Leprosy - Introduction and Epidemiology

Leprosy - Introduction and Epidemiology in India.

1. LEPROSY INTRODUCTION & EPIDEMIOLOGY PRESENTED BY Md.Fariduddin Malik 2014 Batch MODERATORS : Dr Najmul Aqib Dr Nikhat Dr Abdullah Dr Naveen Dr Arshiya Dr Saleem

2. INTRODUCTION: Leprosy or Hansen’s disease or Kusth rog is a chronic infectious disease caused by M.leprae Probably the oldest disease known to mankind Mainly affect peripheral nerves , also affects the skin, muscles, eyes, bones , testes and internal organs Leprosy is often known as a “social disease” Social stigma is attached to it. Stigma is coupled with physical deformity leads to social isolation and depression

3. PROBLEM STATEMENT: WORLD Prevalence- 1985: 21.1 cases/10,000 population 2015: 0.29 cases/10,000 population Over the past 20 years, more than 16 million patients have been cured Leprosy eliminated in 119 out of 122 countries where the disease was considered as a public health problem in 1985.

4. SOUTH EAST ASIAN REGION (SEAR) 210,75 8 new cases of leprosy were detected during 2015. The number of new cases detected during 2015 in 14 countries that reported ≥1000 new cases accounted for 95% of all new cases; In SEAR: Multibacillary :60.2% Females : 38.8% Children (<15yr) : 8.9% Grade-2 disability:6.7%

5. INDIA India alone account for 58.85% of global leprosy burden . 2014-2015 2015-2016 New cases 125785 127334 Prevalence rate (per 10000 population) 0.69 (on 1 st April, 2015) 0.66 (on 1 st April, 2016) ANCDR 9.98 9.71 Multibacillary 52. 82% 51.27% Paucibacillary 47.18% 48.73% Females 36. 81 % 38.33% Children 9.04% 8.94 % G-2D 4.61% 4.60%

6. 34 States/UTs out of 37 achieved the level of elimination i.e. PR less than 1 case per 10,000 population (31 st March 2016) 486 districts out of 669 achieved ANCDR less than 10 cases per 10,000 population (March 2016) Trends of leprosy prevalence and ANCDR per 10,000 population in India Ref: Govt . of India ( 2015,2016): www.nlep.com

7. LEPROSY IN UTTAR PRADESH March 2016 Population: 21873585 State No. of cases MB PB percentage Female Child Gr II Dis ANCDR per Lakh population PR per 10000 population Uttar Pradesh 967 8 13099 42.49 % 57.51% 7423 32.59 % 137 8 6.05 % 887 3. 89 % 10.41 0.65

8. EPIDEMIOLOGICAL DETERMINANTS Enviromental factors Overcrowding Humidity Nutrition Agent factors Agent : M.leprae Source of infection : case Portal of exit : nose Infectivity: High infectivity; low pathogenicity Attack rates: 4.4 -12% Host factor Age : all ages Sex : both Population: Rural>Urban Migration Immunity : Decreased CMI Genetic factors

9. MODE OF TRANSMISSION Droplet infection ₍ main mode ₎ Contact transmission Insect vectors Tattooing needles

10. CLASSIFICATION OF LEPROSY Classifications are based on clinical, bacteriological, immunological and histological status of patient Indian classification Madrid classification Ridley and Jopling classification WHO classification Indian classification Madrid classification Indeterminate Indeter minate Tuberculoid Tuberculoid ., flat,raised Borderline Borderline Lepromatous Lepromatous Pure neuritic

11. RIDLEY AND JOPLING CLASSIFICATION Character Tuberculoid (TT) Borderline tuberculoid (BT) Borderline(BB) Borderline lepromatous (BL) Lepromatous (LL) Bacilli in the skin - +/- + ++ +++ Bacilli in nasal secretions - - - + +++ Granuloma formation +++ ++ + - - Lepromin test +++ + +/- - - Antibodies to M.leprae +/- +/- + ++ +++

12. CLINICAL PRESENTATION Hypopigmented patches Loss of cutaneous sensation Thickened nerve Nasal depression Skin lesion, nodules Eye damage Plantar ulcers, loss of fingers and toes

13. DIAGNOSIS Leprosy present with many symptoms and signs but presence of at least two of the three cardinal signs and presence of fourth sign independently should be sufficient: 1.Hypopigmented patches 2.Sensory loss 3.Thickened nerves 4.Presence of AFB in slit skin smear examination

14. CLINICAL CLASSIFICATION & TREATMENT Paucibacillary leprosy(PBL) Multibacillary leprosy(MBL) No of skin lesions 1-5 ≥6 Bacteriological index BI<2 BI≥2 Included types Indeterminate, TT ,BT LL,BL,BB MDT in NLEP Rifampicin 600mg Dapsone 100mg daily Rifampicin600mg Dapsone100mg daily Clofazimine 300mg 50mg daily Treatment duration 6 months 12 months Follow up Annually for 2 yrs Annually for 5 yrs

15. THANK YOU Ref: 1.Preventive and social medicine K.PARK 24 rd edition 2.NLEP: nlep.nic.in 3.WHO Database 4.Dermatology NEENA KHANNA 5th edition WORLD LEPROSY DAY 31 st JANUARY