Analysis on the detection of new leprosy cases before, during and after the year of leprosy elimination campaigns

To analyse the impact on of case finding of leprosy elimination campaigns (LECs), data on newly detected leprosy cases in a leprosy endemic area were collected before, during and after the year of LEC. The number of new leprosy cases detected during the year of LEC was significantly higher than previously. The number of newly detected cases after the year of LEC was similar to that of detected before the year of LEC in counties with persisting case finding activities. However, the number of newly detected cases after the year of LEC significantly decreased in counties without active case finding activities. The average distance from the homes of leprosy cases detected during LEC to the leprosy control unit at the count town was 62.8 km, which is farther than that of other leprosy cases detected before and after the year of LEC. The average time from disease onset to diagnosis of leprosy cases detected after the year of LEC shortened. The results also showed that carrying out LECs is unlikely to have a significant impact on the trend of case finding within a short time in local areas, but it may improve some indicators of leprosy patients and so promote leprosy control in local areas.     

重复开展消除麻风运动对当地新发现病人情况的影响

目的:观察贵州省兴义市重复开展消除麻风运动对当地新发现麻风病人的影响.方法:收集1996～2004年新发现麻风病人的有关资料进行比较分析.结果:9年共发现麻风病人166例,平均每年发现18.4例,年均发现率为2.65/10万.1999年首次开展消除麻风运动后3年,新病人中的2级畸残率和延迟期呈明显下降趋势,低于开展前3年的水平.两次开展消除麻风运动时的畸残率和平均延迟期均达较高水平,提示该地区虽两次开展消除麻风运动但麻风流行程度仍处于较高水平.结论:重复实施消除麻风运动可促进某些流行病学指标的好转,应反复多次开展.     

开展消除麻风运动后对当地新发现病人状况的影响

目的：分析开展消除麻风运动后对当地新发现麻风病人状况的影响。方法：通过比较麻风高流行县（市）开展消除麻风运动前、中和后一年的麻风新发现病人资料，分析新发现麻风病人各个方面情况。结果：发现所有8个县（市）在开展消除麻风运动当年发现病人数均为最高。在开展消除麻风运动后一年，防治力量强的县（市）发现病人数维持在开展消除麻风运动前一年的水平，防治力量弱的县（市）发现病人数则比开展运动前一年有减少。在开展消除运动期间发现的病人居住地离县麻风专业机构的距离最远，平均为62．8公里／人。开展消除运动期间疾病延迟期为最长，平均为42．9月，消除运动后一年发现的病人疾病平均延迟期缩短至26．5月。结论：开展消除麻风运动后在短期内不会对当地的新发现病人数产生很大的影响，但其促进了部分麻风流行病学指标好转，从而促进了当地麻风防治。     

Leprosy elimination campaigns in Orissa

Four Modified Leprosy Elimination Campaigns (MLECs) were conducted in Orissa by March 2003. Their impact on various leprosy indicators was analyzed. More than 70% of the people of the State were examined during these campaigns. The suspect rate decreased from 1.44% to 0.37% towards the fourth MLEC. About 15% of the suspects were clinically confirmed to be having leprosy. The total number of new cases detected during the MLEC years was on the decrease. A marked fall in new case-detection rate was observed during inter-MLEC years. This has resulted in fluctuation in the prevalence rate during the MLEC years, but the overall PR/10,000 population decreased from 12.18 in 1996-97 to 7.3 in March 2003. More than 40% of the total new cases and about 45% of total new child cases for the corresponding year were detected during the MLECs, and the proportion of total new case-detection was as high as 60.8% during the first MLEC. The proportion of female cases detected during succeeding MLECs improved and an almost equal number of female cases were detected during MLECs III and IV. Considering the present leprosy situation in Orissa and the effectiveness of MLECs in case-detection, it was recommended that such campaigns should be undertaken in select high prevalent blocks of the State at regular intervals, along with the strengthening of the integration of NLEP activities into primary health care activities.     

