Leprosy remains an important cause of preventable disabilities. After the advent of multidrug therapy, new leprosy cases have come down dramatically. Despite this achievement, India, which contributes 60% to the global leprosy burden, faces some challenges to eliminate the disease, including active transmission in the community and delayed diagnosis of leprosy patients. Dr. Thirumugum Muthuvel, the principle author of the study, “Leprosy trends at a tertiary care hospital in Mumbai, India, from 2008 to 2015” talks about Leprosy, how it impacts populations and what can be done to overcome this public health challenge.
You conducted a study titled, “Leprosy trends at a tertiary care hospital in Mumbai, India, from 2008 to 2015”, which was published in late 2016. What were the objectives of the study and what were your findings?
The objectives of the study were: 1) to determine sociodemographic and clinical characteristics of newly diagnosed adults and children (less than 15 years) with leprosy and their trends over time (2008–2015) and 2) to describe the profile of surgical procedures among leprosy patients registered for reconstructive surgeries during 2006–2015 in a tertiary care hospital, Mumbai.
The study reveals an 18% increase in the number of teenagers (under 15 years) contracting the disease from 2008-2015. The study also pointed out that maximum amount of patients, both adult and children, belong to migrant families from Uttar Pradesh (37.5%) and Bihar (8%). The statistics indicate that there is a delay in detection of cases to avoid transmission in children. The study revealed that targeting children and migrants and ensuring early diagnosis and treatment initiation are essential components for leprosy elimination in an urban metropolis in India.
What do you plan to do with the findings of the study?
Against the backdrop of National Leprosy Eradication Programme and the number of new cases being detected throughout the country, we wanted to observe the transmission trend and to understand a better diagnostic approach in patients at a referral centre. We wanted to inform the health care providers about the findings and highlight the age group which needs to be targeted for reducing the disease burden. Despite leprosy being a preventable disability, why is the situation on ground so grim?
The disease starts with a painless skin patch which does not cause any problem in an individual’s routine life. So, people tend to ignore this symptom. As months/years pass by they develop symptoms like numbness or reduced sensation in hand/feet or leprosy reactions in the face/other parts of the body. A majority of them ignore this symptom as well and only a few seek any qualified or non-qualified medical practitioner. These practitioners too do not suspect leprosy at first sight due to limited knowledge about leprosy symptoms. Leprosy diagnosis does not require any sophisticated equipment, it requires a thorough examination of skin, hand, feet for sensory and muscle testing. These tests can be performed even at an Out Patient Department (OPD). However, due to the delay in seeking medical support causes nerve damage, eventually leading to disability.
Further, there is a lack of awareness or low awareness within the community about the symptoms, availability of treatment which poses a challenge to timely diagnosis. Apart from these factors, it is also the stigma which prevents people from seeking treatment. Leprosy treatment is freely available in Government facility, but patients don’t seek them due to the stigma associated.
The bacteria, Mycobacterium leprae that causes leprosy, has an incubation period of months or even years, depending on the immunity of an individual. Parents of infected children need to read the symptoms as early possible to avail treatment so the disease doesn’t reach a chronic stage.
There is a lot of stigma attached to this disease which inhibits its timely diagnosis.
How is leprosy diagnosed and treated effectively?
Leprosy can be diagnosed by thoroughly examining the skin patch for any reduced sensation. Performing nerve function tests to see if there is any sensory loss in hand, feet, is beneficial. Performing muscle testing to assess for any weakness in eye, hand and feet is also helpful.
Treatment is available in the form of blister packs, free of cost at Government facilities across the country. Based on the bacterial load, treatment course can vary between 6 months to 12 months.
- Who is at most risk of contracting leprosy?
Everyone is at risk of leprosy; the immunity level of an individual decides who gets the disease. Leprosy spreads through droplet infection, and it takes long period (months to years) to get the symptoms. Those individuals who are in close contact with a person who is infected with leprosy but has not taken any treatment are the actual disease spreaders.
In your opinion, how can India curb the spread of Leprosy?
Every year India reports 1.2 lakhs new leprosy patients. Only when individuals are self-conscious about their health, symptoms are noticed and if they are made aware of health facilities made available by health care providers, can we suspect and identify the disease at the earliest.