Leprosy- Epidemolgy,Vaccination,NTLEP

Leprosy- Epidemolgy,Vaccination,NTLEP


LEPROSY

  • Chronic granulomatous disease.

Epidemiological determinants of leprosy 

Agent:

  • M. leprae

Source of infection

  • Multibacillary cases (most important), subclinical infections.
  • The current view is all patients with active leprosy considered infectious.

Transmission

  • Long contact with leprosy patient can transmit the disease.
  • Nasal droplets
  •  Insect can transmit the disease.
  • Transplacental spread not seen

Primarily affect 

  • Skin
  • Peripheral nerves
  • Nasal mucosa

Not affect

  • Female genital tract 

 Cell mediated immunity

  • Deficient

Prevalence

  • decreasing in past decade .

Incidence 

  • between 10-20 years.
  • Most sensitive index of transmission in leprosy is incidence

Infectivity 

  • Highly infectious (communicable) disease
  • low pathogenicity. 
  • An infectious patient can be rendered non-infectious by treatment with dapsone for about 90 days
  • Or with rifampicin for 3 weeks. 
  • Local application of rifampicin (drop or spray) might destroy all the bacilli within 8 days.

Country

Commonest leprosy

India, Africa

TT(polar tuberculiod)

Southeast Asia

BT

Mexico

Lepromatous(LL>BL)

 Leprosy Vaccine

  • Protective effect of BCG vaccine against leprosy and ICRC bacillius
  • Candidate” vaccines(underdevelopment) have shown a similar degree of lepromin conversions
  • Lepromatous patients (50-70 %)
  • Lepromin negative healthy individuals (90 %)
  • None of the candidate have attained as yet “vaccinehood”.

 National Leprosy Eradication Programme (NTLEP)

  • Launched in 1983

AIM

  • Achieve control of leprosy
  • Eradicating the disease by the turn of the century.
  • The aim was to reduce case load to I or less than 1 per 10000 population.

HOW

  • Through early detection of cases
  • Dapsone monotherapy on an ambulatory basis. 

SET centres

  • Established if prevalence leprosy Is 1-5

Revised strategy (NLEP) was based on

  • Early detection of case
  • Short term multi-drug therapy
  • Health education
  • Ulcer and deformity care
  • Rehabilitation activiti

NLEP provided :

  1. Domiciliary treatment in endemic districts through specially trained staff
  2. In moderate to low endemic districts, services through mobile leprosy treatment units and primary health care persons. 

Indicators in leprosy control

Operational indicators

  1. Relapse rate – One of the best indicators of the efficacy of drug regimen
  2. Case detection ratio – No. of cases registered / no. of cases estimated.
  3. Proportion of children among newly detected cases.
  4. Proportion of multibacillary cases on regular treatment during the year.
  5. Proportion of female cases among newly detected cases.
  6. Treatment completion/cure rate.
  7. Proportion of new cases presenting with grade 2 disability/impairment at the time of diagnosis. o Proportion of treatment defaulters.
  8. Proportion of patients who develop new/additional disability during MDT.

Epidemiological indicators: 

  • To assess the impact of the actions taken with regard to the problem reduction
  •  Long contact with tuberculoid leprosy can transmit the disease.
  •  goal of eradicating the disease by the turn of the century.
  • The aim was to reduce case load to I or less than 1 per 10000 population.
Exam Question
 

LEPROSY

  • Chronic granulomatous disease.
  • Epidemiological determinants of leprosy 

Agent:

  • M. leprae

Source of infection: 

  • Multibacillary cases (most important), subclinical infections.
  • The current view is all patients with active leprosy considered infectious.

Transmission

  • Long contact with leprosy patient can transmit the disease.
  • Insect can transmit the disease.
  • Transplacental spread not seen

Primarily affect 

  • Skin
  • Peripheral nerves
  • Nasal mucosa

Not affect

  • Female genital tract 

 Cell mediated immunity

  • Deficient

Prevalence

  • Decreasing in past decade .

Incidence 

  • Between 10-20 years.
  • Most sensitive index of transmission in leprosy is incidence

Infectivity 

  • Highly infectious (communicable) disease
  • An infectious patient can be rendered non-infectious by treatment with dapsone for about 90 days
  • Or with rifampicin for 3 weeks. 
  • Local application of rifampicin (drop or spray) might destroy all the bacilli within 8 days.

Country

Commonest leprosy

India, Africa

TT(polar tuberculiod)

Southeast Asia

BT

Mexico

Lepromatous(LL>BL)

 LEPROSY VACCINE

  • Protective effect of BCG vaccine against leprosy and ICRC bacillius

 National Leprosy Eradication Programme (NTLEP)

  • Launched in 1983

AIM

  • Achieve control of leprosy
  • Eradicating the disease by the turn of the century.
  • The aim was to reduce case load to I or less than 1 per 10000 population.

HOW

  • Through early detection of cases
  • Dapsone monotherapy on an ambulatory basis. 

SET centres

  • Established if prevalence leprosy Is 1-5

Revised strategy (NLEP) was based on

  • Early detection of case
  • Short term multi-drug therapy
  • Health education
  • Ulcer and deformity care
  • Rehabilitation activiti

NLEP provided :

  1. Domiciliary treatment in endemic districts through specially trained staff
  2. In moderate to low endemic districts, services through mobile leprosy treatment units and primary health care persons.
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