National Leprosy Eradication Programme

What is Leprosy ?

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae. Official figures

(WHO) show that more than 213 000 people mainly in Asia and Africa are infected, with
approximately 249 000 new cases reported in 2008.

M. leprae multiplies very slowly and the incubation period of the disease is about five years.
Symptoms can take as long as 20 years to appear. Leprosy is not highly infectious. It 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. Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in
eliminating the disease as a public health concern.

History of Leprosy

The earliest records of a leprosy like disease come from Egypt, dating as far back as 1400 BC.
In China and India the first records appeared in the sixth century BC.
In China, a disciple of Confucius named Pai-Nie suffered from a disease resembling lepromatous
leprosy, which was known at that time as li or lai.

A drug Chaulmoogra oil was used for leprosy treatment until Dapsone was discovered with
antileprosy effects during 1940s. It was in 1970s when multi drug therapy (MDT) consisting of
Rifampicin, Clofazimine and Dapsone were identified as cure for leprosy which came into wide
use from 1982 following the recommendations of WHO.
India officially achieved the elimination of leprosy 7 years ago(<1/10,000). But, according to
World Health Organisation, India still records the highest number of fresh cases globally.

As per WHO, 65% of all new cases of leprosy globally are from India.

The health ministrys latest data shows between April 2010 and March 2011, India recorded 1,
26,800 fresh cases of leprosy, of which 12,463 were children under the age of 15. Around 4,000
of these patients had disabilities due to leprosy.

In this context, the Health Ministry recently called up a meeting and discussed these

high numbers. Most of states of India eliminated the disease in 2005 (elimination is less than 1
case per 10,000), but it has been quoted that as many as 209 districts still record more than 10
cases per 10,000 which is tremendously high. These districts are mainly in Bihar, Chhattisgarh
and Dadar & Nagar Haveli.

Now, Indias leprosy prevalence rate stands at 0.69 cases per 10,000.

Under the 12th five-year plan, starting from 2012, India intends to start WHOs child-to-child
policy under which school students will be taught to identify patches on the skin of their
classmates.

Although there is no vaccine, leprosy is curable with multi-drug therapy (MDT). Within a day of
starting MDT, there is no risk of the disease infecting another person.

Treatment of Leprosy
Some drugs such as rifampicin, clofazimine, and dapsone are used to treat Leprosy. In 1993, the
WHO had recommended two types of standard MDT regimen be adopted. One was a 24-month
treatment for multibacillary (MB or lepromatous) cases using rifampicin, clofazimine, and dapsone.
Another was a six-month treatment for paucibacillary (PB or tuberculoid) cases, using rifampicin
and dapsone.

Leprosy in India - Government efforts

The National Leprosy Control Programme was launched by the Government of India in 1955.

Multi Drug Therapy came into wide use from 1982 and the National Leprosy Eradication
Programme was launched in 1983.

Since then, remarkable progress has been achieved in reducing the disease burden. India
achieved the goal of elimination of leprosy as a public health problem, defined as less than 1
case per 10,000 population, at the National level in the month of December 2005 as set by the
National Health Policy, 2002. Here is the current position : (Source Ministry of Health, data is of
January 2009)

29 states/UTs have achieved leprosy elimination status. 6 States/UTs viz. Bihar, Chhattisgarh,
West Bengal, Jharkhand, Chandigarh and D&N Haveli are yet to achieve elimination.With 87,206
leprosy cases on record at end of March 2008, the prevalence rate was 0.74/10,000 population.

During 2007-08, a total of 1.38 lakhs new leprosy cases were detected giving Annual New Case
Detection Rate of 11.70 per lakh population. All the newly detected cases were put under
treatment.

National Leprosy Eradication Programme

Government of India had launched the National Leprosy Control Programme in 1955 based on
"Daps one" immunotherapy.

Then the Multi Drug Therapy (MDT) came into wide use from 1982 and the Programme was redesignated the National Leprosy Eradication Programme (NLEP) in 1983.

The programme was expanded with Assistance of the International Federation of Anti Leprosy
Associations (ILEP), the Sasakawa Memorial Health Foundation & the Nippon Foundation,

NOVARTIES, DANLEP and the World Bank (1993-2004). The 1st phase of the World Bank
supported National Leprosy Elimination Project started from 1993-94 and ended in March 2000.

The 2nd phase of World Bank supported National Leprosy Elimination Project started from April
2001 and ended successfully in December 2004.

During the 2nd phase, NLEP was decentralized to States/Districts and Leprosy Services were
integrated with the General Health Care System.Since then, free Multi Drug Therapy (MDT) is
available at all Sub-Centres, PHCs and Government Hospitals and Dispensaries on all working
days.

The programme has been integrated with NRHM. The state & district leprosy societies have been
merged with the state and district health societies.

Milestones in NLEP
1955 - National Leprosy Control Programme (NLCP) launched
1983 - National Leprosy Eradication Programme launched
1983 - Introduction of Multi-drug therapy (MDT) in Phases
2005 - Elimination of Leprosy at National Level
2012 - Special action plan for 209 high endemic districts.