Leprosy

Introduction
‡ Leprosy is a chronic infectious disease caused by Mycobacterium leprae ‡ Affecting mainly
± peripheral nerves & ± skin,

‡ Known for its potential to cause permanent and progressive Physical disability.

wild animals like ‡ Armadillo ‡ Mangabey monkey ‡ Chimpanzee .Agent factors ‡ M leprae ‡ Source ± Multibacillary case ± Addition to human.

Agent factors ‡ Portal of exit ± Mainly nasal secretions ± Broken skin ‡ Infectivity ± Highly infectious with low pathogenicity ‡ Attack rate ± Over 5 years. 4 to12% household contacts .

Host factors ‡ ‡ ‡ ‡ ‡ Age Sex Migration Prevalence pool Inactivation of disease .

Environmental factors ‡ Humidity ± Favors survival of M leprae ‡ Overcrowding ‡ Lack of ventilation .

Mode of Transmission ‡ Mainly through droplets ‡ Direct or indirect contact ‡ Other routes such as vectors and tattooing can not be ruled out .

Incubation period ‡ Ranges from 6 months to 30 years ‡ Average : 3 to 5 years .

± A slow and insidious clinical evolution. ± A very slow development of pathology.‡ Extremely slow generation time of the organisms results in : ± Long incubation period. ± An unclear epidemiological pattern .

Incubation period ranges from 6 months to 30 years with average of 2 to 5 years. There is no potent anti leprosy vaccine.Introduction ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Leprosy has predominant psycho-social aspects/Social Stigma due to misconceptions/misbeliefs/Taboos/Ignorance. Man is the only host reservoir. It is transmitted from untreated MB patient to healthy person via respiratory tract. The major sites from which bacilli escape from the body of an infectious patient are nose and mouth. . . Wide spectrum of host resistance. ranging from effective immunity to absence of resistance leads to varied presentation of the disease manifestations.

C.C.C. ‡ There is strong evidence to show that leprosy was common as far back as 1400 B. . ‡ A good description of this disease and its treatment is given in "SUSHRUTA SAMHITA" a book on surgery written in 600 B. ‡ The laws of Manu mention the instructions for the prevention of leprosy.History ‡ "KUSHTHA" in the ancient vedic literature as far back as 1400 B. He regarded this disease as a contagious disease carried from a person suffering from this disease to a healthy person.

. ‡ Some reference is made to Leprosy in Chinese literature dating back to 600 B.C. ‡ In ' LEVITICUS' clear instructions are given to the priests about the preventive measures against the spread of disease from persons suffering from leprosy. But there is no conclusive evidence to prove that it existed before. ‡ The term included not only leprosy but also a number of other skin diseases.‡ The word Leprosy is a translation of the Hebrew word "ZARAATH" and is mentioned in the Bible.

D. France. ‡ This known fact was probably responsible for the inhuman measures taken to contain the disease during that period. Moller Christensen through his studies of cranial bones found evidence of Leprosy ‡ In Great Britian. The disease was at its height in Europe between 1000 A. Galen lived about A. 150.D. ‡ The returning Greek and Roman armies probably introduced the disease into Europe.D. . ‡ Prof. ‡ Anderson in his thesis (1969) reviewed all the literature available about the spread and decline of Leprosy in Europe.‡ The earliest description of the disease in Europe was given by Aractus a contemporary of Galen. ‡ Hippocrates who lived in 450 B. ‡ The literature reveals that the authors believed Leprosy to be highly contagious. 500-700. did not mention Leprosy. ‡ Galen also referred to Leprosy as Elephantiasis Graecorum.D and 1400A.C. and Egypt during the period A.

‡ It was strongly supported by the Norwegian scientists but in view of the new epidemiological evidence in favour of the contagiousness of the disease.‡ During the 18th and early 19th century. Armauer Hansen (1841-1912) from Norway in 1873. the hereditary theory lost its ground. ‡ The germ causing Leprosy is called Mycobacterium leprae and was discovered by G. ‡ Few authentic outbreaks of leprosy in Nuaru. Cape Breton. . Therefore. the organism is commonly known as Hansen's bacillus. the hereditary theory of leprosy became very popular in Europe. before Hansen discovered the leprosy bacillus. Louisiana and other places confirmed the contagiousness of the disease.H.

· To provide physiotherapy to needy leprosy patients. · To provide health education. · To detect new cases (Tribal. ‡ To rapidly & effectively integrate vertical programme of leprosy eradication with general health care system. Difficult Hilly area) at the early stage. ‡ To achieve these objective emphasis should be laid on following points.Objectives ‡ To achieve elimination by the end of 2005. · To bring them under MDT. · To perform reconstructive surgery on needy leprosy patients. . · Render services of POD to avoid deformity.

