WHO | WHO to publish first official guidelines on leprosy diagnosis, treatment and prevention 18/03/19 17.

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Neglected tropical diseases

WHO to publish first official guidelines on
leprosy diagnosis, treatment and
prevention
28 June 2018 | Geneva −− The World Health Organization (WHO) will
publish its first guidelines on leprosy as part of renewed efforts to
eliminate the disease and after almost two years since the Global
Leprosy Strategy 2016–2020 was launched.

©JA. Tueller

1
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WHO | WHO to publish first official guidelines on leprosy diagnosis, treatment and prevention 18/03/19 17.42

Despite being eliminated as a public health problem 1 globally in 2000

and at national level in most countries in 2005, cases of leprosy as
reported by 145 countries from all six WHO regions continue to occur;
more than 200 000 new cases were reported in 2016 alone.

“The primary audience of the guidelines includes people involved

in the formulation of national policies and clinicians who are
involved in the management of the disease particularly in low- and
middle-income countries” said Dr Erwin Cooreman, Team Leader
of the Global Leprosy Programme which is housed in WHO’s
South-East Asia Regional Office in New Delhi, India. “With
ongoing transmission of infection, including among children, it is
clear that we need renewed efforts to eliminate the disease.”

This is the first time that WHO has developed guidelines for leprosy
through evidence-based recommendations utilizing guideline
development methods based on the GRADE (Grading of
Recommendations Assessment, Development and Evaluation 2 )
approach. Previous leprosy guidance documents were developed
through meeting reports and other technical documents.

“Published literature from 2010 onwards on diagnostics, treatment

regimens and on prophylaxis were retrieved and reviewed and
recommendations were based on evidence” said Dr Laura Gillini,
Medical Officer, Global Leprosy Programme. “However, evidence
on benefits and harms of treatment for drug-resistant leprosy was
not available; therefore the recommendation for treating leprosy
cases with drug-resistant strains in the guidelines is based on
expert opinion.”

The guidelines were developed with funding from the Nippon

Foundation. Key research gaps are identified to help inform future
research on leprosy.

Highlights of recommendations
Diagnosis
The guidelines maintain the standard methods for diagnosis, which
include the presence of at least one of the three clinical signs of leprosy:
(i) definite loss of sensation in a pale (hypopigmented) or reddish skin
patch; (ii) a thickened or enlarged peripheral nerve with loss of
sensation; and (iii) the presence of acid-fast bacilli in a slit-skin smear.
Because the clinical diagnosis of early leprosy and paucibacillary leprosy
can be a challenge, a number of serological and other laboratory assays
have been developed to supplement clinical diagnostic methods.

Treatment

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WHO | WHO to publish first official guidelines on leprosy diagnosis, treatment and prevention 18/03/19 17.42

The use of the 3-drug regimen comprising rifampicin, dapsone and

clofazimine is recommended for all leprosy patients, with duration of
treatment lasting 6 months for paucibacillary leprosy and 12 months for
multibacillary leprosy. The potential advantage of using the same three
drugs for both forms of the disease is simplification of treatment. For
patients who are resistant to rifampicin, two of the following drugs are
recommended: clarithromycin, minocycline or a quinolone (ofloxacin,
levofloxacin or moxifloxacin), plus clofazimine daily for 6 months,
followed by clofazimine plus one of the second-line drugs daily for an
additional 18 months. For patients resistant to rifampicin and ofloxacin,
clarithromycin, minocycline and clofazimine may be used for 6 months,
followed by clarithromycin or minocycline plus clofazimine for an
additional 18 months. For adults and children (aged above 2 years) who
are in regular contact with leprosy patients, the guidelines recommend
the use of single-dose rifampicin.

Prevention
The ability of programmes to adequately identify and manage contacts of
leprosy cases is a prerequisite for the successful implementation of the
recommendations. Because leprosy is highly stigmatized, caution must
be exercised when implementing single-dose rifampicin, particularly for
contacts outside the patient’s family. Programmes must respect the wish
of patients to disclose or not disclose their diagnosis.

The disease
Leprosy is caused by infection with the bacillus Mycobacterium leprae,
which multiplies very slowly in the human body. The bacterium has a
long incubation period (on average five years or longer). The disease
affects nerve endings and destroys the body’s ability to feel pain and
injury.

Leprosy is curable. Treatment provided in the early stages of infection

averts disability. Multidrug therapy is available free of charge through
WHO and has been donated to all patients worldwide by Novartis since
2000 (and by The Nippon Foundation since 1995). It provides a simple
yet highly effective cure for all types of leprosy.

Continued discrimination has deterred people from coming forward for

diagnosis and treatment and encouraged cases to remain hidden,
indirectly contributing to transmission.

Social stigma also facilitates transmission among vulnerable groups,

including migrant populations, displaced communities, and the very poor
and hard-to-reach populations. Combating stigma and ensuring early
diagnosis through active early case-finding is critical to making progress.

-----------------------------------------------------------

1 Eliminationof leprosy as public health problem (defined as a registered

prevalence of less than 1 case per 10 000 population). However, pockets
of endemicity have continued in many countries. India and Brazil report

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WHO | WHO to publish first official guidelines on leprosy diagnosis, treatment and prevention 18/03/19 17.42

the highest number of cases annually.

2 GRADE includes an assessment of quality of evidence (high, moderate,

low or very low), consideration of the overall balance of benefits to harms

(at individual and population levels), patient/health worker values and
preferences, resource use, effects on equity, cost–effectiveness and
consideration of feasibility and effectiveness across a variety of settings,
including resource-limited settings and those where access to laboratory
infrastructure and specialized tests is limited.

Contact:
Ashok Moloo
WHO/CDS/NTD
Telephone: +41 22 791 16 37
Mobile phone: +41 79 540 50 86
molooa@who.int
@ntdworld

Further reading

Guidelines -- Read the

Executive Summary

More on leprosy

Fact sheet
Global Leprosy Strategy 2016‒
2020. Accelerating towards a
leprosy-free world
Operational Manual 2016 –
Global Leprosy Strategy
2016−2020. Accelerating
towards a leprosy-free world

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