Impact of COVID-19 on the global leprosy control | WHO: The aim of the global leprosy strategies published by WHO is to reduce the burden of the disease globally and in countries. Early detection and prompt treatment with multidrug therapy (MDT), the basic tenets of leprosy control, led to a significant reduction in the burden of leprosy by the early 2000s. Since 2006, there has been a strategic shift from a campaign approach to long-term integrated services focusing on leprosy complications, chronic care and quality of services, in addition to case detection and treatment. The strategies 2016–20201 and 2021–2030 continued to focus on breaking the chain of transmission and active case detection in both high- and low-burden settings. The recommendations include equity and social justice, emphasizing the inclusion of persons affected by leprosy, reducing stigma and discrimination, building partnerships and coalitions of stakeholders and endorsing increased ownership by countries.
Burden of leprosy (Hansen disease) -Impact of COVID-19 on the global leprosy control | WHO
Essential information on leprosy was collected through a customized, open source platform, District Health Information System (version 2) (DHIS2), and abridged Excel® form was designed for collection of data from countries with very few or no cases of leprosy. In 2020, 127 countries provided information on leprosy: 34 in the WHO African Region (AFR), 19 in the Americas Region (AMR), 22 in the Eastern Mediterranean Region (EMR), 28 in the European Region (EUR), 11 in the South-East Asia Region (SEAR) and 13 in the Western Pacific Region (WPR). Most countries reported for the calendar year (January–December 2020), while a few countries reported for a different 12-month period (e.g. India reported for April 2020–March 2021). Rates were calculated per million population based on estimates (medium variant) provided by the United Nations Department of Economic and Social Affairs.3 The registered prevalence, numbers of new cases and the corresponding rates per million populations are provided in Table 1. The registered prevalence of leprosy (the number of cases on treatment at the end of 2020) was 129 192, with a rate of 16.6 per million populations. Globally, 127 396 new cases were reported, for a case detection rate of 16.4 per million populations. Both figures were much lower than in previous years, with a 27.7% reduction in registered prevalence and a 37.1% reduction in new cases as compared with 2019. This change is probably due to less detection and reporting during the COVID-19 pandemic. Only 127 countries (of 221) provided data in 2020, as compared with 160 in 2019. Data from all 23 global priority countries were received for 2020. The highest proportions of both cases registered for treatment (61.1%) and new cases detected (66.6%) were in SEAR. Brazil, India and Indonesia reported 72.5% of registered cases and 74.0% of new cases detected in 2020. Twenty-seven countries reported a high proportion (>90%) of multibacillary leprosy. Of the total, 67.3% of cases were multibacillary leprosy. More adults (age ≥15 years) had multibacillary leprosy (68.8% of total adult cases), , while more children paucibacillary leprosy (53.2% of all child cases).
Although the significant decrease in the number of cases cannot be explained epidemiologically, decreasing trends in the numbers and rates of new cases, child cases and registered prevalence were seen in 2020, as in previous years. For instance, the new case detection rate was 33.7 in 2011, 26.5 in 2019 and 16.4 in 2020, corresponding to a 21.4% reduction over 9 years (2011– 2019) and 38.1% between 2019 and 2020. Therefore, the rate of reduction between 2011 and 2019 provides a better overview. New child cases decreased markedly (by 27.4% since 2011) during the period. However, the number of new cases with G2D decreased slowly, with a fluctuating trend during 2011–2015, increasing subsequently (25.5% reduction during 2015–2019). Similarly, the registered prevalence staggered with a decrease of 13.3% at the end of the reporting year (2011–2019). The data also show a 48.7% increase in re-treated cases over the same period, indicating that follow-up needs to be strengthened.
Although the COVID-19 pandemic disrupted health services in general, it provided a window for strengthening digital health initiatives for diagnosis, referral, monitoring and training staff in several countries. WHO developed e-learning modules for enhancing knowledge and skills of staff at all levels on topics ranging from suspected referrals and diagnosis to the treatment of leprosy. Though the pandemic affected progress, many countries made commendable advances in achieving the Strategy 2016–2020. Optimization of existing tools, such as for contact-tracing, active case-finding and post-exposure prophylaxis with single-dose rifampicin, and introduction of new diagnostic tests and preventive regimens are critical to address the plateauing of the reduction in new cases. The gains must be sustained to ensure elimination by 2030.
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