 1995; 25: 185-188. Information from the Department of Health, Hong Kong Government, May 1993.
Part II
51
Leprosy indicators in Hong Kong, China (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence New cases (OOOs) per 10000 cases 5313 1638 2.9 5364 5456 5477 5613 5681 5761 5840 5922 65 0.11 26 47 0.08 20 6005 6090 6175 6005 6502 54 0.08 II
New cases per 100 000
MB %
Disability %
Child %
0.44 0.33
65
20
0.17
27
0
0
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
3.5
3 2.5 2 1.5 1 0.5
~
~
~
-+- Prevo rate - 0 - Detee. rate
~
~
o
~
Year
52
Part II
Japan 1993
Grade 2
MDT
Cured
Relapsed
cases
cases
Population: 125 095 000 Epidemiology: The prevalence rate was 0.02 per 10 000 in 1993 (200 registered cases). The case detection rate has remained lower than 0.04 per 100 000 since 1984, and was 0.0 I per 100 000 in 1993 (8 newly detected cases). Programme: Vertical. Patients are referred to the National Sanatorium Tama Zenshoen. Case-finding: Diagnosis: Laboratory: Treatment: Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Japan. References: Information from the Ministry of Health and Welfare, Japan, 1993.
Part II
53
Leprosy indicators in Japan (1984-1993): Year 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Population Registered Prevalence cases (OOOs) per 10 000 119492 884 120760 0.1 121 672 121 535 122026 122930 768 0.06 123612 124106 124603 200 125 103 0.02 New cases 30 42 42 15 33 26 12 17 15 8 New cases per 100 000 0.03 0.03 0.03 0.01 0.03 0.02 0.01 0.01 0.01 0.01 MB % Disability % Child %
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1984 - 1993)
0.12.,----------------------0.1 +---~~~-----------------0.08 0.06 0.04 0.02 +-------'>..,~~---------------
_ _ Prevo rate +------------->.,~,--------------
- 0 - Oetec. rate
+---------------',.,~~---------
+----------------....,..------
Year
54
Part II
Kiribati 1996
Cured cases
Relapsed cases
Population: 79000 Epidemiology: The leprosy prevalence rate per 10 000 was 6 in 1994 (46 registered cases), and decreased to 1.65 in 1995 (13 registered cases), ·due to the implementation of fixed duration MDT. However, a large number of undetected cases remain·s in the country. Intensive case-finding activities led to the detection of 78 new cases in 1996, the highest number of newly detected cases ever recorded in Kiribati. Programme: Vertical. Case-finding: Since 1995, population screening has been done on selected groups, schools, contacts and some villages. From May to December 1997, a systematic survey of the population of Tarawa and several outer islands was conducted, covering 91 % of the estimated population. Out of a total of 64704 individuals examined, 128 leprosy cases (13% MB) were detected. Diagnosis: Based on clinical and bacteriological examination. Laboratory: There is one central laboratory in Tarawa Hospital. There is no quality testing. Treatment: MDT started in 1988. Since 1990, 100% of new leprosy cases have been put under WHO MDT. Treatment is given until skin smears are negative. Prevalence/detection ratio: 0.5 Rehabilitation: There is no programme for rehabilitation of disabled patients Retreatment of cases previously treated with DDS and discharged: All old cases treated with DDS have been retreated with MDT. Achievements: The MDT coverage is 100%. References: Blanc L. (WHO), Special action project for the elimination of leprosy in Kiribati, February 1997. Daulako E.C. (WHO), Report on a field visit to Kiribati, December 1996. Daulako E.C. (WHO), Report on a field visit to Kiribati, February 1997. Daulako E.C. (WHO), Report on a field visit to Kiribati, May-August 1997. Daulako E.C. (WHO), Report on a field visit to Kiribati, October-December 1997. Glaziou P. (WHO), Report on a field visit to Kiribati, April 1995. Guerrits G. (WHO), Report on a field visit to Kiribati, July 1996.
Part II
55
Leprosy indicators in Kiribati (1983-1996): Year Population (OOOs) Registered cases Prevalence New New cases per 10000 cases per 100 000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
61 62 64
118
19
65 67 69 71 72
74 75 76 77
33 90
4.5 9.5
28 63 28 59 33 41 17
79 79
46 13 42
5.97 1.65 5:32
16 78
40.6 88.7 38.9 79.7 44.0 54.0 22.1 20.3 98.7
41 48 20 30 39 65 25
12
39 29 12 37 36 27 29 38
Rate
per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1996)
~~---------------------------------------------18~~-----------------------------------------16+---~-----------------------------------------
14+-----~~----------------------------------~ 12+---------~
__---------------------------------
10+-------------~----------~--------------~j_--
-+- Prevo rate --0- Detee. rate
8+---------------~~~--_A~~~--------_+---6+-----------------+-~~~--~--~~~----r_~4+---------------0-----~----~--~._~_+~---
2+----------------------------------O~~-- O+--+--;_--r__r--+_~--;_~r__r--+_-+--;_~r_~
Year
56
Part 1/
Lao People's Democratic Republic 1997
Cured
Relapsed
Population: 4 845 790 Epidemiology: The prevalence rate has decreased markedly since 1986. Programme: Vertical at the country and provincial levels and supervised by the Dermatology Centre in Vientiane. There are leprosy clinics at the provincial level. The programme is partially integrated at the district level. There are still leprosy villages in the country, perpetuating the stigma attached to the disease. The leprosy programme is partly supported by the NSL (Netherlands Leprosy Relief Association) for operational activities, and Leprosy Mission International for rehabilitation. Case-finding: Mainly passive. Active case-finding is limited to areas with a known high number of cases. Diagnosis: Mainly based on clinical examination. Laboratory: Available at the provincial level. Treatment: WHO MDT was initiated in 1984. All newly detected cases receive MDT. Prevalence1detection ratio: 2.1 Rehabilitation: Reconstructive surgery and physiotherapy is performed in Vientiane and Savannakhet. Retreatment of cases previously treated with DDS and discharged: Achievements: MDT coverage was 86% in 1994 and close to 100% in 1995. References: Choulamontry T., "Report on leprosy in Laos", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHFIMDT Series 2, 1991, 110-111. Farrugia R. (WHO), Lutte contre la lepre, Repuhlique Populaire Democratique Lao, January 1996. Farrugia R. (WHO), Lutte contre la lepre, Repuhlique Populaire Democratique Lao, November 1996. Farrugia R. (WHO), Lutte contre la lepre, RepuhJique Populaire Democratique Lao, January 1997. Farrugia R., Blanc 1. (WHO), Progranune national de lutte contre la lepre, RepubJique Populaire Democratique Lao, June 1996. Gerrits G., Glaziou P., Quimpo J., Voskens J. (WHO), Report on a field visit to Lao P.D.R., June 1994. Infonnation from the Centre of Dermatology and Venerology, Vientiane, Lao P.D.R., June 1993.
Part J[
57
Leprosy indicators in the Lao People's Democratic Republic (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population (OOOs) 4209 4315 3585 3708 3831 3954 4077 4200 4200 4360 4474 459] 4882 4882 4846 Registe~ed
cases 2988 3 152 3381 2353 1955 1376 2529 1393 1 361 1085 967 694 574 533
Prevalence per 10 000 8.3 8.79 9.12 6.14 4.94 3.38 6.02 3.32 3.12 2.43 2.ll 1.42 1.l8 1.1
New cases
New cases per 100000
MB %
Disability %
Child %
307 426 702 168 264 371 340 317 234 304 298 270 256
8.56 11.49 18.32 4.25 6.48 8.83 8.10 7.27 5.23 6.62 6.10 5.53 5.28
34 64 30 46 41 43 47 53 58 75 67 68 66
34 38 29 25 29 25
3 4 4
Rate per 10000 10
Leprosy prevalence and case detection rates per 10 000 (1983-1997) ~
9
8 7
~
\
\
6 5 4
\
"'-"'\. b-
3
\/
1\ / \
- - Prevo rate - 0 - Detee. rate
L ...