.Leprosy Elimination ‡ Decentralization of NLEP to Districts ‡ Integration of leprosy services with General Health Care System (GHS) ‡ Leprosy Training of GHS functionaries ‡ Early Diagnosis & Prompt MDT.Strategy . ‡ Monitoring & Evaluation. ‡ Monitoring & Periodic Evaluation ‡ Inter-sectoral collaboration. Through routine and special efforts. ‡ Inforamation Education and Communication (IEC) using Local & Mass Media for reduction of Stigma & Discrimination. ‡ Prevention of Disability & Medical Rehabilitation.

± Referral services & long term care. ± Physical. ± Improving community awareness & involvement. . Socio & Economical Rehabilitation of Leprosy patients. ± Integration of NLEP in to General Health Care Services ± Strengthening of integrated services.GOI has issued "New paradigms in NLEP for post elimination which are as follows ‡ To reduce the leprosy burden in the community. ‡ To provide high quality leprosy services for all persons affected by leprosy. through General Health Care System including referral services for complications & chronic care. ± Prevention & management of impairments and disabilities.

± Proportion of child (0 to14 years of age) MB cases & ± Proportion of Female cases among new cases. ± Proportion of new cases presenting with Grade II disability / impairment at the time of diagnosis.‡ Indicators for Monitoring & Evaluation ± ± No. ± Treatment Completion / Cure rate. of New Cases Detected in given area each year. of relapses. No. ‡ Indicators for patient management & follow up ± ± ± ± Proportion of new cases verified as correctly diagnosed. . Proportion of patients who develop new / additional disability during Multi Drug Therapy. Proportion of treatment defaulters.

000 in State PR < 1/10. II disabled cases reduction (Base ± 2006-07) Outcome expected by March 2012 100% 100% < 10/100.000 in Districts ANCDR (National) Cure rate MB Cure rate PB No.Expectations Indicators PR < 1/10. of Gr.000 >95% >97% 25% .Maharashtra .

One PME/NMS will be appointed in blocks with high endemic pockets for guidance and support. additional PHCs and dispensary centres will offer leprosy diagnosis and treatment facilities independently. SAPEL/LEC Full integration of anti-leprosy activities with GHS in rural as well as urban area. Availability of MDT services upto sub-centres.Strategy now« ‡ ‡ ‡ No active searches except for high Prevalence Rate (PR) pockets. Modified Leprosy Elimination Campaign (MLEC). PHCs. MDT management at all the health facilities. Treatment follow up will be carried out by the male MPW every month at village and sub centre level. He will also advise new patient and provide POD services. health education. defaulter identification. ‡ ‡ ‡ ‡ ‡ . Accompanied MDT for needy persons. The female MPW/ANM and the AWW will refer suspected cases. The Male MPW will include leprosy work in his activities with emphasis on case finding. Promotion of voluntary reporting by creating enhanced awareness among masses. General hospitals. CHCs.

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PB Supervised monthly dosage.Treatment . Drug Adult Children 10 Children to 14 less than 10 year 450 mg 50 300 mg 25 Rifampicin Dapsone 600 mg 100 Unsupervised dosage Dapsone 100 50 25 .

Drug Rifampicin Clofazimine Dapsone Adult 600 mg 300 100 Children 10 to 14 450 mg 150 50 Children 6-9 years 300 mg 100 25 Unsupervised dosage Clofazimine Dapsone 50 100 50 alternate day 50 50 mg twice a week 25 .Treatment .MB Supervised monthly dosage.

Achievements .

Achivements Year 1981-82 1990-91 1993-94 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 (Upto Mar.9 10.7 29.2 11.7 15.10 8.12 12.7 6.55 .1 12.2 43 31.4 6.09) PR/ 1 Lac 624 196 87 31 32.5 49.1 7.9 48.5 28.70 NCDR / 1 Lac 133 119 105 45.

75 70 0.53 2.84 32. of Blocks having PR <1 No.12 3.12 3.4 55 1 44 Mar.73% 232 13.11 4.59 2.91 36.14 1.87 0 0% 1 5% 33 9.12 0.04 2.88 34 100% 22 100% 152 45% 1160 -65% 1.6 34 100% 22 100% 271 80% 1518 -85% 0.of districts having PR<1 No.06 0.84 1.0% 4.4 55 1 44 Mar.05 0.59 2.54 6.5 34 100% 22 100% 339 100% 1786 -100% 0.94 29 85% 22 100% 118 33% 982 -55% 1.3 42.75 0.96 Mar.of Municipal Corporations having PR<1 No.57 7 20% 8 36% 78 23% 578 -32.Achievements-Maharashtra Mile stones PR/10000 No.45 60 0.8 45 Mar. of PHCs having PR<1 NCDR SC NCDR ST NCDR MB proportion of New cases Disability proportion Female proportion Mar.13 Dec.31 40.07 0.25 65 0.7 34 100% 22 100% 203 60% 1340 -75% 1.5 50 Mar.8 1 1.75 0.4 50 .36% 3.3 5.09 0.59 7. 05 1.12 1.

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