A review of trends in new case-detection in Subarnapur district of Orissa

Trends in new case-detection are analysed by reviewing the demographic and leprosy epidemiological data and current indicators in Subarnapur district, Orissa State and India. Population-specific new case-detection rates were calculated for analysis. The trend of skin-smear positive cases over a period of 10 years was reviewed in respect of smear positive cases of 1991. During the years 2002 to 2004, a sudden fall was noticed in the new cases detected in both India and Orissa state, whereas the decline in Subarnapur district was more gradual. The fall in the female-specific new case-detection rates is found to be rapid from 11 to 2.5 over the last three years. This also indirectly indicated the health-seeking behaviour of women in accessing health services and hence required a changed strategy. A similar rapid decline was observed in child-specific new case-detection rates. On analysiS, the decline of highly bacilliferous cases from 1991 to 2001 was found to be statistically significant. The analysis also brought out the fact that cases with bacterial index of 1+, 2+ and 3+, though small in numbers, were detected during the last three years indicating continued presence of cases with low bacterial density in the community. The review indicates a definite decline in the occurrence of new cases in all groups. Caution needs to be exercised about continued presence of cases with low bacterial index though in small numbers. The rapid decrease of cases in all groups during the years 2004 and 2005 warrants meticulous surveillance. The surveillance activities could include monitoring of population-specific new case-detection rates and skin-smear positive cases at district and state levels in order to advise on leprosy eradication programme strategies.     

重复开展消除麻风运动地区的病例发现和患者临床情况分析

目的：观察湖南省西部2个麻风高流行县重复开展消除麻风运动对当地麻风患者发现及临床指标的影响。方法：收集自1997—2002年麻风新发病例，其中包括开展消除麻风运动年份的病例资料，对各年发现病人数，平均确诊年龄，畸残率，延迟期等进行比较分析。结果：从1997年至2002年共发现133例患者。平均每年发现22．2例，年发现率2．4/10万。1998年开展LEC时发现的新病人数是接近开展IEC前一年的2倍，以后新发现病人数减少到一个稳定的低水平，在2002年重复开展LEC时，发现数又是接近前一年的2倍。但与1998年首次开展LEC时发现数相比，减少了50％。新发病人的疾病延迟期平均为34．8月，疾病延迟期在开展LEC前后未显示有缩短或延长的趋势。133例患者中，35例有可见畸残(26．3％)。但新发现病人中2级畸残率从1998年的32．0％下降到2002年重复实施LEC时的12％。结论：作者认为重复实施消除麻风运动促进了当地某些流行病学指标的好转。     

Trends in new case-detection leprosy in Bihar, India

Multi-drug therapy (MDT) has been successfully implemented in all leprosy endemic countries. Prevalence of leprosy has declined remarkably after the introduction of MDT. Detection of new cases did not show expected decline in many endemic and low endemic situations. Bihar in India started implementing MDT in 1993. The Damien Foundation India Trust (DFIT) supported the leprosy control programme in Bihar by providing a district technical support team (DTST) for each district assigned to DFIT. Effective coverage was achieved in 1996-98. Data for the period 1996-2004 from 10 districts are presented in this paper. The total population in these districts was 29.4 million. Deformity among newly detected leprosy patients declined to 1% indicating effective early case-detection. Intensive new case-detection activities were in vogue contributing to high new case-detection rate (NCDR). The NCDR remained high during the 9-year period reported here and did not show any declining trend.     

Leprosy scenario in southern part of Dakshina Kannada district, Karnataka, after 16 years of control work

This article examines the changes that occurred in epidemiological indices over a period of 16 years following the introduction of MDT in Ullal town, south of Mangalore city, having a population of 130,000. The analysis indicates that new case-detection rates and prevalence rates showed a declining trend due to shorter duration of treatment with MDT. There was a ten-fold reduction in the prevalence rate during the first 6 years, from 23 in 1987 (230 cases) to 2.76 per 10,000 (29 cases) at the end of 16 years. The number of nmultibacillary cases among the newly detected cases showed a downtrend (from 28 cases in 1987 to 5 in 2001). The number of newly detected cases presenting with single lesion also showed a declining trend.     

Future scope and expectations: why, when, and how LECs should continue

There is a strong case to continue to use LEC approaches, as they are a comprehensive and cost effective means of delivering the key elements of leprosy control. LECs should be conducted when there is evidence of large numbers of hidden cases. Probably a minimum of two LECs is required but where large number of new cases continue to be detected they could be run on an annual basis. The methodology of LECs needs to be improved through experience, evaluation and from LECs conducted elsewhere; feedback from the community is also important. There is room to improve all aspects of LECs: planning, training, education, diagnosis and treatment completion.     

Treatment outcome and impact of leprosy elimination campaign in Sokoto and Zamfara states, Nigeria

A Leprosy Elimination Campaign (LEC) was implemented in 37 districts of Sokoto and Zamfara states, Nigeria from 13 August to 30 November 1998. The campaign utilized intensive community mobilization and training of local health personnel to detect hidden leprosy cases. During 8 weeks of case finding, 160,127 persons were screened; 353 new cases of leprosy were detected and placed on MDT; 236 (67%) of new cases detected were classified as MB, 64 cases (18%) suffered visible deformities and 24 patients (6.8%) were children. Follow-up in December 1999 of patients placed on MDT revealed 97% PB and 96% MB cure rates, respectively. Detection of cases in communities led some community leaders to ask for repeat surveys in their communities. Repeat surveys continue to yield new cases. The authors recommend that LECs be maintained for 3 years to accelerate leprosy elimination in the region. The cost effectiveness and impact of LEC in Sokoto-Zamfara are discussed.     