2 1 Lor
~
~
o
... "',:;-
Year
58
Part 1I
Macao 1997 Grade 2 Cured Relapsed
Population: SOO 000 Epidemiology: Programme: Case-finding: Diagnosis: Bacteriological and histological examinations are performed systematically. Laboratory: Treatment: MDT was implemented in 1982. Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Macao. References: Lopez-Bravo L. (WHO), Report on a tield visit to Macao, March 1982.
Part II
59
Leprosy indicators in Macao (1983-1997): Year Population Registered Prevalence (OOOs) cases per 10 000 New cases New cases per 100 000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
304 309 392 417 414 444
96
2.8
460 452 467 482 498 480 424 500
18 15 13
0.39 0.21 0.26 0.17 0
2 2 1 0 0
0.43 0.41 0.20 0 0
50
7 0
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
3r-----------------------------------------------
-+- Prevo rate - 0 - Detee. rate
94
95
96
97
60
Part II
Malaysia 1997 Number Rate Prevalence per 10000 1181 0.54 New cases per 100 000 277 1.28
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
Population: 21 665 000 Epidemiology: High-risk groups consist largely of migrant populations. Programme: Coordinated at the Sungei Buloh National Leprosy Control Centre, and partially integrated into the general health care system. Case-finding: Passive. Diagnosis: Based on clinical and bacteriological examinations. Skin biopsies are processed occasionally. Laboratory: Treatment: MDT was implemented in 1985. Treatment is given until skin smears are negative. Many cases were still under DDS monotherapy as at February 1994. Prevalence/detection ratio: 4.3 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Malaysia has eliminated leprosy as a public health prohlem. References: Blanc L. (WHO), Report on a field visit to Malaysia, February 1994. Frankel R., Jacobson R., Revankar c., Viardo C. (WHO), Report on a lield visit to Malaysia. September 1993. Information from Dr K.K. Lim, Ministry of Health. Kuala Lumpur. Malaysia. April 1993.
Part II
6/
Leprosy indicators in Malaysia (1983-1997): Year Population Registered Prevalence (()(10s) per 10000 cases 14863 15204 15880 16109 16749 16958 17353 17552 17567 18031 18513 18995 20140 21 168 21665 1823 I 561 1 314 1 181 0.96 0.78 0.62 0.54 330 293 273 277 1.74 1.45 1.29 1.28 74 73 70 68 9 5 3 3
New cases
New cases per 100 000
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
5730 6373 5723 5031 4149 3439
3.6 3.81 3.37 2.90 2.36 1.96
313 348 311 329 296 315 220
2.0 2.08 1.83 1.90 1.69 1.79 1.22 55 20 28 23 19 19 7 5
8 9 9 11 5
10 5
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
4 3.5
~
3
2.5 2
1.5
'" '" ~ . Year
-+- Prevo rate
~
-D-Detec. rate
~
0.5 ~
~
o
62
Part II
Northern Mariana Islands 1997 Prevalence per 10 000 New cases per 100 000
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
Number Rate
4 0.63
5 7.84
Population: 63 763 Epidemiology: High-risk groups comprise migrants from the Federated States of Micronesia, Palau and the Philippines. Programme: Integrated with the tuherculosis control programme, supervised at the Public Health Clinic. Case-finding: Passive. Diagnosis: Laboratory: Treatment: Rifampicine was introduced in the treatment regimen in 1980 and MDT started in 1986. Prevalence/detection ratio: 0.8 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: MDT coverage is 100%. References: Carillo M. (WHO), Report on a lield visit to Northern Mariana Islands. March 1994. Jesudasan K. (WHO). Report on a field visit to Northern Mariana Islands. June 1995.
ParI 1/
63
Leprosy indicators in the Nonhern Mariana Islands ( I YR:I- I YY7):
Year
Population Registered Prevalence (OOOs) cases per 10000
New cases 3
New cases per 100000
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
17 19 20 20 36 38
17.65 10.53 15.00 10.00 11.11 7.89 2.63 6.82 17.78 8.70 6.00 2.00 12.77 9.68 7.84 0 67 66 60 0 0 0 20 100 ()
2 3
67 75
°
50 33
2 4 :I
25
38 44 45 46 50 50 47 62 64
1 3 8 4 9 7 \I
0.87 1.8 1.49 1.77 0.63
4 3 I
100
100
25
6 6 5
17 ()
4
Rate per 10000 2 1.8
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
1.6 1.4 1.2
T+--------------H.------I'---~___7''----t_-
+-\-----;f-\.-----------.~+--___cl-----+-
+--++--+--------f---+-+--------\--
-+- Prevo rate -D-Oetec. rate
0.8+--------~---~---~~----_f
0.6
+---------\---~
0.2+-----O+-~--~--~_+--+__+--~--~_+--+__+--~~~~
Year
64
Part II
Marshall Islands 1997 Number Rate Prevalence per 10 000 163
New cases per 100000 68 112
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
26.8
Population: 61 000 Epidemiology: Recent active case-finding activities resulted in the detection of 68 new cases in ]997, as compared to 18 new cases in 1995. Programme: Partially integrated. A three-year LEC is planned. Case-finding: Active case-finding activities started in 1996. Diagnosis: Bacteriological examinations are performed systematically in MB suspected cases. Biopsies are taken in nearly all cases. Laboratory: Biopsies are sent to Hawaii, USA. Treatment: MDT was introduced in 1986. Prevalence/detection ratio: 2.4 Rehabilitation: There is no programme for rehabilitation. Retreatment of cases previously treated with DDS and discharged: Achievements: MDT coverage is ]00%. References: Jesudasan K. (WHO), Report on a field visit to Marshall Islands, June 1995. Jesudasan K. (WHO), Report on a field visit to Marshall Islands. March-May 1996. Information from the Ministry of Health, Marshall Islands, October 1994.
Part II
65
Leprosy indicators in the Republic of Marshall Islands (1983-1997); Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence (000s) per 10000 cases 33 35 28 29 30 43 40 46 47 49 54 56 55 51 61 20 8 46 85 163 3.70 1.43 8.36 16.67 26.8 50 10.6 New cases 2 5 7 13 10 19 24 26 32 21 20 8 18 112 68 New cases per 100000 6.06 14.29 25.00 44.83 33.33 44.19 60.00 56.52 68.09 42.86 37.04 14.29 32.73 219.6 112 65 63 78 38 41 0
MB %
Disability %
Child %
13 50
.
31 36
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1996) 30,----------------------------------------------
25+-----------------------------------------------~
~+---------------------------------------~~--
___ Prevo rate 15+-------------------------------------------H---~
- 0 - Detee.
rate
10+-------------------------~~----------_f~----
Year
66
Parr /I
Federated States of Micronesia 1997 Prevalence per 10000 163 14.8 New cases per 100 000 123 112 Grade 2 disability MDT coverage Cured cases Relapsed cases
Number Rate
Population: 110000 Epidemiology: Leprosy incidence is unevenly distributed between states and islands. Programme: Tbere is a leprosy and tuberculosis control programme coordinator in cach state. A twoyear programme for mass preventive therapy of leprosy using a single dose of the comhination rifampicine. ofloxacin and minocycline (rifampicine alone for children) once a year for two years started in J 996. The programme included a two-round mass screening of the wholc population and newly detected cases were put under WHO MDT. In total. 317 new cases were detected during the rirst round and 80 during the second round. During 1996-1997 almost 500 patients also completed the treatment.. As at February 1998. preventive therapy coverage was 83% for one dose and 53% for two doses. The proportion of new cases detected during the second round among the persons who have previously received preventive therapy was 38% but it was highly suspected that some of these cases already had lesions when given preventive therapy. The second round was planned to be completed hy May I'I'IX. Details of the programme are presented in Part I. Case-finding: Aetive from 19'16 to 1998 through mass screenings. Diagnosis: Based on clinical grounds and often on histological examinations. Laboratory: Biopsies are sent to Carville. USA. for processing. Treatment: Rifampicine was introduced in the regimen in 1980 and WHO MDT started in 1984. Prevalence/detection ratio: I. 3 Rehabilitation: There is no programme for rehabilitation of disabled cases. Retreatment of cases previously treated with DDS and discharged: Achievements: The MDT coverage is 100%. References: Blanc L. (WHO). Leprosy control in the Federated States of Micronesia, December 1995. Landwehr D. (WHO), Special Action Project for the Elimination of Leprosy in the Federated States of Micronesia, Fehruary-March 1997. Revankar C.R. (WHO), Report on a held visit to the Federated States of Micronesia, February-June 1995. Takashima J. (WHO), Report on a lield visit to Federated States of Micronesia, March I 996-January 1997. Tin Mynt U. (WHO), Implementation, monitoring and evaluation of the special programme on leprosy elimination. Federated States of Micronesia, June 1996-Fehruary 1997. Diletto C. (WHO), Development of a national leprosy plan of action for the second year of implementation of preventive therapy, Federated States of Micronesia, March-June 1997. Diletto C. (WHO), Development of a nalional leprosy plan of action for the second year of implementation of prevent, vc therapy, Federated States of Micronesia, July I 997-Fehruary 1998.
