Children with leprosy

Abstract

It is a sad thing to see a young child with irreversible nerve impairment due to leprosy. We must do all we can to prevent leprosy in children and to prevent disability in leprosyaffected children. However, it is important to be confident of the diagnosis of leprosy before giving multi-drug therapy to avoid over-diagnosis and unnecessary treatment. Leprosy in children (under 15 years old) is still common in countries where leprosy continues to be endemic. The global figures for 2012 show 21,349 new child cases, 9% of all new cases, with 76·5% of these residing in the South-East Asia region. The proportion of new cases which are in children varies between individual countries from 0·6% in Argentina to 41·3% in Micronesia. In India, 10 states have child proportions of over 10%, while in Daman and Diu it was 30%. Studies from well documented hospital series have reported 4·5–14% of cases to be in children. Active population surveys give much higher proportions, for example 35% inMaharashtra and 32·5% in Agra. The number of child cases has decreased in line with a general reduction in case detection, but there is not necessarily a reduction in the proportion of child cases amongst new cases. The time has come to change the standard indicator (proportion of child cases amongst new cases) and in future to express the burden of child cases as an age-specific rate – the number of cases per 100,000 children under 15 years. A recent study from Cebu shows that the age-specific new case detection rate in those under 15 years declined from around four cases per 100,000 to just under two per 100,000 between 2000 and 2011, while the proportion of child cases remained the same, at 11%. This study also showed that the mean age of children who developed leprosy remained static over the same period. The case detection rate in children in Norway fell from around 15 per 100,000 in 1851, to under two per 100,000 by 1890 and to less than 0·1 per 100,000 by 1920. The age specific incidence of leprosy varies from place to place but it has been observed to have two peaks, in under 14 s and in older adults and age is a risk factor independent of other factors. An increase in mean age at diagnosis has been observed, and was noted both in Japan over the period 1964-2008, and in China, coinciding with a fall in prevalence rate.