开展消除麻风运动的效果评价

目的：通过开展消除麻风运动,评价其在发病人方面效果。方法：防治机构在当地政府支持下举办县级培训班和工作会议。各乡镇负责人和乡镇卫生院院长、防疫医生参加工作会议和培训班,同时通过媒介向公众开展健康教育运动。在运动中乡村医生和群众向医疗机构报告麻风人可颖线索,然后由麻风专家组成的医疗队确诊。结果：运动中覆盖９９个乡、镇的１４１１个行政村共计１３５万人口,上报１７３例麻风可疑线索,共确诊４１例麻风,其中多菌型３２例,少菌型９例,查菌阳性者２４例;２级畸残者１６例。永顺县、桑植县和崇义县、上犹县在运动中发现的病人数分别占各县全年发现病人总数的５６．３％,７７．８％和９０％。结论：短时间内发现许多病人说明消除麻风运动可有效地发现隐藏在社区内的病人。消除麻风运动还是对公众一次很好的麻风健康教育,促进了当地麻风的基本消灭。     

Leprosy elimination campaign, Amazonas-Brazil 1997

A leprosy elimination campaign (LEC) was carried out in 15 endemic areas of Amazonas State, Brazil, in 1997. The LEC concentrated effort to detect leprosy cases during a multi-vaccination national campaign for serious public health problems other than leprosy, such as polio, diphtheria, hepatitis, measles, etc. The national campaign involved intensive population mobilization, giving a valuable opportunity to examine people for leprosy. The LEC personnel included 2964 individuals (municipal and state health workers and community volunteers), distributed in 688 health units and 53 reference health centres. As a result of the LEC, 74,814 person-to-person communications in the community were given; 10,297 clinical skin examinations were conducted, and 40 new leprosy cases were detected on the day of the campaign in urban areas of the municipalities. This total was low, compared to results in other states of Brazil, possibly due to the development of health education activities and regular community services in the state of Amazonas since 1987 and to the early implementation of WHO multiple drug therapy (MDT) from 1982 onwards. Despite the fact that the LEC was carried out only in the urban areas of the municipalities, the finding of no cases of leprosy in 7 out of 15 of them was surprising and may indicate that the prevalence of hidden cases of leprosy is not all that high, at least in these areas of the Amazonas State.     

A comparison of Rapid Village Survey and Leprosy Elimination Campaign,detection methods in two districts of East Java,Indonesia, 1997/1998 and 1999/2000

A Rapid Village Survey (RVS) was planned to estimate the extent of the leprosy problem in two well documented endemic districts of East Java, Indonesia. Furthermore, the aim was to investigate the efficacy of the routine programme in detecting new and early cases, as well as the feasibility of RVS in detecting disabled people affected by leprosy in the community. A random sample survey (RVS: a simple method compared to a Population Sample) was used to determine the extent of the leprosy problem. In addition, a Leprosy Elimination Campaign (LEC), was used particularly to detect new and backlog cases in the community. Both RVS and LEC involve a health education campaign followed by the examination of persons voluntarily reporting. Routine programme case finding, involving passive case finding and contact examinations, was also carried out. The RVS prevalence rate of 12 per 10,000 was more than twice the known prevalence rate of 5 per 10,000. The LEC prevalence rate was less than the rate found by RVS, but was within the RVS confidence interval. During the RVS, many children with leprosy were detected, and 10% of all RVS new cases already had disability grade II. The population disability grade II rate due to leprosy was 9 per 10,000. Despite the fact that an active leprosy control programme had been carried out in the surveyed endemic area over a period of many years, the actual prevalence rate found was more than twice the known prevalence. Many children were found during the RVS, thus indicating continuing widespread transmission. In general, it seems that there is still a serious delay in detecting new cases under the routine programme. Consequently, there are substantial numbers of persons affected by leprosy in those districts in need of rehabilitation.     