• Part 1I 67
Leprosy indicators in the Federated States of Micronesia (1983-1997): Year Population Registered Prevalence (OOOs) per 10 000 cases New New cases cases per 100000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
73 88 91 94 94 97 95 101 104 107 109 112 122 122 110 163 14.80 123 112 28 44 851 782 658 628 501 349 362 290 368 90.53 80.62 69.26 62.18 48.17 32.62 33.21 25.89 30.16 177 87 96 80 84 90 220 95 206 188 89.7 101 79.2 80.8 84.1 201 84.8 169 42 22
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
100,---------------------------------------------90+-----------~~-------------------------------
80 + - - - - - - - - -
70 +------60+------50+---------------------------~--------------40+----------------------------~------------------
-+-- Prevo rate -a- Detee. rate
30+----·-----------------------20
10 +------------- O+-~--~--+-~--~--+_~--~--+__+--~--~_+--~
Year
68
Part II
Mongolia 1997 Number Rate Prevalence per 10000 New cases per 100 000 Grade 2 disability MDT coverage Cured cases Relapsed cases
o o
o o
Population: 2 400 000 Epidemiology: Programme: Case-finding: Diagnosis: Laboratory: Treatment: Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Mongolia. References: WHO. Bulletin of Regional Health Information. South-East Asia Regional OtTtce, New Delhi, India, 1992.
Part II
69
Leprosy indicators in Mongolia (1983-1997): Year Population Registered Prevalence (OOOs) cases per 10 000 New cases New cases per 100000 MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 2250 2410 2400 2 400 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2103 1 915
70
Part /I
Nauru 1996 Prevalence per 10000 4 New cases per 100 000 2
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
Number Rate
3.6
18
Population: 11 000 Epidemiology: Since 1982 there has been no evidence of a declining trend in the case detection rate. Programme: Control activities take place at the Community Health Clinic of the Division of Public Health. Case-finding: School screenings are performed occasionally. Diagnosis: Laboratory: Treatment: WHO MDT was implemented in 1993. Prevalence/detection ratio: 2 Rehabilitation: Retreatrnent of cases previously treated with DDS and discharged: Achievements: MDT coverage is 100%. References: Daulako E.C. (WHO), Report on a field visit to Nauru, September 1994. Daulako E.C. (WHO), Report on a field visit to Nauru, April 1995. Information from Nauru General Hospital, Nauru, November 1994.
Part 1I
71
Leprosy indicators in Nauru (1983-1996): Year Population Registered Prevalence cases (000s) per 10000 8 8 8 8 8 8 9 9 9 9 10 10 11 10 8 8 4 8.00 7.27 4 14 15.56 42 46.7 40 57.1 New cases 1 1 3 0 3 3 2 1 2 2 3 2 2 2 New cases per 100000 12.50 12.50 37.50 0.00 37.50 37.50 22.22 11.11 22.22 22.22 30.00 20.00 18.18 20 67 100 100 100 100 67 100 100 0 0 0 0 0 0 0 50 100 0 0 0 0 0
MB % 0 100 33
Disability %
Child % 0 100 33
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1996)
60 50 40 30
\
\
\
-+- Prevo rate
20 10
\
- 0 - Detee. rate
~ .n.
o ~ ~
~/~ ~ ~ ~
~ ~
~ M ~ ~ ~
M
~
~
~
~
Year
72
Part Il
New Caledonia 1995 Prevalence per 10000 13
New cases per 100000 7 3.87
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
Number Rate
0.72
Population: 181 000 Epidemiology: Since 1983, the case detection rate has declined at a mean annual rate of 13%. Implementation of fixed duration MDT has also led to a marked decrease in the prevalence nHe. Programme: Coordinated at the Service de Dermatologie of the Centre Hospitalier Territorial. Case-finding: Mainly passive. Diagnosis: Bacteriological and histological examinations are performed in all cases. Laboratory: Treatment: Modified WHO MDT with fixed duration was implemented in 1983. Rifampicine is given on a daily basis to all cases. Prevalence/detection ratio: 1.9 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Almost all former patients have been retreated with MDT. Achievements: MDT coverage is 100%. References: Blanc L. (WHO), Report on a tield visit to New Caledonia, June 1996. Farrugia R. (WHO), Report on a field visit to New Caledonia. May 1993. Monchy D., Huerre M .. Crouzat M .• Dubourdieu D.. Duval D., Sottil J.P. Leprosy in New Caledonia from 1983 to 1992, Histopathological and epidemiological data, Bull Soc Palhol Exot, 1994,87,28-32. Information from DTASS, Noumea, New Caledonia, June 1995.
Part /I
73
Leprosy indicators in New Caledonia (1983-1995): Year Population (000s) Registered Prevalence per 10000 cases New cases New cases per 100 000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995
145 152 150 148 154 160 160 164 167 171
363 334 315 326 339 352 70 90 48 64
25.03 21.97 21.00 22.03 22.01 22.00 4.38 5.49 2.87 3.74 1.26 1.46 0.72
23 20 20 32 22 14 15 16 13 10
15.86 13.16 13.33 21.62 14.29 8.75 9.38 9.76 7.78 5.85 5.75 4.86 3.87
26 35 40 34 41 36 53 38 31 50 60 33 71 28
48 45 25 22 18 21 27 6 23 10
174 185 181
22 27 13
10 9 7
20 0 14
Rate per 10000
Leprosy prevalence and case detection rates per 10000 (1983 -1995)
~.OO.-------------------------------------------
25.00 20.00 15.00 10.00 5.00 ..0.
0--.-
'I
\ 83 84 85
-+- Prevo rate - 0 - Detee. rate
\ \.. ... ".. ....... n 89
0.00
86
87
88
90 Year
91
92
93
94
95
74
Part II
New Zealand 1997 Prevalence per 10000 New cases per 100000 Grade 2 disability MDT coverage ·i. . .
Cured cases
Relapsed cases
Number Rate
2 f). 005
2 f).05
~\iiiF:I\: •.••..
:T
......
IOO'!!
........
Population: 3 696 000 Epidemiology: Since 1982, most cases have occurred in migrants from the Pacific Islands or from Asia. Programme: Integrated in the general health services. Information at national level is collected on new cases only. Case-finding: Diagnosis: Laboratory: Treatment: MDT was implemented in 1983. Prevalence/detection ratio: 1 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from New Zealand. References: Cornwall J .• Cameron G .. The effects of World Health Organization chemotherapy on imported leprosy in Auckland. New Zealand, 1983-1990, Lepr Rev.. 1993,64.236-249.
