B) WORKSHOP REPORTS
1) Defining the Disease and Antibacterial Therapy
Chair： Dr. R. Jacobson
Membership：
(A) Defining Disease：
The WHO definition for a case of leprosy is：
A person having one or more of the following features/and who has yet to complete a full course of treatment：
- Hypopigmented or reddish skin lesion (s) with definite loss of sensation;
- Involvement of peripheral nerves, as demonstrated by definite thickening with loss of sensation;
- Skin smear positive for leprosy.
This definition is meant for public health purposes with respect to the required duration of treatment. However a person affected by leprosy has several other medical needs consequent to M. leprae infection. It was pointed out that a complete definition of leprosy would require inclusion of its bacterial, physical, disabling, interpersonal, social and cultural manifestations as well as its impact on woman in many societies.
Furthermore cure involves more than the killing of bacterial and the disappearance of outward signs of active disease. The Group discussed these requirements extensively. Because creating such an all inclusive definition would be difficult a majority of the Group felt that the basic definition given by the WHO Expert Group is acceptable for operational purposes but is only a starting point for defining the needs of patients beyond the point of bacterial cure. Thus the Group strongly recommended that the programme (either a vertical programme or general health services) retain a registry of persons affected by leprosy since it will need to provide care to the patients, particularly with reference to reactions, neuritis, sensory impairment, iritis etc. and their consequences continuing or arising after treatment. Only in this way will the patient be reasonably assured access to the necessary care in many programs which are changing rapidly as prevalence decreases.
After completion of multi-drug therapy, it is expected that programmes will be capable of providing all the services required by leprosy patients to both treat and prevent further complications in addition to continuing to manage the public health component. Thus health services will have the primary responsibility, both to control transmission and meet their social responsibility to provide medical relief and
rehabilitation for the persons affected by leprosy.
(B) Antibacterial Therapy
Antibacterial therapy was considered with respect to duration, safety, efficacy, acceptability, simplicity and cost. All 6 elements are felt to be important but efficacy was considered as the key factor.
