INDIA’S STRIDE TOWARDS A LEPROSY-FREE NATION
Dr. Roma Patil
Bangalore Medical College and Research Institute
Leprosy (Kushtrog in Hindi) holds social, political and historical significance in India. Leprosy is one of the oldest diseases known to mankind and is thought to have spread from India, via trade and war, to China, Egypt, and the Middle East, and later to Europe and America. Reference to leprosy can be traced back to the earliest medical texts i.e. the Sushruta Samhita and the Charaka Samhita (dating from 600 BC and 300 BC respectively).
While the colonial government in British India enacted the Leprosy Act of 1898, which segregated lepers into newly established leper asylums, people like Mahatma Gandhi and later Mother Teresa worked towards their inclusion into mainstream society. People with leprosy still face discrimination in all aspects of life. In India, ‘World Leprosy Day’ is observed on 30th January every year, coinciding with the death anniversary of Mahatma Gandhi with an aim to create awareness against the stigma attached to the disease.
Leprosy, also known as Hansen’s disease is an infection caused by slow-growing bacteria called Mycobacterium leprae. The disease manifests commonly through skin lesions and peripheral nerve involvement. Leprosy is diagnosed by finding at least one of the following cardinal signs: (1) definite loss of sensation in a pale (hypopigmented) or reddish skin patch; (2) thickened or enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles supplied by that nerve; (3) presence of acid-fast bacilli in a slit-skin smear. It mainly spreads through droplet infection. Prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease. You cannot get leprosy from casual contact with a person who has the disease like shaking hands or hugging, sitting next to each other on the bus or sitting together at a meal.
With early diagnosis and treatment, the disease can be cured. Leprosy was once feared as a highly contagious and devastating disease, but now we know it doesn’t spread easily and treatment is very effective. Therapeutic modalities that were initially restricted to chaulmoogra oil have expanded to include multi-drug therapy and even surgical reconstruction of deformities.
The National Leprosy Control Programme (NLCP) was launched in 1955. Multi-drug therapy (MDT) for leprosy was introduced and the NLCP was renamed as National Leprosy Eradication Programme (NLEP) in 1983. India achieved the elimination of leprosy as a public health problem i.e., defined as less than 1 case per 10,000 population, in 2005.
The National Strategic Plan and Roadmap for Leprosy 2023-2027
The National Strategic Plan and Roadmap for Leprosy 2023-2027 was launched in January 2023. This Strategy is aligned with the Global Leprosy Strategy and the WHO Roadmap for Neglected Tropical Diseases aiming to achieve interruption of transmission of leprosy by 2030.
Vision: Leprosy-free India with zero infection and disease, zero disability, zero stigma and discrimination.
1. Strengthen leadership, commitment, and partnerships
2. Acceleration of Case Detection
3. Provision of Quality Services
4. Enhanced measures for Prevention of Disease, Disabilities, Stigma, Discrimination and Violation of Human Rights
5. Digitalization of Surveillance Systems
Highlights of this new plan:
1) Welfare allowance has been raised from Rs 8,000 to Rs 12,000 for patients for Reconstructive Surgery.
2) Acceleration of new case detection by targeted approach:
A mobile app will be rolled out for supporting self-examination and voluntary reporting. High-Intensity Awareness Campaigns for self-examination and voluntary reporting in endemic settings will be conducted. An incentive will be provided for any person reporting a confirmed case of leprosy. The facility of a tele-helpline to support self-reporting will be made. Active case detection through Leprosy Case Detection Campaigns (LCDC), Focused Leprosy Campaigns (FLC), Special plans for hard-to-reach areas and Based Surveillance for Leprosy Suspects (ABSULS) to be undertaken.
3) Stronger anti-microbial resistance(AMR) surveillance systems:
A nationwide robust surveillance system for AMR in leprosy is to be set up through laboratories in both government and NGO sector. A database will be developed to capture information on every relapse case and all relapse cases will be adequately treated.
4) Providing quality services:
- Coordination with other National Health Programmes for case management and counselling. Physiotherapists, psychiatrists and counsellors of other programmes may be utilised for Leprosy services.
- Availability of second-line drugs in cases of drug contraindications, lepra reactions and confirmed cases of resistance with evidence of active disease after MDT therapy. Detection of early nerve damage, prompt treatment and monitoring.
- Patients are to be provided with a treatment card linked with AADHAR and can avail leprosy related services under the Ayushman Bharat Scheme. Treatment for worm infestation is to be provided before starting prednisolone for lepra reaction. Nutritional guidance and treatment for anaemia are also to be provided.
5) Digitalization of reporting and recording systems of the programme and its integration with the ‘Integrated Health Information Platform’. Nikusht 2.0 was launched for the digitalization of individual patient records.
6) Introduction of advanced tools and techniques for early diagnosis: Molecular tests (RLEP PCR) may be considered for the differentiation of indigenous and non-indigenous strains of M. leprae.
7) Provide the most effective prophylaxis to all contacts of cases: Since SDR-PEP( Single dose Rifampicin – Post-exposure Prophylaxis) is not very effective, research to be done to incorporate the MIP vaccine as an immunoprophylactic agent
8) Widespread awareness with impactful communication methods: NLEP has come out with print material and audio-visual videos and Information, Education and Communication(IEC) materials for social empowerment. Inclusion of cured and enabled leprosy patients in the teams imparting IEC activities has a profound healing as well as destigmatizing effect on both the patients and the community. It is also important to sensitize our leaders and policymakers to leprosy.
9) Strengthen existing partnerships and collaboration with new partners and donors. Leverage Corporate Social Responsibility (CSR) activities for leprosy-affected persons and their families for support in education, socio-economic rehabilitation etc.