Part 1I
75
Leprosy indicators in New Zealand (1983-1997): Year Population Registered Prevalence (000s) cases per 10 000 3203 3250 3230 3707 3301 3290 3385 3389 3435 3463 3463 3463 3575 3696 3696 2 0.005 1 0.00 1 1 10
New New cases cases per 100000
MB 0/0
Disability 0/0
Child 0/0
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
3 0
0.01 0.00
1 4
0.03 0.12
100
0.03 0.03 0.27 0.05
2
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
0.03 0.025
-r-----------------------
+----------------------1-\-+------------------------+-+-
0.02 0.015
-+- Prevo rate +---------------------+--\_ - 0 - Detee. rate
0.01 +-------------+----1----''''''-------/---+ 0.005 + - - - - - - - - - - - - - - - I ' - \ - - - - - - " .__--+----c:fl O+--+-+--;-;-~-;_-/-~-/_-r-~-+-+_~
Year
76
Part /I
Niue 1997 Number Rate Population: 2 100 Epidemiology: No case has been detected since 1992, and there are no registered cases. Programme: Case-finding: Diagnosis: Laboratory: Treatment: Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Niue. References: Prevalence per 10 000 New cases per 100 000 Grade 2 disability MDT coverage Cured cases Relapsed cases
o o
o o
Part II
77
Leprosy indicators in Niue (1983-1997):
Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Population Registered Prevalence (000s) cases per 10000 3 4 3 3 3 3 3 2 2 2 2 2 2 2 2 0 0 0 0 0 0 0 0 0 0
New cases
New cases per 100000
MB %
Disability %
Child %
0 0 0
0 0 0
0 0 0 0
0 0 0 0
7S
Part II
Palau 1997 Prevalence Cured Relapsed
Population: 17 728 Epidemiology: There has been no apparent decline in the case detection rate since 1983. Programme: Partially integrated, and coordinated by the Leprosy Control Unit at the Bureau of Public Health Service. Case-finding: Mainly passive. Diagnosis: Bacteriological examinations are systematically performed. Biopsies are taken in some cases. Laboratory: Treatment: WHO MDT was implemented in 1982. Treatment is given until skin smears are negative. Prevalence/detection ratio: 2 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: The MDT coverage is 100%. References: Blanc L. (WHO), Report on a field visit to Palau, May 1995. Blanc L. (WHO), Report on a field visit to Palau, December 1995. Carillo M. (WHO), Report on a field visit to Palau; April 1994. Information from the Ministry of Health, Republic of Palau, November 1994.
Part II
79
Leprosy indicators in the Republic of Palau (1983- I997): Year Population Registered Prevalence (OOOs) per 10000 cases New cases New cases per 100000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
14 13 12 14 14 14 12 12 12 12 15 17 17
7 2 2 1 3 3 I
50 15.4 16.7 7.1 21.4 21.4 8.3 41.7 50 16.7 26.7 35.3 52.9 23 5.3
71 50 100 100 67 0 0 \00 50 100 75 33 33 25 \00
0 0 0 0 0 0 0 0 17 0 0 0 II
0 0 0 0 33 33 0 20 50 0 0 22 0 0
5 16 13.33 6 2 4 12 8 5 2 7.06 4.71 2.9 1.1
6 9 4 1
17 17
0 0
Rate
per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997) ________________________
14~----------------------
12t----------------------------~-----------------10t------------------------------~-------------
8t------------------------------~---------6t--------------------------------~__-----4t\------------------~~~
- - Prev. rate - 0 - Detee. rate
__----~~~\_----
O+-~--~--r__+--+_~--~--r__+--+_~--~--r_~
Vear
80
Part 1/
Papua New Guinea 1997 Prevalence per 10000 New cases per 100000 Grade 2 MDT Cured Relapsed
Population: 4 533 511 Epidemiology: Leprosy has been declining since 1977. The prevalence rate has declined from 30.6 to 2.2 per 10 000 from 1977 to 1997. The disease is unevenly distributed. Eight provinces still have a prevalence rate greater than 2.5 per 10 000. Programme: Integrated. Implemented in 1991, it covers 19 of the 20 provinces. Bougainville (North Solomon) will be the last province covered. Pockets of uncovered areas remain due to difficult access. Programme activities are supervised by a National Programme Manager, assisted by a Programme Coordinator. There are two specialized teams, one in the southern and one in the northern part of the country. The programme is further organized according to health structures. Extra-governmental support is provided by the Sasakawa Memorial Health Foundation of Japan and Leprosy Mission International. Case-finding: Passive. Diagnosis: Based mainly on clinical signs. Laboratory: Treatment: WHO MDT started in 1987 and was implemented in all provinces but one by the end of 1994. Fixed duration MDT was implemented in 1995. The prevalence/detection ratio has decreased since 1983 (10.7), but was still 5.7 in 1995. Prevalence/detection ratio: 1.8 Rehabilitation: There is no programme for rehabilitation. Retreatment of cases previously treated with DDS and discharged: Achievements: The MDT coverage is 100% in the 19 provinces covered by the programme. References: Abella J.E., Frankel R., Samson P.O. (WHO). Report on the Joint Evaluation Survey on NLEP-199S. May 1996. Blanc L. (WHO), Report on the evaluation of leprosy elimination programme in Papua New Guinea. October 1997. Kyaw, T. (WHO), Report on collaboration with the Government in the implementation of the National Leprosy Elimination Programme, Papua New Guinea, December 1994. Kyaw T. (WHO), Report on the National Leprosy Elimination Programme. Papua New Guinea, January-April 1997. Malau c.. "Leprosy programme in Papua New Guinea", in Leprosy profiles wirh special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHF/MDT Series 2, 1991, 32-40. Tran H.K. (WHO), Report on a country visit in Papua New Guinea, September-November 1997.
Part II
8/
Leprosy indicators in Papua New Guinea (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence New cases New cases cases (OOOs) per 10000 per 100000 3508 3252 3362 3419 3585 3580 3910 3741 3823 3907 3823 4056 4302 4327 4533 2167 1 318 1105 1004 5.3 3.1 2.6 2.2 9752 8715 8203 7583 7465 8163 5 188 4330 2964 2755 27.8 26.8 24.4 22.2 20.8 22.8 13.3 11.6 7.8 7.1 912 683 773 568 579 652 544 512 519 219 519 345 231 699 547 26 21 23 16.61 16.15 18.21 13.91 13.69 13.58 5.61 13.58 8.51 5.37 16.2 12.1 50 52 52 56 28 23 6 12 18 20 21 33 MB % Disability Child % %
Rate per 10000
Leprosy prevalence and case detection rates per 10000 (1983 - 1997)
~.oo~------------------------------------------
25.00 +--------"'.,..-------------------------------------20.00 15.00 10.00 +------------~--__\_--------------------------
_ _ Prevo rate +------~---------\_-----------------------
- 0 - Detee. rate
+--------------------~------------------
5.00 +---------------------------------"",,-------
Year
82
Part Il
Leprosy indicators by province in Papua New Guinea (1997): Province! Region Western Gulf Central National Capital Milne Bay Oro Southern Region Southern Highlands Enga Western Highlands Simbu Eastern Highlands Highlands Region Morobe Madang East Sepik West Sepik Monase Region Manus New Ireland East New Britain West New Britain North Solomon Islands Region Total Population Registered Prevalence (OOOs) cases Rate 140 72 161 270 185 113 941 389 302 391 209 400 1697 438 288 280 162 1168 39 106 234 170 178 727 4533 103 42 120 101 65 6 437 IS 10 II
New cases 59 16 51 20 40 3 189 16 II 13
New cases Prevalencel per 100000 Detection 42.1 22.2 32.5 7.4 21.6 2.7 48.5 4.1 3.6 3.3 2.4 0.5 2.8 1.4 23.1 19.3 8 11.9 13 38.8 37.2 22.9 0.8 0.3 0.2 0.5 0.2 0.2 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.2 0.7 0.3 0.1 0.05 0.1 0.1 -
7.3 5.8 7.4 3.7 3.5 0.5 4.6 0.3 0.3 0.2 0.2 0.1 0.2 0.6 3.4 3.8 5.3 3.1 1.3 1.9 3.9 2.9 -
4 2 42 26 99 107 138 370 5 20 92 38 -
5 2 47 6 66 54 13 139 5 41 87 39 -
24.5 12.1
ISS 1004
2.1 2.2
172 547
0.1 0.2
Part 1/
Xi
(This page intentionally left blank.)
