DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

AY 2018-2019

LEPROSY

I. INTRODUCTION
● chronic infectious disease caused by ​Mycobacterium leprae
● mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and
the eyes
● incubation period: normally between two and 10 years, but may be as long as 20 years
● Transmission of leprosy is poorly understood, although it is thought to be through
inhalation of droplets containing the causative agent. Transmission via skin contact or
other means cannot be entirely excluded.
● Leprosy has a reservoir in armadillos and a few other animals

II. EPIDEMIOLOGY
● Despite being eliminated as a public health problem globally in 2 000, cases of leprosy as
reported by 145 countries from all six WHO regions continue to occur
● In 2016, 216 108 new leprosy cases were registered globally
● Based on 173,358 cases at the end of 2016, prevalence rate corresponds to 0.29/10,000
● Though leprosy has been eliminated as public health burden at the national level, there
are still pockets of cases in the country causing the Philippines to remain as the highest
in terms of new cases detected in the western pacific region and with high prevalence
rate, an indication that transmission is still ongoing.
● WHO-NLCP 2012 report listed the following cities with highest recorded new cases of
leprosy: Metro Manila with 99 new cases detected and 9% prevalence rate, Nueva Ecija
(Lupao) with 60 new cases and 4% prevalence rate and Cebu City with 37 new cases
and 27% prevalence rate

III. GLOBAL LEPROSY STRATEGY 2016-2020

The current global leprosy strategy builds on previous five-year strategies. The Final
push strategy for the elimination of leprosy, 2000-2005 focused on MDT and passive case
detection. The Global strategy for further reducing the leprosy burden and sustaining leprosy
control activities, 2006-2010 consolidated the principles of timely detection and effective
chemotherapy in the context of integrated leprosy services. The Enhanced global strategy for
further reducing the disease burden due to leprosy, 2011-2015 refined joint actions and
enhanced global efforts to address challenges faced in leprosy control with a focus on early
detection to reduce disabilities due to leprosy.

A. Vision
i) Zero disease
ii) Zero transmission of leprosy infection
iii) Zero disability due to leprosy
iv) Zero stigma and discrimination
 B. Goal
i) Further reduce the global and local leprosy burden

C. Targets

Indicators 2020 Target

er of children diagnosed with leprosy and visible deformities 0

of newly diagnosed leprosy patients with visible deformities <1 per million

er of countries with legislation allowing discrimination on basis of 0

leprosy

IV. NATIONAL LEPROSY CONTROL PROGRAM (NLCP)

VISION:​ ​ Leprosy-free Philippines by the year 2022

MISSION:​ To ensure the provision of a comprehensive, integrated quality leprosy services at all
levels of health care

OBJECTIVES:

● To further reduce the disease burden and sustain provision of high-quality leprosy
services for all affected communities ensuring that the principle of equity and social
justice are followed
● To decrease by 50% the identified hyper endemic cities and municipalities

PROGRAM COMPONENTS

● Early diagnosis and treatment

● Integration of leprosy services
● Referral system
● Case detection and diagnosis
● Advocacy and IEC focusing on stigma discrimination and reduction
● Prevention of Deformity, self-care and rehabilitation
● Recording and reporting
● Monitoring, supervision and evaluation

POLICIES AND LAWS

● Administrative Order No. 167, s. 1965: Rules and Regulations of Leprosy Control in
the Philippines
● Republic Act No. 4073: An Act further liberalizing the treatment of leprosy by
amending and repealing certain sections of the revised Administrative Code
 ● Presidential Decree No. 384 January 30, 1974: Amending Republic Act No. 4073
entitled An Act further liberalizing the treatment of leprosy by amending and repealing
certain sections of the revised Administrative Code
● Proclamation No. 467: Declaring the Last Week of February of every year as Leprosy
Week
● Administrative Order No. 26 – A, s. 1997: Guidelines on Elimination of Leprosy as
Public Health Problem
● Administrative Order No. 5, s. 2000: Guidelines on the integration of leprosy services
in hospitals
● Department memorandum No. 79, s. 2004: Recommendations to pursue Leprosy
Elimination Activities in all areas in the country
● Department Circular 366-B, s. 2003: First Leprosy Forum of the Philippine
Dermatological Society on November 12, 2003
● Department Circular 254, s. 2004: Second Leprosy Forum of the Philippine
Dermatological Society on November 9, 2004

PARTNER INSTITUTIONS

● World Health Organization

● Novartis Foundation
● Sasakawa Memorial Health Foundation
● Culion Foundation, Inc.
● Philippine Leprosy Mission
● Cebu Leprosy and TB Research Foundation Inc.
● Philippine Dermatological Society
● Coalition of Leprosy Advocates and Patients in the Philippines
● International Leprosy Association
 
STRATEGIES, ACTION POINTS AND TIMELINE

1. Strengthen local government ownership, coordination and partnership

● Ensuring political commitment and adequate resources for leprosy programs at
all levels
● Contributing to UHC with a special focus on children, women and underserved
populations including migrants and displaced people.
● Promoting partnerships with state and non-state actors and promote
inter-sectoral collaboration and partnerships at the international, national and
sub-national level
● Facilitating and conducting basic and operational research in all aspects of
leprosy and maximize the evidence base to inform policies, strategies and
activities.
● Strengthening surveillance and health information systems for program
monitoring and evaluation (including geographical information systems)