Characteristics and treatment outcomes of leprosy patients detected during a leprosy elimination campaign in Mozambique compared with routinely detected patients

The objective of this study is to assess whether the case-finding method is a determinant for diagnostic characteristics and treatment outcome of newly diagnosed leprosy patients in Northern Mozambique. This is a retrospective cohort study of 3202 patients on the differences between entrance characteristics and treatment outcome in self-reporting patients and patients detected during a leprosy elimination campaign (LEC) in 1999 in Northern Mozambique. As a consequence of LEC activities, 3 times more patients were found compared with the same period 1 year earlier. After the LEC, case detection remained higher in the years 2000-2002 compared with the years preceding the LEC. More young (<15 years) paucibacillary (PB) cases were diagnosed during LEC activities with, surprisingly, equal percentage of disability grades. No gender imbalance was found in diagnosed LEC patients contrary to self-reporting patient groups. Comparing patients detected during a LEC in 1999 with the passive group of 1998 and 1999 showed a slight but statistically significant better treatment result for the passive group. The classification of leprosy (in favour of PB) and age (in favour of older age groups) were also determinants for favourable treatment outcomes. Volunteers had a significantly better result of treatment compared with trained nurses and regardless of detection method. LEC proved to be a useful addition to the National Leprosy and Tuberculosis Programme in Northern Mozambique. As a result, many new cases were diagnosed and put on treatment and their treatment results were very satisfactory. LEC had a lasting impact on case finding. Volunteers make a valuable contribution to leprosy control in Mozambique because they have consistently better treatment results compared with nurses.     

Epidemiological trends of leprosy elimination in CLTRI rural field operation area, Tamil Nadu, India

The analysis of computerized data of patients in our Rural Field Operation Area (Kunrathur Taluk, Kancheepuram District, Tamil Nadu) from the start of MDT in 1986 has shown a decrease of leprosy prevalence from 275/10000 in 1986 to 0.7/10000 in 2005. Leprosy has been eliminated as a public health problem after 19 years of MDT implementation. Although the control programme was started in 1962, MDT implementation began only in 1986. The new case-detection rate has declined significantly from 27.3 in 1987 to 2.4/10000 in 2005 (y = -1.6x + 2325.1, p = < 0.05). The age-specific cumulative detection rates calculated showed highest case-detection at 10-14 years for total, 10-14 years for PB, 50-54 for MB, and 10-14 for both males and females. MB percentage was more among new cases in the last three years as compared to the initial three years, and this difference was found to be statistically significant, but there was no significant difference between the first three and the last three-year periods in child, male and disability rates (grade +/-2) among new cases. Thus, the declining trend in NCDR has not reflected any change in sex and age-groups of new cases. This analysis strengthens the hypothesis of sub-clinical cases possibly transmitting the disease and MB cases accruing after long incubation period.     

Leprosy situation in endemic states of India and prospects of elimination of the disease

In India there is a dramatic fall in the prevalence rate (PR) of leprosy, but the new case-detection rate (NCDR) has not been reduced concomitantly. It is the operational efficiency of the National Leprosy Eradication Programme (NLEP) that has led to a significant reduction in the NCDR in Andhra Pradesh and Tamil Nadu. The ratio of PR to NCDR has been declining in these two states and it reveals that elimination could be reached even with the high NCDR level of 3 to 4 per 10000 population, particularly if single skin lesion (SSL) cases are discharged through single dose treatment of rifampicin, ofloxacin and minocycline (ROM). On the other hand, the significant number of cases detected in Bihar and Orissa during modified leprosy elimination campaigns (MLECs) reveals that there are lacunae in operational activities in new case-detection resulting in a large number of undetected cases in the community. Only one-third of the cases are reporting voluntarily. Awareness of leprosy is not adequate to motivate the patients to report voluntarily and complete their treatment, thus underscoring the need for relying on active case-detection so that transmission can be broken and elimination of leprosy achieved. In addition, the influence of socio-economic factors on continued occurrence of leprosy cannot be ruled out. The establishment of a sentinel surveillance system along with a computerized simplified information system to gain in-depth knowledge on the functioning of the NLEP will ensure operational efficiency. In view of this situation, the NLEP should adopt a more realistic approach towards reaching the elimination goal.     

Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign

India (population 943 million) has seen a highly significant decrease in the prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 1981, the figure has declined to 5.2/10,000 in March 1999. This was possible due to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton vertical staff in the remaining districts, coupled with the recruitment of additional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemic districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden (and undiagnosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than 1 case per 10,000 of the population) in the whole country, it was decided to implement a massive leprosy elimination campaign (LEC) in all the States/Union Territories (UTs). The reports of 22 States/UTs indicate that 415 out of the total of 490 districts in the country were covered by modified LEC (MLEC), with 85% coverage of the population. The campaign used in India was modified from the pattern previously described by the World Health Organization. The detection of hidden or suspected cases took place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy detection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detection of 454,290 hidden cases of leprosy, whilst providing training to a large number of General Health Care staff and volunteers and creating widespread awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful health care interventions undertaken in India in recent years, particularly in the states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, the results of the MLEC strongly support the possibility that elimination levels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.     