84
Part /I
Philippines 1997 Prevalence New cases
Grade 2
MDT
Cured
Relapsed
Population: 7 I 388 899 Epidemiology: Since 1983, there has been a steady decline in the prevalence rate, but no evidence of a declining trend in the case detection rate. Programme: Integrated. New policies and a new recording and reporting system were implemented in 1995. Four LECs and one SAPEL were conducted between 1996 and 1997. Case-finding: Mainly passive. Diagnosis: Based on clinical findings; skin smears are not carried out routinely. Laboratory: No quality control at the regional level and no nationwide standardization of procedures. Treatment: MDT was started in 1983 in Ilocos Norte and Cebu Provinces and implemented nationwide from 1986 to 1989. Prevalence/detection ratio: 1.8 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: MDT coverage is 100%. References: Abella J.E., Carillo M.P., "Leprosy Control in the Philippines". in: Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation. SMHF/MDT Series 2. 1991.41-53. Blanc L. (WHO). Leprosy Elimination Campaign. Philippines. February 1996. NLCP. Elimination ofleprosy as a public health problem. Plan of Action 1996-1998. Rao K.• Yuasa Y .. Landwehr D. (WHO). Third WHO-DOH independent evaluation of the NLCP in the Philippines. November 1995. Rao P.S. (WHO). Review of leprosy elimination campaign and special action projects for elimination of leprosy in the Western Pacitic Region. June-September 1997. Rao P.S. (WHO). Report on a country visit. Philippines. July-August 1997. Van der Hoeck W. (WHO). Report on a lield visit, Philippines. February-May 1996.
Part II
85
Leprosy indicators in the Philippines (1983-1997): Year Population Registered Prevalence per 10000 (OOOs) cases 52055 53395 54668 55980 58721 59456 60097 61481 62895 64 342 65065 65000 67581 69804 71389 37323 37377 38814 38570 35281 36972 31947 20280 17347 15317 15441 16486 11674 8664 8749 7.17 7 7.1 6.89 6.01 6.22 5.32 3.3 2.76 2.38 2.37 2.54 1.73 1.24
New cases I 730 1726 I 139 2 185 2748 2442 4163 5725 7169 5896 3442 4450 3988 4051 4942
New cases per 100000 3.32 3.23 2.08 3.90 4.68 4.11 6.93 9.31 11.40 9.16 5.29 6.85 5.90 5.X 6.92
MB % 49 49 49 52 55 63 65
Disability %
Child % 14.6 14.5 14.3 14.5 14.5
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
12 7 9 1\
9 6
X l)
8 10 78 84 84 81 7 5 4 5
X 10 8 8 <)
1.22
X
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
8.00.,----------·---
- - Prevo rate - 0 - Detee. rate
Year
Leprosy indicators by province in the Philippines (1997):
:>
%
Province
Population (OOOs)
Total
Rate
Newly detected cases Disability MB
Children
Treated MDT
MDT completed
Relapse (MDT)
Registered end of year
Prevalence ratc
Prevalence! detection
CAR Region I Region II Region III
1327 3958 2885 7122 q 570
59 519 270
4.45 13.1 9.36 4.52 2.49 1.44 3.95 10.4 7.44 5.8 803 4.1 8.5 5.05 18.2 10.0 6.92
38 324 191 309
2 19 28 3 7 7 37 19 13 19 I
15 28 23 14 13 7 23 71 34 32 24 12 14 9 52 22 393
192 1284 660 1 190 732 328 645 1636 786 856 664 789 432 317 842 I 563 5887
85 297 198 392 217 52 180 365 134 206 308 207 124 99 203 446 3513
0 9 0 0 2 0 0
112 894 444 562 494 272 451 1 248 562 585 356 551 298 219 547 I 154 3522
0.84 2.26 1.54 0.79 0.56 0.54 0.7 2.4 1.48 1.99 1.32 1.04 1.32 1.02 2.8 1.23 1.22 -
1.9 1.7 1.6 1.7 2.4 3.7 1.8 2.3 2 2 1.6 2.3 1.6 2 1.3
-
'" ""
'tl
322 204 73 256 537 282 288 217 242 192 108 436 937 4942
Region IV Region V Region VI Region VB Region VIII Region IX Region X Region Xl Region XII Caraga ARMM NCR Total
174 71 223 445 244 237 181 224 154 92 272 804 3983
5067 6474 5201 3788 2937 2703 4476 2260 2 137 2 135 9350 71389
2 0 0 0 0 4 1 0
IX 16 7 51 5 252
3 21
1.2 1.8
CAR: ARMM: NCR:
Cordillera Autonomous Region. Autonomous Region of Muslim Mindanao. National Capital Region.
WESTERN PACIFIC REGION
Leprosy Surveillance Programme
PHILIPPINES Leprosy prevalence rates per 10.000 population
.5 .1 00
o
m10 4.9 D.Sm 0.9
m
m 0.4
.. . . .
•
c·
'.l :
.J-
Leprosy Surveillance ....rnnr~,mrrlA
WESTERN PAIt:IFlIC
PHILIPPINES Distribution of leprosy cases registered for treatment (1998)
." ..
.... ,'
:' ... .. " ~
~,.,
.. ~
.
~
,i'
.J-
1 dotes cases
Dots are randomly distributed within provinces
Part /I
89
(This page intentionally left blank.)
90
Part II
Republic of Korea 1997 Number Rate Prevalence per 10000 707 0.15 New cases per 100000 34 0.07 Grade 2 disability MDT coverage Cured cases Relapsed cases
Population: 45 991 000 Epidemiology: Since 1982, there has been a steady decrease in the case detection rate, with a big decrease from 0.25 per 10 000 in 1994 (113 newly detected cases) to 0.07 in 1997 (34 newly detected cases). Programme: Coordinated by the Korean Leprosy Control Association. Case-finding: Diagnosis: Based on clinical and bacteriological examination. Laboratory: Treatment: Modified WHO MDT started in 1982: intensive phase with daily rifampicine and continuation until skin smears are negative. Some patients receive DDS aft~r completion of MDT. Prevalence/detection ratio: 21 Rehabilitation: Patients requiring care for disabilities are maintained on a register and followed up in settlement villages. There are an estimated 588 disabled individuals. Retreatment of cases previously treated with DDS and discharged: There is no systematic retreatment of old cases. Achievements: Leprosy as a public health problem has been eliminated from the Republic of Korea. References: Blanc L. (WHO), Attendance at the National Seminar on Leprosy Control, Republic of Korea, October 1995. Blanc L. (WHO), Report on a field visit to Korea, May 1994. Farrugia R. (WHO), Report on the attendance at a seminar on leprosy control in Seoul, Republic of Korea, November 1991. WHO, Report from the major endemic countries, International conference on Elimination of Leprosy, Hanoi, Viet Nam, July 1994. Information from General Bureau of Public Health. Ministry of Health and Social Affairs. Republic of Korea. July 1991.
Part II
91
Leprosy indicators in the Republic of Korea (1983-1997):
Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
Population Registered Prevalence (OOOs) per 10000 cases 39951 40578 41208 41 865 42082 41 975 42591 43207 43415 43623 44056 44453 44995 45248 45991 1469 1309 1209 1126 1072 707 0.34 0.30 0.27 0.25 0.24 0.15 1637 0.38 2762 0.67
New cases 345 293 195 142 131 157
New cases per 100000 0.86 0.72 0.47 0.34 0.31 0.37
MB %
Disability %
Child %
59
23
I
157
0.36
62
136 130 113 39 39 34
0.31 0.30 0.25 0.09 0.09 0.Q7
75 64 63 67 59 79
12 5 12 15 5 3 0 1
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983-1997)
0.8 0.7 0.6
0.5
0.4
'" -n.
