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Increase in leprosy cases in Maharshtra creates fear

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With the number of new leprosy cases detected in Maharashtra showing a rise since 2009-10, there is a fear that the dreaded disease is alive and kicking.

The number of new cases detected in 2009- 10 was 15,071 which went up to 15,498 in 2010-11 and 17,892 in 2011-12. According to the state health department's figures, in 2012-13, the number of new patients detected was at a much higher 18,715, which, however, fell to 16,400 in 2013-14. In April 2014, 1,327 new cases were detected.

Consequently, the annual new cases detection rate (ANCDR) per lakh population has also risen from 12.99 in 2009-10, to 13.79 in 2010-11 and 15.69 in 2011-12. It stood at a higher 16.17 in 2012-13 and 13.96 in 2013-14 to end at 13.74 in 2014-15. The ANCDR was 13.74 for the month of April 2014. The percentage of child cases among the new cases detected was 11.50% in 2009-10, but rose to 13.01% in 2011-12 to end at a lower 12.70% in 2013-14.\

"Leprosy is a disease with an incubation period ranging from two years to 30 years," noted Dr Satish Pawar, director general of health services (DGHS), Maharashtra. "This is among the slowest growing organisms known unlike other bacteria... the epidemiology of a disease like leprosy is different," he explained, adding that the department held surveys every two to three years to detect leprosy in patients, which led to the number of patients being checked increasing in that period.

Pawar said the detected patients were put under treatment and rendered non-infectious within a month and modern treatment had ensured that leprosy did not reach alarming levels. However, he admitted that since this was a respiratory disease, people living in congested areas like slums were at risk. There were pockets in Mumbai, Thane, Chandrapur and Gadchiroli where the disease was prevalent.

Uday Thakar, managing committee member of the Kustharog Nivaran Samiti, Shantivan, Panvel, said integration of various leprosy eradication programs had also increased reporting of the disease and hidden cases had also come out of the closet. "However, in tribal areas... which are inaccessible, leprosy cases are prevalent," said Thakar, adding that the rise in new patients could also be attributed to the spread of infection.

According to the health department's statistics, the cure rate for paucibacillary (PB) leprosy was 97% in 2013 while that for multibacillary (MB) leprosy is 95%. The disease is classified into PB or MB based on the bacillary load.

Leprosy eradication activities were launched in Maharashtra by the Government of India in 1955 through the National Leprosy Control Program (NLCP). In 1981-82, multi drug therapy (MDT) was launched in the state in a phased manner, covering all districts by 1995- 96.

This helped reduce the prevalence rate from from 62.40/10,000 (3,12,877 balance leprosy cases under treatment) in 1981-82 to 14.70/10,000 (1,18,864 cases) after the first decade i.e. by end of 1991-92 and 3.27/10,000 (32,318 cases) after second decade (end of 2001-02) and 0.92/10,000 (10,813 balance leprosy cases under treatment) by March 2014 end. Maharashtra has 237 urban leprosy centres and four government leprosy dispensaries at Kondhwa in Pune, Osmanabad, Kolhapur and Ratnagiri.

Major challenges before the state include reaffirming political commitment and removing the sense of complacency, strengthening referral systems, developing effective tools for early recognition and management of leprosy reactions and nerve damage and improve the quality of life of patients. Moreover, recent reports of patients relapsing with drug-resistant strains are a cause for concern and a challenge lies in closely monitoring the development of drug resistance.

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