Assessment of Transmission Dynamics of Leprosy in India

Leprosy, a chronic mycobacterial infection caused by Mycobacterium leprae, is an infectious disease that has ravaged human societies throughout millennia. This pathogen causes disfiguring cutaneous lesions, peripheral nerve injury, osteoarticular deformity, limb loss and dysfunction, blindness and stigma. It affects the skin and peripheral nerves with a wide range of clinical manifestations of long-term nature, including permanent physical disability.
Even though, the Indian Ministry of Health launched The National Leprosy Eradication Programme (NLEP) in 1983, with government funds, India has high leprosy incidence and in 2016 contributed to about 63% of the global burden. Annual New Case Detection Rate (ANCDR) is 10.17 per 100,000 populations.
Despite ongoing efforts in interrupting leprosy transmission, large numbers of new cases are persistently identified in many endemic areas. Moreover, at the time of diagnosis, most newly identified cases have a considerable neurologic disability. Many challenges remain in our understanding of the epidemiology of leprosy including: the precise mode and route of transmission; the socioeconomic, environmental, and behavioral factors that promote its transmission; strategies to achieve early diagnosis and prevent neurologic impairment to reduce the large burden of disability among newly identified cases and among those who endure long-term disability despite completing multidrug therapy.

The current application developed for NLEP captures case-based data which can be aggregated at various levels i.e.: District, State, and National levels real time for analysis by the national team and to make effective policy decisions. The current leprosy information system captures demographic details of the patient as well as the history of migration which will come in handy in understanding the dynamics of the disease. The application allows classification of the case into PB and MB case based on the symptoms entered (i.e. peripheral nerves involved, nodules, etc.). The details of contact tracing, antibiotics given, and the status of treatment are being entered for all the patients. All the states are currently entering data at the Block level since April 2018.

Historically, the surveillance system has been paper-based or based on Excel sheets. HISP India’s objective is to strengthen and modernize the surveillance system. This requires a flexible information system responsive to the needs of NLEP towards understanding the dynamics in the disease transmission.