~
~
-+- Prevo rate
0.3 0.2 0.1
~
--- ... "'
- 0 - Detec. rate
"'.
~
o Year
92
Part II
Leprosy indicators by province in the Republic of Korea (1997): Province/ Region Seoul Metropolitan City Pursan Metro City Taegu Metro City Inchon Metro City Kwangju Metro City Taejon Metro City Uisan Metro City Kyonggi Province Kangwon Province Chungchongbuk Prov Chungchongnam Prov Chollabuk Province Chollanam Province Kyongsangbuk Prov Kyongsangnam Prov Cheju Province Total Population Registered Prevalence (000s) cases per 10 000 10547 3932 2525 2380 1297 1 311 997 7888 1 513 1439 1822 1 961 2 131 2759 2968 521 45991 53 151 110 0 13 3 1 169 14 23 4 44 48 46 23 0.05 0.38 0.44 0 0.1 0.02 0.01 0.21 0.09 0.16 0.02 0.22 0.23 0.17 0.08 0.1 0.15 New New cases Prevalence/ cases per 100 000 Detection 2 0 13 0 2 1 0 2 0 4 1 0 4 4 1 0 34 0.02 0 0.51 0 0.15 0.076 0 0.025 0 0.28 0.054 0 0.19 0.14 0.034 0 0.07 27 -
8.5 -
6.5 3 -
85 -
5.8 4 -
12 12 23 -
5 707
21
Part II
93
(This page intentionally left blank.)
94
Part II
Samoa 1997 Prevalence per 10000 16 0.95 New cases per 100000 13 Gradel disability MDT coverage Cured cases Relapsed cases
Number Rate
7.8
Population: 167000 Epidemiology: Programme: Partially integrated, supervised by the TuberculosisJLeprosy Section of the Public Health Division of the Ministry of Health. Case-finding: Passive. Diagnosis: Based on clinical findings and bacteriological examinations, which are performed systematically. Laboratory: There is no quality control. Treatment: WHO MDT was implemented in 1985, and is given until skin smears are negative. Prevalenceldetection ratio: 1.2 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: There is no patient under DDS monotherapy. Achievements: The MDT coverage is 100%. References: Farrugia R. (WHO), Report on a field visit to Samoa, September 1996. Farrugia R. (WHO), Report on a field visit to Samoa, May I ~95. Farrugia R. (WHO), Report on a field visit to Samoa, April 1996. Farrugia R. (WHO), Report on a field visit to Samoa, May 1997. Jesudasan K. (WHO), Report on a field visit to Samoa, February 1997. Lynch M.J. (WHO), Report on laboratory diagnosis of leprosy and tuberculosis in Samoa, April 1994.
Part Il
95
Leprosy indicators in Samoa (1983-1997): Year Population Registered Prevalence (OOOs) cases per 10000 New cases New cases per 100000
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
161 163 160 159 161 161 170 162 163 163 166 162 1.7 1 167 167
274 133 118 72
17 8.2 7 4.4 4.6 3.2 3.1 2.22 2.09 1.53 0.84 1.23 1.23 1.38 0.95
51 15 15 16 19 I1 18 13 10 9 5 10 13 13 13
31.6 9.38 9.4 10.1 11.8 6.8 10.6 8 6.1 5.5 3 6.2 7.6 7.8 7.8 53 63 58 27 28 15 40 78 60 70 77
20 6 5 9 17 38 20 0 0 0 31 23 0 15 8 8
75 52 50 36 34 25 14 20 21 23 16
92 54
Rate per 10000
Leprosy prevalence and case detection rates per 10000 (1983-1997)
18 16 14
1\
12 10
\ \
8 6
~
_ _ Prevo rate - 0 - Detee. rate
4 2
[\.. '\. 83 84
'" '\.. -n.
.......
............... J"\.
o 85 86 87
Y
88
89
90 Year
91
--92
93
94
95
96
97
96
Part /I
Singapore 1997 Number Rate Prevalence Per 10000 44
New cases per 100 000
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
0.15
Population: 3 185 000 Epidemiology: Programme: Case-finding: Diagnosis: Laboratory: Treatment: MDT started in 1982. Many patients receive DDS monotherapy after completion of MDT. Prevalence/detection ratio: 4.4 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: In 1993, 688 of the 1063 cases under treatment (65%) were still under DDS monotherapy. Achievements: Leprosy prevalence is still high in Singapore. References: Blanc L. (WHO). Report on a field visit to Singapore. February 1994.
Part 1/
97
Leprosy indicators in Singapore (1983-1997): Year Population Registered Prevalence (OOOs) cases per 10 000 2502 2540 2558 2588 2613 2647 2685 2700 2735 2771 2870 2880 2848 747 2.62 33 1.16 48 0 1406 I 171 1063 5.14 4.23 3.70 36 13 41 24 1.33 0.48 1.48 0.84 46 42 4 61 6 2145 8.3 New cases 39 New cases per 100000 1.5
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
:> 0
3185
10
0.3
40
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
9
8 ~~~-------------------------------------------
7~-~------=-~.---------------------------------5
6~-------~--~-=------------------
----.. 90 Year
-+--- Prevo rate ~
4~---------------------·
- 0 - Detee. rate
3t-------------------------------------~~==~ 2~--------------------------~\~ ~
"\
o~~~~~~~~~~~~~~~\~· 83 84 85 86 87 88 89 91 92 93 94 95 96 97
98
Part /I
Solomon Islands 1997 Cured ~Iapsed
Population: 425 078 Epidemiology: Programme: Integrated into the general health services, with a vertical component at both national and provincial levels. Case-finding: Passive. Diagnosis: Laboratory: Available at the provincial level. Treatment: WHO MDT was introduced in 1986. Prevalence/detection ratio: 2 Rehabilitation: Disabled patients come under the care of the new Community-based Rehabilitation Programme. Reconstructive surgery and physiotherapy are available in Honiara. Retreatment of cases previously treated with DDS and discharged: By the end of 1994, I casc out of 36 registered cases was still under DDS monotherapy. In March 1994, 13 cases under DDS mono therapy were found free of signs of active disease, were given a single dose of 600 mg of rifampicine, and subsequently released from treatment and control. Achievements: The MDT coverage was 97% at the end of 1994. The Solomon Islands has reached the goal of elimination of leprosy as a public health problem. References: Franckcl R. (WHO). Report on a Ileid visit to Solomon Islands. April 1995. Franckel R. (WHO), Report on a field visit to Solomon Islands. September-Octoher 1996. Information from the Directorate of Health and Medical Services. Honiara. December 1994.
Part /I
99
Leprosy indicators in Solomon Islands (1983-1997): Year Population Registered Prevalence cases (OOOs) per 10000 New cases New cases per 100000
MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
259 269 270 286 289 306 320 318 330 341 356 379 394 409 425
700
31.7
21 23 24 14 116 140 66 40 24 26 42 3.48 4.24 1.86 1.06 0.61 0.64 0.99 19 21 IS
7.34 7.96 7.84 4.38 5.97 6.36 4.40 2.25 2.64 2.29 5.86 4.94
52 52 54 71 84 82 80 50 90 78 58 47 0 0 8 5
19 4 4 14 II
5 7 0 10 22 29 33
8 10 9
24 21
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
30 25 20 15 10 5
~
~
~
- - Prevo rate --0- Detec. rate
~ 88
~ ..89 90 Year 91 92 93 94 95 96 97
O+--r--~~~~~~F=~~~~~;=~~~~=~¢ 83 84 85 86 87
100
Part II
Tokelau 1995
Prevalence per 10000
New cases per 100000
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
Number Rate
o o
o o
Population: 2000 Epidemiology: Programme: Integrated. Case-finding: Diagnosis: Based on clinical findings. Laboratory: Treatment: MDT was implemented in 1990. Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: References: Information from the Office for Tokelau Affairs. Apia. Samoa. April 1992.
