WHO updates fact sheet on Leprosy (21 February 2017)

The World Health Organization (WHO) has updated its fact sheet on Leprosy.

Background information:

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus.

M. leprae multiplies slowly and the incubation period of the disease, on average, is 5 years. In some cases, symptoms may occur within 1 year but can also take as long as 20 years to occur.

The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes.

Although not highly infectious, leprosy is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.

Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs, and eyes.

Leprosy is curable with multidrug therapy (MDT), and treatment in the early stages can prevent disability.

In 1991 the World Health Assembly passed a resolution to “eliminate” leprosy as a public health problem by the year 2000.

Elimination of leprosy is defined as a registered prevalence rate of less than 1 case per 10 000 persons. The target was achieved on time at global level.

Key Messages:

Over the past 20 years, more than 16 million leprosy patients have been treated.

The prevalence rate of the disease has dropped by 99%: from 21.1 cases per 10 000 people in 1983 to 0.2 cases per 10 000 people in 2015.

According to official reports received from 138 countries from all WHO regions, the global registered prevalence of leprosy at the end of 2015 was 176 176 cases (0.18 cases per 10 000 people).

The number of new cases reported globally in the last three years are as follows:

2015: 211 973 (0.21 new cases per 10 000 people)
2014: 213 899
2013: 215 656.

The number of new cases indicates the degree of continued transmission of infection. Global statistics show that 203 600 (96%) of new leprosy cases were reported from 22 priority countries:

leprosz_news_18102016_table

As can be seen from the above table, only three countries reported more than 10 000 cases in 2015- India, Brazil, and Indonesia.

With 127,326 new cases, India accounted for 60% of the global new cases.

Brazil, reported 26 395 new cases, representing 13% of the global new cases; and Indonesia reported 17 202 new cases, 8% of the global case load.

In 2016 WHO has launched the “Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world“ – which aims to reinvigorate efforts for leprosy control and to avoid disabilities, especially among children affected by the disease in endemic countries.

This strategy emphasizes the need to

sustain expertise and increase the number of skilled leprosy staff,
improve the participation of affected persons in leprosy services, and
reduce visible deformities – also called grade-2 disabilities (G2D) – as well as stigma associated with the disease.

The targets of the new global strategy to be met by 2020 are:

Zero disabilities among new paediatric patients.
A grade-2 disability rate of less than 1 case per 1 million people.
Zero countries with legislation allowing discrimination on basis of leprosy.

The strategy is structured around 3 core pillars:

Pillar I: Strengthen government ownership, coordination and partnership

Key activities of Pillar I include:

Ensuring political commitment and adequate resources for leprosy programmes.
Contributing to universal health coverage with a special focus on children, women and underserved populations including migrants and displaced people.
Promoting partnerships with state and non-state actors and promoting intersectoral collaboration and partnerships at the international and national levels.
Facilitating and conducting basic and operational research in all aspects of leprosy and maximizing the evidence base to inform policies, strategies and activities.
Strengthening surveillance and health information systems for programme monitoring and evaluation (including geographical information systems).

Pillar II: Stop leprosy and its complications

Key activities of Pillar II include:

Strengthening patient and community awareness of leprosy.
Promoting early case detection through active case-finding (such as campaigns) in areas of higher endemicity and contact management.
Ensuring prompt start of, and adherence to treatment, including working towards improved treatment regimens.
Improving prevention and management of disabilities.
Strengthening surveillance for antimicrobial resistance including laboratory network.
Promoting innovative approaches for training, referrals, and sustaining expertise in leprosy, such as e-health.
Promoting interventions for the prevention of infection and disease.

Pillar III: Stop discrimination and promote inclusion

Key activities of Pillar III include:

Promoting societal inclusion by addressing all forms of discrimination and stigma.
Empowering persons affected by leprosy and strengthening their capacity to participate actively in leprosy services.
Involving communities in action for improvement of leprosy services.
Promoting coalition-building among persons affected by leprosy and encouraging the integration of these coalitions and/or their members with other community-based organizations.
Promoting access to social and financial support services, for example to facilitate income generation, for persons affected by leprosy and their families.
Supporting community-based rehabilitation for people with leprosy-related disabilities.
Working towards abolishing discriminatory laws and promoting policies facilitating inclusion of persons affected by leprosy.