A Short Report on Status of Leprosy in India

Leprosy is one of the most prevalent neuromuscular disorders caused by several strains of Mycobacterium leprae. The disease has recently shown reemergence due to development of resistant strains. The gravity of the problem is being underplayed due to lack of proper infrastructure for reporting of cases and the social stigma associated with the disease, which hinders self-reporting. Large numbers of new cases of leprosy come up every year despite WHO and state run initiatives [1]. The situation made further grim by the presence of unofficial leper colonies resulting from boycott by the society. Multidrug therapy in children is not taken seriously resulting in deformities and secondary infections.

An online survey was performed to get information about the history, misconceptions, spread, treatment regime, stigma and related policies for disease control of leprosy. Different feasible diagnostic methods along with ways to mitigate the symptoms were also overviewed. Relapse and reaction cases of the disease were also compared [2]. Effectiveness of various multidrug regimens was also scrutinized. Socioeconomic rehabilitation of the affected masses by the Ministry of Health and Family Welfare was also noted.

In India clinical trials for leprosy was initiated at the urban leprosy center at Delhi in 1986 when the country suffered from an epidemic of the dreaded disease marked with horrifying deformity and when the very of idea "Multi Drug Therapy" was scoffed at. Later on with the rise in popularity in the use of antimicrobials along with widespread vaccination significant reduction in transmission of the disease was able to be achieved. The reduction in new incidences was seen most prominently in the age group of 1-12 years while consistent protection was achieved in the age group of 7-8 years, where a booster dose was seen required to maintain the protection [3,4]. From epidemiological point of view the results of the surveys indicate that vaccination was successful in controlling the disease and reducing the transmission of the disease amongst susceptible individuals. However, vaccination has been found to provide no substantial benefits in already infected patients. A rationale use of BCG as a preventive vaccine against leprosy was conducted based on cross-reacting antigens presence due reaction of vaccine with the Mycobacterium leprae strain [5]. The drug rifampicin single drug found to be the most effective in preventing leprosy in those individuals who have been exposed to family members with the disease and is already being trialed for the same in several countries. According to a recent study conducted by "The Leprosy Mission" in Bangladesh new leprosy cases in people who had been given a single dose of rifampicin were found to be 60 percent lower than those who had been given a placebo.

Social banishment has been a major discouragement in self reporting by effected person. Disfigurement and various hearsays regarding the ailment instigate the local gentry to ostracize the inflicted individual, who is regarded a disgrace, unnatural and unacceptable being. Lack of knowledge and ignorance in the society goad these irrational beliefs [6]. The misconception regarding the disease that is still prevalent in the twenty first century is that the disease is highly contagious. Social seclusion of infected population can be evidenced from creation of colonies where such people were isolated in official terms. Though today there is no official decree pertaining to existence of leper colonies but the disgrace being faced have repressed people to isolate themselves in remote places and live the life of an outcast, denied the comforts of social life even in modern scenario. An account confirms the existence of several such colonies in different parts of India. It is also important to note that the direct family members of the contagion like children are also the victims of this social apathy.

Broadly speaking, leprosy is not just a medical condition but a medico-socioeconomic condition. People are now aware of the social and economic complications of the disease. The moot point has now shifted to assuaging public fear regarding the disease in conjunction with maintaining concern to address the gravity of the disease. Improving economic productivity of leprosy patients has been the main objective behind rehabilitation efforts. More effort is required to rehabilitate leprosy patients with deformity than rehabilitating orthopedically handicapped or blind people due to the associated prejudice within a social setup. The initial step towards rehabilitating leprosy patients should be creating a receptive environment, which could be accomplished by The Ministry of Social Justice and Empowerment. The present schemes run by the government though improving are still dismal when compared to their counterpart deformity cases [7-12].

According to WHO 16 million leprosy patients have been treated worldwide since the past 20years. 96% out of the total new cases registered in 2016-17 were from countries outside Asia. Though there was significant rise in the number of newly diagnosed cases as reported from diagnostic laboratories; very few cases are registered due to lack in infrastructure and poor self reporting due to social excommunication. The Indian government had disowned leprosy the status of being a major health problem since 2005 resulting in shift of focus and dwindling statistics to attract research and development. Adequate data is required to come to the government's attention and schemes to be implemented, which is lacking in case of leprosy. Disgrace and defame caused by social seclusion has incited effected individuals to ignore symptoms and those diagnosed choose to remain hidden making it further difficult to depict the facts and figures on leprosy. This short communication will help to enrich data pertaining to the disease and thereby compel the government to work in the direction with renewed interest.

1. World Health Organization (1980) International classification of impairment, disabilities and handicaps. Geneva, Switzerland.
2. WHO (2009) Enhanced global strategy for further reducing the disease burden due to leprosy (plan period: 2011-2015). World Health Organization Regional Office for South-East Asia, New Delhi, India.
3. Lwin K, Sundaresan T, Gyi MM, Bechelli LM, Tamondong C, et al. (1985) BCG vaccination of children against leprosy: fourteen year findings of the trail in Burma. Bull World Health Organ 63(6): 1069-1078.
4. (1996) Randomised controlled trail of single BCG, repeated BCG, or combined BCG and killed mycobacterium leprae vaccine for prevention of leprosy and tuberculosis in malawi. Karonga prevention trail group. Lancet 348(9019): 17-24.
5. Bagshawe A, Scott GC, Russell DA, Wigley SC, Merianos A, et al. (1989) BCG vaccination in leprosy: final results of the trail in Karimui, Papua New Guinea, 1963-79. Bull World Health Organ 67(4): 389-399.
6. The Leprosy Mission Trust India.
7. National Leprosy Eradication Programme. Central leprosy division (disability prevention and medical rehabilitation) Ministry of Health and Family Welfare. Government of India, New Delhi, India.
8. Katoch VM, Lavania M, Chauhan DS, Sharma R, Hirawati, et al. (2007) Recent advances in molecular biology of leprosy. Indian J Lepr 79(2-3): 151-166.
9. Fighting disease, poverty and prejudice. Lepra.
10. Ridley DS, Jopling WH (1962) A classification of leprosy for research purposes. Lepr Rev 33: 119-128.
11. Saunderson P (2000) The epidemiology of reactions and nerve damage. Lepr Rev 71: S106-S110.
12. Van Brakel WH, Nicholls PG, Wilder SEP, Das L, Barkataki P, et al. (2008) Early diagnosis of neuropathy in leprosy-comparing diagnostic tests in a large prospective study (the INFIR Cohort Study). PLoS Negl Trop Dis 2(4): e212.