Part Jl
fOf
Leprosy indicators in Tokelau (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Population Registered Prevalence (OOOs) cases per 10000 2
New cases
New cases per 100 000
MB %
Disability %
Child %
3 2 2 2 2 2 2 2 2 2 2 2
0 1 1
0 5 5
0 1 1
0 50 50 0 0
0
0
0
0
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1995)
6 5 4
T
3
2
I \ \ I \ I Year
\
-+- Prevo rate -{]- Detee. rate
o
\
I ()2
Part /I
Tonga New cases Grade 2 Prevalence per 10000 per 100 000 disability ~----~--------+---------~ Number Rate 0.1
1997
MDT coverage
Cured cases
Relapsed cases
Population: 98 077 Epidemiology: Programme: Integrated into the activities of the General Hospital. The Medical Officer for Communicable Diseases has responsibility for the leprosy control programme. Case-finding: Passive. Diagnosis: Based on clinical findings. Bacteriological examinations are carried out in most cases. Laboratory: There is no quality control. Treatment: WHO MDT was implemented in 1986. The treatment is of fixed duration. Prevalence/detection ratio: I Rehabilitation: There is no specific programme for rehabilitation of disabled individuals. Retreatment of cases previously treated with DDS and discharged: All old cases were retreated with MDT. Achievements: Leprosy as a public health problem has been eliminated from Tonga. References: Glaziou P. (WHO). Report on a lield visit to Tonga, June 1994.
Part /I
103
Leprosy indicators in Tonga (1983-1997): Year Population Registered Prevalence (OOOs) per 10000 cases New cases New cases per 100000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
98 96 96 97 95 96 98 97 97 98 98 98 99 98 98 1 0,1 2 0.2 1 2 1 1 0.1 0.21 0,1 0,1 11 l.l
0 1 0 2 0 2 1 1 1 0 0 0 1
0 1.04 0 2.06 0 2.08 1.02 1.03 1.03 0 0 0 1 100 100 0 100
i'
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
1.2~---------------------------------------------
0.8t-------------~-------------------------------
_ _ Prevo rate 0.6+---------------~-----------------------------
-o-Detec. rate
0.4t-----------------~~-------------------------
0.2
+----------,~----_j_J<
__--~___:7'"_;;:__--------~.....::::_---
O~~--~--+_~r_~--+_~--~~o_~r_~--O=~--~
~
M
~
~
~
~
~
00
~
~
~
~
~
~
~
Year
IO..J
Part I!
Tuvalu 1996
r-----+-------r--------h Number Rate Population: 10 000 Epidemiology: Programme: Integrated. 10
Prevalence per 10000
New cases per 100000
Grade 2 disability
MDT coverage
Cured cases
Relapsed cases
'i
Case-finding: Active case-finding occasionally takes place in schools and on highly endemic islands. Diagnosis: Based on clinical findings and bacteriological examinations. Laboratory: Treatment: WHO MDT started in 1984. Prevalence/detection ratio: I Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: The MDT coverage is 100%. References: Daulako E.C. (WHO). Report on a field visit to Tuvalu; August 1993. Daulako E.C. (WHO), Report on a field visit to Tuvalu; April 1995. Daulako E.C. (WHO). Report on a field visit to Tuvalu; December 1996. Information from the Ministry of Health. Tuvalu. September 1994.
Part /I
105
Leprosy indicators in Tuvalu (1983-1996): Year Population Registered Prevalence (OOOs) cases per 10000 8 8 8 8 8 8 8 9 9 9 9 13 13 10 1 1 1 10 100 0 0 0 0 2 2 3 0 0 2.22 2.22 2.31 0 0 0 2 3 0 0 0 22.22 23.1 100 33 0 10 14.3 New cases New cases per 100 000 MB % Disability % Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1996)
16
14 12 10
.~
8 6
"" ~
~
-+- Prevo rate
4 2
"" $
- 0 - Detee. rate
~
~
.....
o M ~ ~
M
00
.""
/./ ~ ~ ~
~ M
00
%
%
W
Year
106
Part II
Vanuatu 1997
Prevalence per 10000 8
New cases per 100000
Grade 2 disability
MDT
coverage
Cured cases
Relapsed cases
Number Rate
6 3.5
0.5
Population: 173 000 Epidemiology: Programme: Vertical at the national and district levels (there are five districts in Vanuatu). Partially integrated at the provincial level. Case-finding: Mainly passive. There are occasional community surveys. Diagnosis: Based on clinical findings. Laboratory: Not available or not functional at the district level. Treatment: MDT started in 1983. In 1992, a modified WHO MDT without DDS was introduced due to the high level of DDS intolerance in Vanuatu. PB cases receive six monthly supervised doses of the combination RMP plus CLO, in addition to daily CLO. MB cases receive two monthly doses of RMP and CLO, in addition to daily doses of CLO plus MINO, followed by 22 monthly supervised doses of RMP plus CLO plus MINO in addition to daily doses of CLO. Prevalenceldetection ratio: 1.3 Rehabilitation: Retreatment of cases previously treated with DDS and discharged: By the end of 1994, 22 out of 67 selected unregistered patients under DDS monotherapy had started MDT retreatment. By the end of 1995, all registered patients were under MDT. Achievements: Vanuatu is reaching the goal of elimination of leprosy as a public health problem. References: Blanc L. (WHO), Report on a field visit to Vanuatu, December 1994. Frankel R. (WHO), Report on a field visit to Vanuatu, October· November 1997. Gerrits G. (WHO). Report on a field visit to Vanuatu. December 1994. Gerrits G. (WHO). Report on a field visit to Vanuatu. November 1995. Landwehr D., Gerrits G. (WHO), Report on a field visit to Vanuatu. April 1995. Montaville B., Bouree P., Leprosy in Vanuatu, Bull Soc Pathol Exot, 1989,82,351·358. Information from the Ministry of Health, Vanuatu. November 1994.
Part II
107
Leprosy indicators in Vanuatu (1983-1997): Year Population Registered Prevalence New New cases (000s) cases per 10000 cases per 100000 MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
124 127 130 133 136 139 142 146 146 154 161 164 169 170 173
226
17.7
31 28 21 15 11
25 22.1 16.2 11.3 8.1 7.9 4.9 6.9 4.8 11
11 7 10
15 23 29 16 20 20 8
1.03 1.49 1.80 0.98 1.18 1.15 0.5
7 17 14 3 14 6
29 53 14 67 36 67 6 0 0 7 17
0 6 7 33 14 17
8.7 1.8 8.3 3.5
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)
20 18 16 14
~
12 10
8 6 4 2
"'" "'" ~
'" "'"
_ _ Prevo rate - 0 - Detee. rate
u-
o
"'""'"
"'" Year
"-
....,
~
108
Pan IJ
VietNam 1997 Number Rate Prevalence per 10000 4676 0.61 New cases per 100000 2808 3.65 Grade 2 disability MDT coverage Cured cases Relapsed cases
Population: 76900 000 Epidemiology: Leprosy cases are unevenly distributed: 12 provinces in mountainous areas and four provinces on the high plateau are still considered as highly endemic, while the elimination goal has been attained in 38 of the 53 provinces (as at September 1996). A total of 7360 cases were estimated in the IS provinces where the prevalence rate is higher than I per 10 000 (5301 cases are currently under treatment). Programme: Vertical. The responsible unit at the central level is the National Institute of Demmtology and Venereology in Hanoi. Activities are integrated into the general health system at the village level. There are several leprosaria in the country. Two SAPELs were introduced in 1995 in Kon Tum and Lamdong provinces and led to case detection rates which were much lower than expected. The plan of action to reach the elimination goal at district level includes 12 SAPELs and two LECs. Case-rmding: Mainly active, through mass, contact and group screening. Diagnosis: Based on clinical findings and bacteriological examination. Confirmation of the diagnosis is made by a specialist dermatologist of the provincial dispensary of dermatology and venereology. Laboratory: Available at the provincial or district level. Treatment: WHO MDT has been gradually implemented from 1982. Prevalenceldetection ratio: 1.7 Rehabilitation: There were an estimated II 300 disabled individuals in 1995. Retreatment of cases previously treated with DDS and discharged: Achievements: The leprosy programme has achieved the goal of elimination of leprosy as a public health problem at national level and in most provinces. However, there are 16 provinces with areas of difficult access where MDT coverage and detection are not satisfactory. References: Blanc L. (WHO), Report on a field visit to Viet Nam, November 1996. Blanc L. (WHO), Review of special action projects for the elimination ofleprosy. February-March 1997. Cabanos G., Landwehr D., Yuasa Y. (WHO), Evaluation of the leprosy control programme in Viet Nam, November 1996. Dai Z-C, "Leprosy control in China", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHFIMDT Series 2, 1991, 1-10. WHO, Report from the major endemic countries, International Conference on Elimination of Leprosy, Hanoi. Viet Nam, July 1994. Leclerc E. (Damien Foundation, Belgium), Report of a mission to Viet Nam, September 1994. Lienhardt C. (WHO), SAPEL in Kon Tum province, Viet Nam, May 1995. Information from the National Institute of Dermatology and Venereology, Hanoi, November 1994.
