World Leprosy Day is observed on the last Sunday of January every year and 18 years after being declared “eliminated as a public health problem”1, The World Health Organization (WHO) says national programs should boost active case-finding, strengthen surveillance, improve contact-tracing and focus more on early detection of leprosy cases among children to ensure achievement of the global target of zero child infection by 2020.
Data published by WHO in 2017 show that although the overall number of cases is slowly declining, that of new cases does not align with global efforts and resources deployed to interrupt transmission.
Reports from 145 countries of WHO’s six regions show that of the total of 216,108 newly diagnosed cases of leprosy during 2016, 18,472 involved children, representing almost 9% of all new cases reported annually.
“It is a harsh reality that nine out of every 100 new cases diagnosed today are children,” said Dr Erwin Cooreman, Team Leader of WHO’s Global Leprosy Programme. “The world has the tools, the right medicines and the political will – yet we are falling short of detecting the disease in time, particularly among children.”
Some of the children who have recently been diagnosed already showed signs of disability. This strongly calls for early case detection and surveillance.
“Leprosy in children clearly shows that transmission of the infection is occurring in many communities and that detection efforts are inadequate,” added Dr Cooreman. “We again re-emphasize the importance of periodic follow-up, contact tracing and monitoring of everyone in a household where a case is detected.”
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 and treatment provided in the early stages averts disability.
Multidrug therapy is made available free of charge through WHO and has been donated to all patients wordwide by Novartis since 2000 (and earlier by The Nippon Foundation since 1995). It provides a simple yet highly effective cure for all types of leprosy.
Despite global efforts to repeal laws that discriminate against those affected by leprosy, adults still face crippling social barriers and children are deprived of education or subject to bullying and rejection due to stigma associated with the disease.
Besides elimination, WHO’s new global strategy focuses on working with governments and partners to end the discrimination and stigma associated with the disease and ensure that all legislation that allows for discrimination on the basis of leprosy is overturned.
Continued discrimination against people affected by leprosy 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 ultra-poor and hard-to-reach populations. Combating stigma and ensuring early diagnosis through active case-finding, which the new strategy emphasizes, is critical to making progress.
1 Elimination of leprosy as public health problem (defined as a registered prevalence of less than 1 case per 10 000 population) was achieved globally in 2000. However, pockets of endemicity have continued in many countries. India and Brazil report the highest number of cases annually.