berculosis, the WHO recommended a standard leprosy treatment that consisted of two regimens: rifampicin and dapsone over six months for PB leprosy and rifampicin, clofazimine and dapsone over 24 months for MB leprosy

Leprosy is a chronic infectious disease that can lead to physical disability, social stigma and great suffering. As the disease is transmitted person to person, it has remained endemic in some developing countries. From biblical times to the modern period, leprosy has been described as a horrifying disease due to the physical appearance of infected individuals. Leprosy results in disfigured limbs and creates marks of cultural dishonour that have caused “lepers” to remain on the darker side of society. Confirmed reports of leprosy first appeared approximately 600 BC in sacred Indian texts that describe an affected individual’s loss of finger and toe sensations. However, the disease originated in Eastern Africa or the Near East and spread with successive human migrations. Europeans and/or North Africans then introduced leprosy into West Africa and the Americas within the past 500 years (Monot 2005). Historically, leprosy was associated with social exclusion and isolation in leper colonies was considered the only instrument of control until the mid XX century. The social exclusion of those affected by the disease was, at first, based on the religious belief that the patients were impure. In the second half of XIX century, which was also known as the bacteriologic era, the hypothesis that leprosy was caused by a transmissible agent conflicted with the alternative hypothesis of leprosy being a hereditary disease. Mycobacterium hansen was the first microorganism identified as a cause of disease in 1873, which provided a scientific basis for patients’ isolation. In the 1940’s, the introduction of treatment with dapsone brought hope for a cure and disease control, but for multibacillary (MB) leprosy patients, this progress meant lifelong treatment. Then, it was not until the 1970’s that multidrug therapy (MDT) with rifampicin provided an effective cure for MB cases after many years of treatment. In 1981, which was 20 years after the international medical practice abandoned single-drug therapy for tuberculosis, the WHO recommended a standard leprosy treatment that consisted of two regimens: rifampicin and dapsone over six months for PB leprosy and rifampicin, clofazimine and dapsone over 24 months for MB leprosy or until skins smears became negative. In May 1991, the 44th World Health Assembly adopted resolution WHA44.9, which committed the World Health Organization (WHO) to attaining global elimination of leprosy by the year 2000. The goal was to reduce the known prevalence of leprosy to below 1 in 10,000 inhabitants. Furthermore, the implementation of MDT turned a previously lifelong disease into a curable one. Thus, given the resulting shorter disease duration, a rapid and significant reduction of the known prevalence was anticipated, along with a reduction of the burden of leprosy on health systems. WHO’s Secretariat also predicted an important incidence decrease to be reflected in case detection rate (CDR) (Nordeen 1991), despite the absence of any previous evidence of huge impact on transmission in consequence of leprosy or tuberculosis isolation or treatment programs. The target of elimination of leprosy as a public health problem through universal and efficient MDT assumed the reduction of health care period as well as the reduction in transmission. In 1997, the WHO recommended reducing MB leprosy treatment from 24-12 months after the 7th Expert Committee Meeting stated in its final report that “based on the available information, it is possible that the duration of the current MDT regimen for multibacillary leprosy could be shortened to 12 months” (p. 37) (WHO 1998). This new reduction in disease duration enabled the global elimination target to be achieved by the end of the year 2000. + Corresponding author: [email protected] Received 14 March 2012 Accepted 11 July 2012 Leprosy frequency in the world, 1999-2010