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MADURAI, India—Despite running one of the largest leprosy elimination programs in the world, India reported more than 100,000 new cases in 2019—more than half of the global total.

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NLEP works to reach a "Leprosy-free India" and provides care during and after treatment

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WHO Assists in Monitoring, Educating, and Supplying Treatments

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WHO Assists in Monitoring, Educating, and Supplying Treatments

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When Mr Narrattam Meher, 44, developed weakness in the fingers of his right hand, he immediately visited the District Headquarter Hospital in Boudh in Odisha, a coastal state in eastern India. "I had no other symptoms, but I could not hold up food to eat. I'm a weaver, and it worried me," said Mr Pradhan.

At the hospital, he was counselled by the WHO Neglected Tropical Disease (NTD) officer, who informed him that disabilities may develop due to leprosy. Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy causes light-coloured patches on the skin with loss of sensation in the early stages of the disease. If left untreated, advanced disease includes weakness or paralysis in muscles of hands, feet, face and eyes, ulcers in the soles of the feet and blindness. Leprosy is curable and treatment in the early stages can prevent disability.

The World Health Organization (WHO), working through the country office in India, supports the National Leprosy Eradication Programme (NLEP). WHO ensures uninterrupted supply of the specific drugs needed for multi-drug combination treatment (MDT) of leprosy. WHO also assists in planning, capacity building, community education, monitoring and supervision, preparedness for campaigns and supporting monitoring of service quality. WHO NTD state and zonal coordinators provide technical support to states and districts to implement the national programme.

Under the NLEP, active case detection and regular surveillance under the Leprosy Case Detection Campaign (LCDC), ASHA-based Surveillance for Leprosy Suspects (ABSULS), Active Case Detection and Regular Surveillance (ACDRS) are being conducted to interrupt transmission of the causative organism Mycobacterium leprae.

The active case detection activities aim at early identification of suspected cases in the community for prompt diagnosis and treatment. Countrywide awareness drives at the village level are conducted every year under the SPARSH Campaign to educate communities, stop stigma and discrimination and find people who may be infected and link them to health care services.

In addition, the expansion of leprosy post-exposure prophylaxis (LPEP) treatment using the single-dose rifampicin is underway. The LPEP initiative was implemented after successful outcomes of the feasibility implementation study in the Union Territory of Dadra and Nagar Haveli in western India. In this study, household, social contacts and neighbours of persons newly diagnosed with leprosy were systematically traced by health services, linked for leprosy screening, and if they are found to be affected - provided with single dose rifampicin (SDR).

The study registered 1 662 infected persons (called index cases) and on average, traced 26 contacts of each index case. Screening was conducted for 42 333 contacts (97.8% of those listed) and 42 cases of leprosy were confirmed among them. The new case detection rate per 10 000 contacts was 10. Of the contacts, 30 295 (71.6%) were eligible and provided SDR treatment. Prior to the start of the COVID-19 pandemic in 2020, more than half a million contacts were screened annually and about 65% of them were administered SDR treatment.

Leprosy is endemic in several states and union territories of India, with the annual case detection rate of 4.56 per 10 000 population. The prevalence rate of leprosy is 0.4 per 10,000 population in the country. Of the new cases detected during 2020-2021, 58.1% were multibacillary, 39% were women, 5.8% were children less than 14 years of age, and 2.41% had visible deformities. The rate of visible deformities was 1.1 per million population.

In March 2021, 79 898 patients were under free MDT treatment for leprosy across the country. Despite COVID-19 disruption of health services during 2020-2021, 65 147 new cases of leprosy were identified, diagnosed and provided free treatment. Continuity of these essential healthcare services during pandemic response ensures that leprosy is cured and disability is prevented.

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When Mr Narrattam Meher, 44, developed weakness in the fingers of his right hand, he immediately visited the District Headquarter Hospital in Boudh in Odisha, a coastal state in eastern India. "I had no other symptoms, but I could not hold up food to eat.

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India on Track to Eradicate Leprosy by 2027

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India on Track to Eradicate Leprosy by 2027

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Program works to spread awareness of the disease and gives treatments free of cost

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Centre releases roadmap & strategy for eliminating leprosy by 2027

In a virtual address at an event to observe National Anti-Leprosy Day, Union Health Minister Mansukh Mandaviya said India is making progress as new leprosy cases are declining year after year.

"With the whole of government, the whole of society support, synergy, and cooperation, we can achieve the target of Leprosy Mukt Bharat by 2027, three years ahead of the SDG," Mandaviya said.

The theme of this year was ' Let us fight Leprosy and make Leprosy history '.

Reiterating Mahatma Gandhi's enduring concern for people affected with leprosy, he said that the concern and commitment to treating leprosy have its origin in our history.

"His vision was not only to treat them but also to mainstream them in our society. Our efforts to eliminate leprosy from this country under National Leprosy Eradication Program is a great tribute to his vision. We are successful in achieving a prevalence rate of 1 case per 10,000 population at the national level in 2005. The need of the hour is consistent efforts to eliminate leprosy. It is a curable disease, however, if it is not detected and treated at the early stage, it can cause permanent disabilities and deformities among the affected person, leading to discrimination of such persons and their family members in the community," he said.