Contribution of mini-LECS to cluster approach case finding in Kaduna State, Nigeria

Mini-leprosy elimination campaigns (Mini-LECs) were carried out over a period of 5 years (2000-2004) in Kaduna State, Nigeria. After careful preparation, the campaign team visited areas with a high suspicion of hidden cases in 12 selected Local Government Areas (LGAs). During the years of the 12 campaigns, 156 new cases of leprosy were detected against an expected number of 70 within the same LGAs. The results of the mini-LECs were analysed to find out if this cluster approach contributed significantly to the overall leprosy case finding and change in the proportion of the multi-bacillary (MB) forms of leprosy among new cases in the State. The analysis shows that, at LGA level, the number of cases detected during the year of mini-LEC is statistically higher then the expected number of cases. The MB proportion at LGA level did not change due to the mini-LEC exercises. Due to the limited number of exercises, the impact at state level is insignificant. However, the experience at LGA level suggests that with an increase in number of mini-LEC campaigns per state per annum an impact at the state indicators can be expected. In addition the campaigns should be repeated for further yield of new leprosy cases.     

酚糖酯-免疫球蛋白M和鼻分泌物中麻风菌PCR检测在麻风流行病学中的应用

目的通过对流行乡村(同烘和南丘)麻风病患者、家内接触者及普通人群麻风菌感染的检测,评估实验流行病学对预测麻风病传播的意义。方法采用酚糖酯-酶联免疫吸附试验(PGL-ELISA)和检测鼻携带麻风菌的PCR方法,开展流行病学调查。结果(1)麻风病家内接触者的酚糖酯-免疫球蛋白M(PGL-IgM)阳性率和PCR检测的麻风菌鼻携带率分别为30.4%和23.1%;但PGL抗体阳性率在家内接触者和普通村民之间却无显著性差异。(2)两村普通村民的PGL-IgM阳性率,在统计学上无显著差异。然而,在<20岁的年龄组中,同烘村的PGL-IgM阳性率却显著高于南丘村。无论同烘或南丘村,PGL-IgM阳性率高峰均在<20岁的年龄组。随年龄的增加,阳性率逐渐下降。此外,女性的PGL-IgM阳性率高于男性。结论两村的新发现病人主要为年轻人,这与两村PGL-IgM阳性高峰位于<20岁年龄组相关。在<20岁的年龄组中,同烘村的PGL-IgM阳性率显著高于南丘村,除与同烘村患病率和发现率均高于南丘村相关,也与消除麻风病运动(LEC)后,同烘村仍有新病人出现有关。这一现象似乎支持麻风患病率与PGL-IgM阳性率相关。为评价麻风病的传播是否得到控制,以PGL的血清学仍是一种有用的方法。     

An epidemiological analysis of leprosy from 1951-1996 in Sichuan

Through the leprosy surveillance system established in 1990s the authors analysed the epidemiology of leprosy in Sichuan province from 1951 to 1996. By the end of 1996, the total number of registered cases was 32,772, the peak incidence rate (2.44/100,000) was in 1958. The annual average progressively decreasing speed (AAPDS) of the number of new cases, incidence rate, incidence rate among children, number of newly detected patients, detection rate, number of registered cases and registered prevalence rates were 4.7% (xg = 0.9534), 5.9% (xg = 0.9407), 7.4% (xg = 0.9263), 6.7% (xg = 0.9326), 8.1% (xg = 0.9195), 10.9% (xg = 0.8913) and 11.7% (xg = 0.8828) respectively. Among newly detected cases, the proportion of children gradually declined with an AAPDS of 2.9% (xg = 0.9712), but that of household contacts gradually increased, showing a gradual decline of source of infection. The multibacillary (MB) rate among new cases, newly registered cases and active cases also increased gradually. The MB rate among child cases was much lower than that among adults. The disability rates among newly registered cases tended to decline. The peak incidence was in the 20 to 35 years age group, the average age at onset being 31.92 years. Average age at onset gradually increased to 34.19 during 1991-1995. The average interval between onset of symptoms and diagnosis was 4.89 years and that had reduced gradually to 3.24 years during 1991-1995. The authors conclude that: (1) the epidemiological trend of leprosy in Sichuan province shows decline; (2) the case-finding activities have improved and intensified; but (3) the disability rate among newly detected cases is still high (> 20%) and the average delay in diagnosis is still too long, showing that early case finding is still not satisfactory.