Part /I
109
Leprosy indicators in Viet Nam (1983-1997): Year 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Population Registered Prevalence (000s) per 10000 cases 54000 55 800 57400 59000 60500 62000 63 500 67514 67774 69306 72 771 74000 75350 75310 76900 36616 34240 30750 28240 26750 24 ISO 23463 20997 18342 9449 7320 7419 5277 4743 4676 6.78 6.14 5.36 4.79 4.42 3.9 3.69 3.65 2.71 1.36 1.01 1 0.70 0.63 0.61 New cases 2021 2103 2062 2292 2183 I 847 2073 1995 2 500 3 142 3 185 3173 2591 2883 2808 New cases per 100000 3.74 3.77 3.59 3.88 3.61 2.98 3.26 3.47 3.69 4.53 4.38 4.29 3.44 3.83 3.65 45 44 41 54 57 40 56 68 55 66 65 63 64
MB %
-Disability %
Child %
41 30 32 30 28 28 28 28 24 22 18 20 31 32 30
6 4 7 8 9 8 6 7 3 8 7 5 9 7 6
Rate per 10000
Leprosy prevalence and case detection rates per 10 000 (1983 -1997)
8 7
6 5
~
4 3 2
""
~
_ _ Prevo rate ~ ~
""""'.-. Year
-G-.Detec. rate
o
110
Part 1/
Leprosy indicators in Viet Nam by province (1997): Province An giang Sa ria Vung tau
Population 1996 (000,) 2188 739
Registered cases 180 107 II 12 81 II 30 148 81 108 424 150 102 17 43 192 226 66 174 II 13 6 25
Prevalence per 10 000 0.82 1.45 0.38 0.08 1.05 0.1 0.21 1.0 I I 18 1.88 4.26 U6 0.51 03 0.63 29 I 14 0.4 1.99 0.18 015 0.02 0.11 0.17 0.06 00.1 0.84 0.04 0.06 15 2 2.86 0.47 0.81 0.81 016 0.18 0.11 0.14 0.03 2.99 0.11 0.8 0.1 0.17 0.8 0 0.19 039 04 J27 0.07 0.14 0.12 0.42 0.65 0.58 0.14 0.9 0.14 0.12 0.61
New cases 76 54 5 4 36 4 20 86 62 76 270 80 60 19 30 41 157 48 74 I I 2 14 15 7 0 282 3 0 95 168 51 32 56 72
New cases per 100000
,5
Prevalence! detection 2.4 2 2.2
Bac can Bae giang Bac lieu Bac ninh Ben tre Binh dinh Binh ducng Binh phuoe Sinh thuan ea mau
291 1456 772 1060 I 397 1459 985 573 995 I 105 2007 559 680 662 1991 1647 875 601 864 2465 2358 1345 1764 1759 5032 786 I 182 995 1459 287 589 850 I 364 788 658 1962 2892 971 499 I 253 797 858 I 495 I 197 99, 641 1272 886 897 1875 1095 J 669 1069 1699 1025 698 1093 1096 679 76900
Can tho Cao bang Oa nang Dae lac Dong nai
Dong thap Gia lai Ha giang Ha nam Ha noi
Ha tay Ha tinh Hai duong
23 10 5 424 3 7 149
Hai phong Ho Chi Minh Hun binh Hong yen Khanh hua
Kien giang Kon tum
292 82 28 69 III 13 12 21 40 3 149 14 64 9 25 96 0 12 50 35 293 14 15 45 45 110 59 10 98 15 8 4676
La chau Lam dong Lang an Lang soa
Lao cai Nan binh Nghe an Ninh binh Ninh thuan
Phu tho Phu yen Quang binh
Quang nam Quang ngai Quang ninh Quang tri Soc trang Son la Tay ninh Thai binh Thai nguyen Than hoa Thun thien Hue
Tieu giang Tra vinh Tuyen Quang Vinh long Vinh phue Yeu bai Total
10 8 4 21 I 186 8 41 20 24 48 I 7 33 17 145 5 12 17 19 54 35 5 68 13 5
7.3 1.7 0.27 4.7 0.38 1.4 5.9 6.3 I, 2.7 7.2 3 3.4 4.4 6.2 7.9 2.9 8.5 0.17 0.12 0.081 0.59 1.1 0.4 0 5.6 0.38 0 9.5 12 1.8 5.4 6.6 5.3 U 1.2
.1 2':2.8 1.5 17 U 14 1.6 1.9 1.7 0.9 1.4 4.7 1.4 1.4 2.4 II
1.1 .1 1.8 1.5 1.4 J)
I 1.6 1.7 I /1 0.9 1.2 1.5 U U 5 ..1 1.9 .1
0.2 0.73 0.1 37 0.64 5.1 2.3 1.6 4
0.1 1.1 2.6 1.9 16 027 1.1 046 1.8 l'
0.8 1.8 1.6 05 I 2.() 0 1.7 1.5 2.1 2 2.R U 2.6 2.4
3.4 0.72 6.2 12 0.73
2808
3.7
2 1.7 2 14 1.2 1.6 1.7
WESTERN PACIFIC REGION
VIET NAM
Kien, Giawnga . "<'\",,~ •. . . •. •. .•· . .• n . :.·. • . .i........... ocTl1IngJ inh Hai . i/o.
~
----------------------'
1
1
1
WESTERN PA CIFIC REGIO Leprosy Surve N illa
1
nce Programm e
1
1
1
1
1
Distribution o f r e g is te r e d for leprosy cas. . treatment (199 7)
VIETNAM
1
1
1
1
1
1
1
1
1
1
1 d o t- 5 e. . . .
1
1
1
1
1
1·.
•
1
1
1
Part 1/
113
(This page intentionally left blank.)
114
Part /I
Wallis and Futuna 1994
Prevalence per 10000
New cases Per 100 000
Grade 2 disability
MDT coverage
Number Rate
o o
o o
---+-----1
Cured cases
Relapsed cases
Population: 14 000 Epidemiology: No leprosy case has been detected in Wallis and Futuna since 1992. Programme: There is no leprosy control programme. Any case occurring in Wallis and Futuna would he handled according to the current leprosy control programme procedures in New Caledonia. Case-finding: Passive. Diagnosis: Laboratory: Treatment: Prevalence/detection ratio: Rehabilitation: Retreatment of cases previously treated with DDS and discharged: Achievements: Leprosy as a public health problem has been eliminated from Wallis and Futuna. References: InformaCion from DTASS. Noumea, New Caledonia. July 1993.
Part 1/
115
Leprosy indicators in Wallis and Futuna (1983-1997): Year Population Registered Prevalence (OOOs) cases per 10000 New cases New cases per 100 000 MB %
Disability %
Child %
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
10 10 12 12 14 12 14 14 14 14 14 15 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0