This year is the target date to eliminate leprosy as a public health problem in every country. What are the prospects, and what happens post 2005?

　

Since multidrug therapy (MDT) was introduced on a global scale in 1985, more than 14 million people around the world have been cured of leprosy.
　Over the last two decades, the global prevalence of the disease has fallen by almost 90% ― from around 5.4 million at the beginning of 1985 to some 0.45 million at the beginning of 2004. (Table 1)
　In addition, new case detection has fallen by about 33% since 2001, with approximately 500,000 new cases detected during 2003, down from about 621,000 during 2002 and 763,000 during 2001. (Table 2)
　Of 122 countries where leprosy was considered a public health problem in 1985, some 113 had eliminated leprosy at the national level by the end of 2003. Leprosy now remains a public health problem in only nine countries in Africa, Asia and Latin America. (Table 3)
　Encouragingly, countries that have reached the goal of elimination have been able to sustain leprosy control activities, and WHO and its partners continue to provide them with critical support in terms of MDT and technical guidelines.
　The leprosy elimination strategy is now at a crucial stage, focused on the nine countries where leprosy remains a public health problem, namely Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal and United Republic of Tanzania.
　Together, these countries accounted for 84% of registered cases at the beginning of 2004 and 88% of the new cases detected during 2003.

　In some of these countries, the reported data suggest that a significant part of the caseload is artificially inflated due to non-adherence to standard definitions and/or the re-registration of old cases as new, and wrong, diagnoses.
　As a priority, regular updating of leprosy registers and strict adherence to standard definitions for case, cure, defaulter and point prevalence will be carried out in identified countries during 2005.
　All efforts will be made to ensure that these nine countries reach the elimination target by year's end. For a variety of reasons, however, some may need additional time to reach the defined target of a PR of below one per 10,000 population. Nonetheless, they are showing strong commitment and have been intensifying their efforts in the field.

　

　

In some countries that have already achieved the goal of elimination at the national level, there is still a significant incidence of the disease in certain provinces or districts. These countries will need sustained efforts to reduce the disease burden in pockets of high endemicity. This is especially true of countries that have reached the elimination goal recently.

　However, in most countries where leprosy was a public health problem in 1985, it is clear that it has become a relatively rare disease. Given such a scenario, maintaining MDT services for leprosy in the context of low prevalence conditions will be a big challenge for a majority of countries in the coming years. This will be necessary if acheivements are to be sustained, the disease burden further reduced, and MDT services made easily accessible to communities in which new cases of leprosy will continue to be detected.
　Key to this is integrating all essential components of leprosy control within the existing primary health care system. This also includes the development of integrated referral facilities. This will need careful planning and probably different approaches within each country, depending on the local leprosy burden and the availability of an appropriate health infrastructure or program for integration.
　Therefore, in close consultation with member states, regions and local and international partners, efforts are under way to develop a global strategy to sustain leprosy control activities in all endemic countries beyond 2005.
　This strategy will assist in sustaining achievements of the elimination strategy to date and in reducing the disease burden further at national and sub-national levels.
　It will be presented to the World Health Assembly in 2006 to obtain support and commitment from all the member states. The fight against leprosy continues.

　

　

　

　

　

Dr. Hiroyoshi Endo

　

Once diagnosed with leprosy, patients are put on a 6- or 12-month course of multidrug therapy (MDT).
A defaulter is a patient who has not collected MDT for at least 12 months consecutively after the start of his or her treatment.
A defaulter must be removed from consideration when calculating prevalence rates.