The rise in the number of recorded leprosy cases from 86,147 (in 2013-14) to 90,709 (2017-18), reported a decade and a half after India was declared leprosy-free in 2005, has turned the spotlight on the hotspots for the disease.

The World Health Organisation (WHO) has set the goal of zero children with leprosy and deformities by 2020, and less than one patient per million for other newly diagnosed patients.

Today, though, Bihar, Chhattisgarh, Odisha, Jharkhand, Uttar Pradesh, West Bengal and Maharashtra remain the ‘hotspots’ from which maximum prevalence was detected last year. High population density, poor sanitation and inadequate access to nutrition are among the reasons for the number remaining high. The Centre says a more aggressive detection campaign is being carried out, explaining the numbers.

The Leprosy Case Detection Campaign has shown that 34,730 cases were detected in 2016, 32,147 in 2017, and 16,097 in 2018. “We welcome the rise. It means we are catching these cases and putting the patients on treatment. But what the department is looking at is the new cases detected, the existing cases with leprosy-related handicap, and new cases in children. They are our actual ground check. The three parameters have shown a downward trend,” said Anil Kumar, Deputy Director-General (Leprosy), Union Health Ministry.

Moreover, he clarified, “The figures don’t tell us the actual story,” adding that that India’s leprosy management programme is running in a very aggressive sweep mode, after the “relaxed period” of 2005.

The number of cases reported fell after 2005-06, when India was declared leprosy-free — the prevalence rate at the time was 0.84%. “It was only at the end of 2011 that we realised leprosy is very much around — when people started reporting in with leprosy-related disabilities — and we refreshed our strategy to find and treat new cases,” Dr. Kumar said.

Social stigma

Disease management efforts now include going down to the village level in what is called the “active seeking mode” for cases, where health workers go from house to house and physically examine people for a leprosy patch. “We were earlier missing many cases because people weren’t reporting due to fear, social stigma and lack of awareness,” said Dr. Kumar.

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae, which multiplies slowly. The incubation period of the disease, on average, is five years. In some cases, symptoms may occur within one year but can also take as long as 20 years to occur. “This is exactly the trouble with the elimination of leprosy. The long incubation period, and the social stigma attached to it, makes it a tough disease to eliminate,” said Dr. Kumar.

Leprosy mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and also the eyes. The disease is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. Untreated leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. It is curable with multi-drug therapy (MDT).

Focus on children

There has been a change in the percentage of new child cases from 9.49% in 2013-14 to 8.15% in 2017-18, with the level having remained almost stagnant at 8.94% in 2015-16 and 8.69 % in 2016-17. “Our special emphasis is on children, for whom we have brought in active detection intervention, with primary health workers educating them from the school-level onward. We are working at developing a positive attitude towards detection and treatment,” said Dr. Kumar.

In 2016-17, the proportion of new child cases was more than 10% of the new cases detected in 10 States.

Children are not predisposed to leprosy, but there is an element of risk in late detection, with parents hiding the disease, especially in the case of girls till the handicap sets in. Also, disability in children has a longer lifespan, which can hamper their quality of life.