The next patients below I per 10,000 and all those that follow, will still be patients in need of treatment. After populations have been efficiently dealt with, the individuals are still there.
This being said, what has definitely emerged from the Congress is a strong consensus that the future will be different. New challenges will need new approaches.
What will be different?
A preliminary remark to start with. Changes will not be achieved overnight. It will be a long process requiring patience, flexibility and determination. The key components as summarized by the Congress read as follows： a comprehensive patient-oriented approach, relevance to those affected, partnership, sustainability, and training.
What will be different though?
First, to the extent that the elimination program is successfully completed, and there is every chance that it will, the epidemiological situation will show different patterns than at present.
Second, the political commitment is likely to evaporate as the elimination program
becomes increasingly successful.
Third, the general evolution of society, together with reforms in the health sector,
will bring with it threats as well as opportunities.
Let us start first with the changed epidemiological context. In low endemic situations, that is where the disease is becoming rare, patients will become harder to find. They could also show up at a later stage, with an increased risk to present impairment of some sort.
The activities will have to focus on sustained detection and early case-finding. The surveillance of cured cases will become of major importance. With leprosy being in some way now defined as, and classified according to, "eligibility for a treatment of fixed duration", there has been some tendency towards complacency, i.e. a tendency to overlook follow-up after completion of therapy. At times it looks as though patients are not supposed to relapse. There is, however, a set of post-treatment complications, such as neuritis, eye lesions, problems associated with sensory loss and deformities, reactions, which need to be watched closely for several years after treatment has been stopped. Such surveillance is particularly important in view of the recently introduced shortening of MDT in MB patients, possibly bringing with it an increased risk of relapse. This is one more reason for reinforcing surveillance, because the occurrence of small outbreaks or clusters of secondary cases cannot be excluded.
It should be kept in mind that low endemicity, however it is defined, refers to two contrasting situations： "natural low endemicity" on the one hand, in those areas where leprosy has been tailing off for many decades, and "induced low endemicity" engineered by the great chemotherapeutic initiative, on the other.
