Leprosy in Nepal: a re-emerging threat
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Leprosy in Nepal: a re‑emerging threat Frank Houghton1 · Michael Winterburn2 Accepted: 1 October 2020 © Springer Nature Limited 2020
Abstract Nepal has long been known as a leprosy endemic country. However, in 2010, the application of World Health Organization guidelines in Nepal led to the misleading determination that leprosy had been ‘eliminated’ there. This misnomer has contributed to the current situation in which leprosy is on the increase. A national active case finding program is urgently required. Keywords Leprosy · Nepal · WHO · Active case finding · Hansen’s disease
Introduction: leprosy in Nepal Nepal has long been known as a leprosy endemic country [1], and is one of 22 global priority countries for the disease according to the World Health Organization (WHO) [2]. Leprosy is a chronic infectious disease usually caused by Mycobacterium leprae, or Mycobacterium lepromatosis. Leprosy impacts the skin, the peripheral nerves, the upper respiratory tract, and the eyes. Without appropriate treatment Leprosy can lead to deformities and blindness, and therefore early detection and treatment is crucial. It is thought to be transmitted from person to person following prolonged close proximity. Leprosy is curable, and the WHO recommends multidrug therapy (MDT), a combination of either rifampicin and dapsone for multibacilliary (many bacilli) leprosy (MB), or rifampicin, clofazimine and dapsone for paucibacillary (few bacilli) leprosy (PB) [2]. Post-exposure prophylaxis has also been shown to reduce the risk of developing leprosy by 60% [3]. According to WHO guidelines Leprosy was categorized as ‘eliminated’ in Nepal in 2010 [4]. However, it remains an ongoing threat [4]. As can be seen from Box 1, elimination of a disease usually refers to either zero cases or zero transmission [5, 6]. However, the WHO went against accepted wisdom and unilaterally defined elimination as an incidence of less than one case per 10,000 people. The WHO definition * Frank Houghton [email protected] 1
HEALR Research Group, Limerick Institute of Technology, Limerick, Ireland
2
Department of Information Technology, Limerick Institute of Technology, Limerick, Ireland
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F. Houghton, M. Winterburn
Box 1 Standard definitions of terminology for the control and elimination of disease [5] • Control The reduction of disease incidence. prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Example diarrhoeal diseases • Elimination of disease Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts. Continued intervention measures are required. Example: neonatal tetanus • Elimination of infections Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts: continued measures to prevent re-establishment of transmission are required. Example: measles. pol
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