Accentuating on the efforts of the National Leprosy Eradication Programme, Union Minister of State for Health, Dr. Bharati Pravin Pawar, said: "Our Leprosy Program strives to detect and treat cases as early as possible, gives treatment free of cost to prevent the development of disabilities and deformities, and medical rehabilitation of those with existing deformities. The Welfare allowance has been raised from Rs.8,000 to Rs.12,000 for patients for their reconstructive surgery."

Highlighting the achievements of the program, she informed that the prevalence rate of leprosy has come down from 0.69 per 10,000 population in 2014-15 to 0.45 in 2021-22. Further, the annual new case detection rate per 100,000 population has come down from 9.73 in 2014-15 to 5.52 in 2021-22.

"The program also works towards spreading awareness and reducing the stigma attached to the disease. Surveillance was also strengthened by introducing ASHA-based Surveillance for Leprosy Suspects (ABSULS) where grassroots-level workers constantly engaged in examining and reporting suspects. The special emphasis under the Focused Leprosy Campaign (FLC) was given to areas that were difficult to access or had child cases and cases with disabilities. Since 2015, with the constant efforts under NLEP, we have been able to prevent many cases of disability due to leprosy," she added.
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India to Achieve Leprosy Mukt Bharat Goal by 2027, Says Mansukh Mandaviya

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In a virtual address at an event to observe National Anti-Leprosy Day, Union Health Minister Mansukh Mandaviya said India is making progress as new leprosy cases are declining year after year. "With the whole of government, the whole of society support, synergy, and cooperation, we can achieve the target of Leprosy Mukt Bharat by 2027, three years ahead of the SDG," Mandaviya said.

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India reached the prevalence of <1 case per 10,000, however with its large population, roughly 100,000 people have leprosy. This accounts for nearly half of the world's cases.

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Abstract

Traditionally, India holds the unenviable position of the origin of . The disease is thought to have spread, via trade and war, to China, Egypt, and the Middle East, and later to Europe and the Americas. From antiquity to modernity, Indian society treated leprosy singularly for custom and law, a response shaped by both scientific knowledge and cultural attitudes. Over the past centuries, tireless research by eminent physicians and scientists working in India have helped establish a better understanding of clinical, bacteriologic, pathologic, and immunologic aspects of leprosy. leprosy Therapeutic modalities that were initially restricted to chaulmoogra expanded to include newer anti-leprotic medications and even surgical reconstruction of deformities. India's future challenges in leprosy control include stigmata, educational knowledge gaps, and multiple systems of medicine. This contribution is an attempt to comprehensively discuss the historic aspect of this exclusive disease focusing on the varied scientific contributions from India.

Introduction

Leprosy is one of the oldest diseases known to man. Ancient Indian society marginalized those with leprosy due to several factors: its chronic, potentially disfiguring nature; inconsistently effective therapy; association with sin; and the fear of contagion. This combination endowed leprosy with a unique stigma that persists even today and resulted in its treatment with both seclusion (leper colonies) and medical therapy. Over the past century and a half, physicians and researchers based in India have taken tremendous strides covering every aspect of the disease including diagnosis, prevention, and management. Despite all such advances, leprosy continues to be a public health challenge in India and remains deeply entrenched in the social-economic milieu. Much like the long history of our nation, the association of the disease is significantly rooted in the Indian subcontinent across centuries. In this narrative review, we recapitulate the journey of leprosy in India from prebiblical times to the preceding century, highlight landmark Indian contributions, trace the evolution of public health measures, and point out some archaic legal issues and their subsequent redeeming legislative measures.

Section snippets

Ancient history

India may well be where leprosy first appeared based on skeletal evidence dating back to the second century BCE. Interestingly, comparative genomics research has suggested Mycobacterium leprae evolved either in East Africa or South Asia during the Late Pleistocene epoch (11,700-129,000 years ago). The disease is thought to have spread through trade routes and subsequent wars to other parts of Asia, the Middle East, and across the continents of Africa, Europe, and the Americas.

The circumstantial

Conclusions

The history of leprosy in India offers insights into one of the world's most misunderstood diseases. Explorative scrutiny of the past will lay the foundation to better tackle the future challenges of leprosy and its related psycho-social implications. Leprosy control and elimination in India still face many challenges. Although many of the theoretic and practical approaches of the past have been discarded, their careful examination provides insights for the future. Sustaining the gains made so

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History of leprosy in India: An overview of historic and modern contributions

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Traditionally, India holds the unenviable position of the origin of . The disease is thought to have spread, via trade and war, to China, Egypt, and the Middle East, and later to Europe and the Americas. From antiquity to modernity, Indian society treated leprosy singularly for custom and law, a response shaped by both scientific knowledge and cultural attitudes.

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India declared itself free of leprosy in 2005 and ended its prevention programs, focusing on other illnesses

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Many with leprosy do not seek medical care because of their negative attitudes and little knowledge towards to the disease

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