Leprosy elimination—a virtual phenomenon or a reality?

Why are evidence based policies not guiding the World Health Organization's leprosy elimination campaign, asks Diana Lockwood Leprosy is an infectious disease but it has many features in common with neurodegenerative disorders. It results in a chronic neurological illness, which is progressive unless treated; frequently produces long term disability; and is associated with high levels of stigma. As it has a known infective agent, Mycobacterium leprae , there is the possibility of disease control. Multidrug treatment with the antibiotic combination rifampicin, dapsone, and clofazimine is highly effective in curing infection, with relapse rates of 1%.1 It was hoped that having effective antibiotics would permit disease control and thus the concept of leprosy elimination developed. “Leprosy elimination by the year 2000” was first proposed in 1986 and at the 44th World Health Assembly in 1991 modified by the addendum “as a public health problem,” defined as less than one case per 10 000 population.2 The leprosy elimination campaign has had some notable successes but also illustrates the epidemiological, medical, and political problems of the elimination concept. #### Summary points Leprosy is a leading cause of neurological disability The World Health Organization's leprosy elimination campaign has treated 11 million patients, but case numbers are still rising in the major countries where leprosy is endemic New methods for diagnosis and treatment proposed by the WHO risk missing disease and undertreating patients, and an opportunity for implementing evidence based policies may be missed Leprosy is a complex mycobacterial disease whose manifestations and complications are determined by the immune response. Many patients experience immune mediated nerve damage, which may occur before, during, or after treatment. Recent field based cohort studies have shown that at diagnosis many patients already have established nerve damage; rates vary from 20% in Bangladesh to 56% in Ethiopia, 3 4 and these …