Challenges facing the control of leprosy in the Indian context.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects the skin, peripheral nerves, the eyes and the mucosa of the upper respiratory tract. There has been a decline in the global annual new case detection rate (NCDR) for leprosy since 2001. The global burden of leprosy in the beginning of 2008 was 212,802 cases, with only 6 countries having a prevalence rate (PR) of >1/10,000. Though India has been declared as having achieved leprosy elimination in 2005, a large proportion of international fi gures still come from India.1 Some key milestones in the development of leprosy control strategies are as follows: In 1948, the World Health Organization (WHO) acknowledged the magnitude of leprosy and enlisted leprosy control work as the sixth priority. In 1952, a WHO expert committee advocated the abolition of the compulsory isolation of leprosy patients, and recommended a strategy based on early detection and regular treatment for all leprosy patients on ambulatory basis.2 As early as 1955, the Government of India (the GOI) had launched its National Leprosy Control Program (NLCP), which was based on a survey, education and treatment (SET) strategy at the national level.3 Diaminodiphenyl sulphone (DDS) was the only weapon in the hands of doctors and paramedical workers who were engaged in leprosy control. In 1981, responding to the widespread problem of secondary and primary resistance to DDS, the WHO recommended the use of multi-drug therapy (MDT) as a standard treatment for leprosy in leprosy control programmes.4 The WHO also provided technical support and ensured uninterrupted supply of MDT drugs free through its global partners to the GOI. In 1983, the GOI renamed the NLCP as the National Leprosy Eradication Program (NLEP) and continued with the SET strategy.5 Registration of all new cases and prompt treatment with MDT and compliance reached record levels. In the year 1991, the WHO resolved to “eliminate leprosy as a public health problem by the year 2000”.6 For this purpose, a “public health problem” was defi ned as fewer than 1 leprosy case per 10,000 population. The assumption was that below this prevalence level, based on historical