Post-elimination Era Research Articles

Role of dermatologists in leprosy elimination and post-elimination era

Would it not have been better to have left out the word 'elimination' altogether in the question and do what WHO has done in its new strategic plan for 2006-2010, 'Global Strategy for further reducing the Leprosy Burden and Sustaining Leprosy Control Activities'? Why not use a title such as 'The Role of Dermatologists in reducing the Leprosy Burden and Sustainig Leprosy Control Activities'? Some elements of the 'foundation' of the elimination policy have been (and are still) very controversial, its definition and the unsubstantiated (up till now) claim that when reaching a prevalence rate of less than 1 per 10,000, the transmission of the infection would be interrupted and the incidence would therefore decline.

Role of a dermatologist in the post-elimination era

When leprosy was declared eliminated from India, the reaction of the entire country and that of the world must have been one of relief, and of achievement. Where does one go from here? Certainly it does not imply that we, as physicians, will never see a case of leprosy again. It is a burden that we shall bear for many more years to come till the happy day when leprosy is completely eradicated. The learning of the many aspects of leprosy takes experience and continued interest. Can this load be borne by the physicians? With the heavy workload of many other National programmes already on their shoulders, it does not seem fair to saddle them with another responsibility. That leaves us only with the dermatologist who is already in know of the cutaneous and the neural consequences of disease and who can be further trained to recognize all the aspects of leprosy.

Role of dermatologist in leprosy elimination and post-elimination era

Role of dermatologist in leprosy elimination and post-elimination era

Role of dermatologists in leprosy elimination and post-elimination era: the Brazilian contribution

Dermatologists in Brazil have always been involved in care of leprosy patients, and have been alternating with public health physicians in the management of control policies. It is worth mentioning that Fernando Terra, founder of the Brazilian Society of Dermatology (BSD) in 1912, established the position of intern dermatologist at the Hospital dos Lizaros, in Rio de Janeiro, in 1913 (Souza-Araújo, 1952; Oliveira, 1991). In 1920, the dermatologist Eduardo Rabello formulated the first national public policy on the control of leprosy in the country, which was called 'Inspection of Prophylaxis of Leprosy and Venereal Diseases'. His son was an enthusiast of dermatological research and his main legacy was the polarity concept of leprosy (Rabelo, 1937). However, from 1930 to 1985, the public health physicians were in charge of the political guidelines that represented the period of establishing the vertical programmatic structure, with compulsory isolation of patients (1933-1962). Moreover, the federal states coordinated the control actions, based on the leprosy prophylaxis campaign. The dermatologists resumed the conduction of the control process in 1986, when multi-drug therapy (MDT) was implemented in the country, and in 1991, when decentralization of public healthcare services to the municipal level took place. In 2003 again, the dermatologists were no longer in control of the national policy. However, active dermatologists have acted in Brazilian references on diagnosis and treatment of Hansen's disease, at municipal, state and national levels. It is true that dermatologists have been getting away from leprosy control actions. And one could ask: who will replace this specialist? In the 'post-elimination' era, when the public primary healthcare technicians no longer consider leprosy of much significance, the knowledge of the expert in this disease and its differential diagnoses will be crucial.

Role of dermatologists in leprosy elimination and post-elimination era in India

Role of dermatologists in leprosy elimination and post-elimination era in India

Role of dermatologists in leprosy elimination and in the post-elimination era

Inst. of Hlth., Sec. of Sao Paulo (Instituto de Saude, Secretaria de Estado da Saude de Sao Paulo), Sao Paulo

A public health approach for leprosy detection based on a very short term-training of primary health care workers in basic dermatology

In countries where leprosy control is integrated to general heath services, health workers, at primary health care level, often manage a large number of patients with skin diseases including leprosy. The distinction of leprosy from others skin diseases requires more skill and attention. Basic dermatological knowledge will help these staff to provide a better quality of care. A few years ago, a short term training programme focussed on leprosy and some common skin diseases was set up in Mali through a pilot project. This study will evaluate the impact of this training on the detection of leprosy at primary health care level. health care workers from two health districts were invited to participate in the training. Trainee was submitted to an anonymous written test before training, immediately after and 12-18 months post-training using a standardized scoring system. The suspected or referred leprosy cases before and after training were compared. Data were recorded and analysed with the software Epi info version 6.04. Overall, 495 HCW attended the three anonymous written tests (before training, just after and 12-18 months later). The proportion of participants who gave correct answers before training, just after were respectively: 33 and 57% for correct diagnosis, 5 and 39% for test of sensation and 28 and 47% for referral. Eight patients suspected of leprosy were referred for further examination; in these, five cases of leprosy were detected. The training showed a huge improvement in the skill of the participants in managing leprosy patients. This study addresses how leprosy control can be improved by involving primary health care staff and by the implementation of only a single day's training on basic dermatology. The role of the dermatologist in this post-elimination era of leprosy needs to be reconsidered and adapted to the increasing need to take multiple programmes, inclusive of dermatology and leprosy, into primary health care services and those interested in leprosy control should fund these programmes.

Epidemiological characteristics of leprosy reactions: 15 years experience from north India.

A retrospective analysis of patient's leprosy clinic records at PGIMER, Chandigarh, India for the period 1983 to 1998 was undertaken to study the frequency, time of onset, and risk factors for leprosy reactions. Of the 2600 cases analyzed, 1494 were multibacillary and 1106 had paucibacillary disease. Presentation with reaction was common with 30.9% of our patients having reactions at the time of first visit. The incidence of reversal reaction (RR) was highest during 6 to 12 months after starting multi-drug therapy (MDT), thereafter declining gradually. Late RR occurred in 9.5% of all cases and was noted up to 7 years after treatment. Female gender, widespread disease, and multibacillary disease were identified as risk factors for RR. Erythema nodosum leprosum (ENL) reactions were noted to occur mostly during second or third year after starting MDT. Of the total number of patients who experienced ENL, 64.3% had recurrent episodes which continued for up to 8 years after the start of treatment. Lepromatous leprosy, female gender, and high Bacterial Index (>/=3) were recognized as risk factors for developing ENL. Occurrence of recurrent and late reactions, even though of mild severity, highlights the importance of recognizing and treating them promptly to prevent or reduce morbidity, complications, and further deterioration in the disability status. Although it is hoped that leprosy will have been eliminated at all levels by 2005, the recognition and management of these reactions will continue to be the most essential/significant task in the post elimination era.