2. Stop leprosy and its complications

● Strengthening patient education and community awareness on leprosy.
● Promoting early case detection through active case-finding (e.g. campaigns) in
areas of higher endemicity and contact management.
 ● Ensuring prompt start and adherence to treatment, including working towards
improved treatment regimens
● Improving and management of disabilities.
● Strengthening surveillance for antimicrobial resistance including laboratory
network.
● Promoting innovative approaches for training, referrals and sustaining
expertise in leprosy such e-Health (LEARNS)
● Promoting interventions for the prevention of infection and disease.
-Chemoprophylaxis
3. Stop discrimination and promote inclusion
● Promoting societal inclusion through addressing all forms of discrimination and
stigma
● Empowering persons affected by leprosy and strengthen their capacity to
participate actively in leprosy services. -CLAP
● Involving communities in actions for improvement of leprosy services.
● Promoting coalition-building among persons affected by leprosy and
encourage the integration of these coalitions and or their members with other
CBOs.
● Promoting access to social and financial support services, e.g. to facilitate
income generation, for persons affected by leprosy and their families.
● Supporting community-based rehabilitation for people with leprosy related
disabilities
 
 
The NLCP has succeeded in building an integrated digital portfolio for leprosy case
finding, case reporting, and capacity building of health providers for leprosy diagnosis and
management. The digital portfolio includes the Integrated Leprosy Information System (ILIS),
the Leprosy Alert and Response Network System (LEARNS) and the leprosy eLearning
Modules.

● Integrated Leprosy Information System (ILIS):​ web-based data management system

that will enable DOH to gather, process and analyze patient data provided electronically
by health providers and leprosy coordinators
● Leprosy Alert and Response Network System (LEARNS):​ country’s first mobile
phone-based leprosy referral system that will enable frontline healthcare providers refer
suspected leprosy patients to specialists through mobile technology to reduce delays in
diagnosis and treatment
● leprosy eLearning Module​: focused on stigma assessment, and provides information
on interventions to address stigma and discrimination among persons affected by
leprosy

Program accomplishments/Status

Indicators 2017
Prevalence rate of <1 per 10,000 population 0.4
MB/PB (new cases) 1660/249
Children below 15 years old & proportion 6.7%
Statistics

V. DIAGNOSIS

The Diagnosis of leprosy is based on clinical signs and symptoms.

● Presence of at least one of the three clinical signs of leprosy

o definite loss of sensation in a pale (hypopigmented) or reddish skin patch
o a thickened or enlarged peripheral nerve with loss of sensation
o presence of acid-fast bacilli in a slit-skin smear

VI. CLASSIFICATION
a. paucibacillary leprosy​: 1 to 5 skin lesions, without demonstrated presence of bacilli
in a skin smear
b. multibacillary leprosy​: more than five skin lesions; or with nerve involvement (pure
neuritis, or any number of skin lesions and neuritis); or with the demonstrated
presence of bacilli in a slit-skin smear, irrespective of the number of skin lesions

VII. PHYSICAL EXAMINATION OF A PATIENT WITH LEPROSY

1) Examine the skin in daylight or in a well-lit room.

2) Examine the whole body, taking care to respect the patient’s privacy.
3) Ask the patient if the patch itches. If so, it cannot be leprosy.
4) Test only one or two skin patches for sensory loss. If there is a definite loss of sensation,
it is leprosy.
5) Ask about treatment received in the past. A person who has completed a full course of
MDT very rarely needs further treatment.
6) Look for any visible disability of eyes, face, hands and feet.
7) When in doubt about the diagnosis, always send the patient to the nearest referral
center.
How to test for Sensory Loss

● Take a pointed object such as a pen.

● Show the person what you are going to do.
● Lightly touch the skin with the pen.
● Ask the person to point to where they felt the pen.
● Now ask them to close their eyes so that they cannot see what you are doing.
● Lightly touch the center of the most prominent skin patch and ask them to point to where
they felt the pen.
● Repeat the procedure on normal skin and on the same patch again.
● If the person feels nothing on the skin patch, it is leprosy. Start treatment immediately.
VIII. WHO DISABILITY GRADING

Hands and Feet

Grade 0 no anesthesia, no visible deformity or damage
Grade 1 anesthesia present, but no visible deformity or damage
Grade 2 visible deformity or damage present
Eyes
Grade 0 No eye problem due to leprosy, no evidence of visual loss
Grade 1 Presence of eye problems due to leprosy; vision is not severely affected (vision
6/60 or better; can count fingers at 6m)
Grade 2 Severe visual impairment (vision: worse than 6/60; inability to count fingers at
6m); also includes lagophthalmos, iridocyclitis and corneal opacities

IX. TREATMENT
(Based on WHO Guidelines for the Diagnosis, Treatment and Prevention of Leprosy, 2018)

Recommended treatment regimens

Recommended regimens for drug-resistant Leprosy

X. Prophylaxis
The use of single-dose Rifampicin (SDR) is recommended as preventive treatment for contacts
of leprosy patients (adults and children 2 years of age and above), after excluding
leprosy and TB disease, and in the absence of other contraindications.​ ​This intervention
shall be implemented by programs that can ensure: (i) adequate management of
contacts and (ii) consent of the index case to disclose his/her disease.

Rifampicin dose for single-dose rifampicin (SDR)

These guidelines are assumed to be valid until at least 2022, unless there is the emergence of
significant new evidence that would require a review before that date
REFERENCES

1. WHO Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. 2018
2. WHO Global Leprosy Strategy 2016-2020.2016
3. WHO-Western Pacific region Leprosy Control and The Burden of Leprosy in the
Philippines 2006-2010
4. WHO disability grading: operational definitions. 2003
5. WHO Guide to Eliminate Leprosy as a Public Health Problem. 2000
6. DOH Leprosy Control Program. ​https://www.doh.gov.ph/leprosy-control-program
7. DOH celebrates World Leprosy Day 2016 Harnessing Digital Tols and Leveraging
Partnership.
http://ro7.doh.gov.ph/downloads/iec-materials-2018/22-press-release/244-doh-celebrat
es-world-leprosy-day-2016-harnessing-digital-tools-and-leveraging-partnership