National Leprosy Eradication Programme.pptx

National Leprosy Eradication Programme (NLEP) in India, highlighting its goals and strategies in the fight against leprosy.

1. National Leprosy Eradication Programme: Leprosy Mukt Bharat by 2027 Dr. Robin Thuruthen Vavachan Community and Family Medicine

2. Feared, ostracized and isolated… to this day

3. Specific learning objectives To list the prevalence of leprosy in India and the world To identify and interpret clinical manifestations of leprosy To list the management strategies of leprosy under NLEP

4. Geographical distribution All six WHO regions Brazil, India and Indonesia Africa, Myanmar, Nepal, Sri lanka , Phillipines Prevalence: 0.45/10000 (2021-22)

5. Vision: leprosy free India Mission: to provide quality leprosy services free of cost to all sections of the population, with easy accessibility, through the integrated healthcare system, including care for disability after cure of the disease. Objectives: reduce the prevalence rate(<1/10000) @district grade II disability(<1%) among new cases @national grade II disability(<1/million) @national zero disabilities among new child cases zero stigma and discrimination

6. Strategies Decentralized integrated leprosy services Early detection and complete Rx of all new cases Household contact survey Capacity building Involve ASHA: ABSULS- n250/pb400/mb600 Strengthen DPMR services IEC to help self reporting nad reduce stigma Monitoring and supervision @HWC, PHC/CHC

7. Newer strategies Focused Leprosy Campaign(FLC): low endemic areas, hard to reach areas, child cases +, cases with disability Leprosy Case Detection Campaign(LCDC): high endemic Sparsh Leprosy Awareness Campaign(SLAC) PEP–SDR ( Single Dose Rifampicin 600 mg) MIP Vaccine Nikusth : online reporting system Grade II cases finding AMR surveillance ACD and RS Modelling studies District Award schemes for achievements

8. Epidemiology Agent Mycobacterium leprae Replicates in 12-14 days Acid fast bacillus Non-cultivable in artificial media M. lepromatosis Source of infection Untreated leprosy patient 9 banded armadillos

9. Transmission Droplets via the respiratory tract Prolonged contact Incubation period Average 5 years Up to 20 years

10. Host factors Any age possible(bimodal) Young adults in endemic countries Child cases? Males more than females Immunological status Other factors Socioeconomic factors Disabilities and stigma Genetics(NOD2) Temp of 27-33℃

11. Symptoms and signs Hypo-pigmented (pale) or erythematous (reddish) patches on the skin Loss, or decrease, of sensation to temperature, touch or pain in the skin patch Shiny or oily or smooth appearance of the skin (infiltration) Nodules on a shiny , erythematous skin Numbness or tingling of the hands or feet Weakness of the hands, feet or eyelids Presence of deformity in hands or feet or eyes Loss of sweating in an area of skin Painful or tender nerves Painless wounds or burns on the hands or feet

12. Reaction Clinical features Manifested as LEPRA 1 (reversal reaction) Acute/ silent neuritis; some generalized symptoms Hypopigmented patches and nerves become red, swollen and tender; loss of function; new lesions; ulceration of skin lesions; edema of hands and feet. LEPRA 2 (erythema nodosum leprosum ) ENL, other organ involvement and general symptoms Sudden erupting nodules which blanches on pressure; iridicyclitis , arthritis, epididymo -orchitis, lymphadenopathy; fever joint pains and fatigue

13. DD Birth mark Vitiligo Fungal infection Pityriasis rosea Psoriasis

14. Clinical Assessment History: how long? How did it start? Has it changed? Are the patches itchy or painful? Visible deformities? Any one in the family affected? Social problems? Examine the patches Test for sensation Feel the nerves: ulnar, common peroneal Examine hands and feet for dryness

15. Nerve function assessment Sensory testing: Semmes Weinstein Monofilaments Voluntary muscle testing Facial nerve : Orbicularis oculi- lid gap and eye closure Ulnar nerve : Little finger out testing Median nerve : Thumbs up Radial nerve : Fist up Common peroneal nerve: Foot up

16. WHO grading of Disability for Leprosy GRADE Hands and Feet Eye No disability found No eye problems due to leprosy; no evidence of visual loss 1 Loss of sensation+ No visible deformity/ damage Eye problems+ ; but vision not severely affected(6/60 or better) 2 Visible deformity/ damage present Severe visual impairment, lagophthalmos, iridocyclitis, corneal opacities

17. 3 cardinal signs = One or More Hypopigmented, Skin Patches with loss of sensation One or More Thickened Peripheral Nerve and with loss of sensation in the area supplied by the nerve, and/or weakness of the muscle supplied by that nerve A Positive Slit Skin Smear for Mycobacterium leprae

18. Classification PB and MB Determines the duration of the treatment PB: A case of leprosy, with one to 5 skin patches with loss of sensation and without demonstrated presence of bacilli in a slit skin smear MB: 6 or more skin patches with loss or impairment of sensation; or with nerve involvement Demonstrated presence of bacilli in a slit skin smear irrespective of the number of skin lesions

19. SN TYPES Duration of the treatment Dapsone Clofazamine Rifampicine 1 PAUCIBACILLARY ADULT 6 months 100 mg daily 300 mg once a month and 50 mg daily 600 mg once a month CHILD 6 months 50 mg daily 150 mg once and 50 mg alternate day 450 mg once a month 2 MULTIBACILLARY ADULT 12 months 100 mg daily 300 mg once a month and 50 mg daily 600 mg once a month CHILD 12 months 50 mg daily 150 mg once and 50 mg alternate day 450 mg once a month