Towards a Leprosy-Free Country - China, 2011-2018.

What is already known about this topic? Leprosy is a chronic infectious disease that is endemic in several countries. Control of leprosy has had targets set by World Health Organization's (WHO) Global Strategy 2016-2020 and by China through a national leprosy-control plan (2011-2020). What is added by this report? Data from the Leprosy Management Information System in China was analyzed and showed a national prevalence of 0.178 per 100,000 and detection rate of 0.037 per 100,000 residents in 2018. In addition, all the main targets for 2020 have been met by 2018 except for the proportion of counties or cities to reach a prevalence of less than 1/100,000 and the proportion of children cases with grade 2 disability (G2D). What are the implications for public health practice? There are still challenges remaining to close the gaps between current progress and the targets set forth by the WHO and China. However, lessons learned in China in developing and implementing the national program may be invaluable for future plans to achieve and sustain elimination of leprosy at global and country level.

[A long-term evolution on the epidemiological characteristics of leprosy, towards the goal of its elimination in 1949 - 2007 in China].

OBJECTIVE: To understand the epidemiological characteristics of leprosy during the evolution of the disease, towards the goal of elimination for the past 50 years and longer, so as to provide experiences for accelerating eradication of leprosy in China. METHODS: Data were collected from National Surveillance System of Leprosy which was composed annually of all the data from county-based leprosy unit reporting system. All the data were reviewed retrospectively. RESULTS: A total number of 487 900 leprosy patients were reported from 1949 to 2007 in China. The case detection rate reduced from the highest of 5.56/100 000 in 1958 to the lowest of 0.12/100 000 in 2007. Leprosy patients mainly distributed in mountain areas in Yunnan, Guizhou, Sichuan, Guangdong Guangxi, Hunan and Jiangxi provinces with warm and damp climate and underdeveloped economy. After more than 50 years of leprosy control efforts, the case detection rate declined quickly in provinces in the eastern and the southern parts but very slowly in provinces in the western and the southwestern part of China. The ratio of relapsed patients to newly detected ones increased from 1:139 in 1960s' to 1:10 after 1980s', annually. The proportion of child cases among newly detected patients had been 3% - 4% since 1968. In the recent 20 years, the proportion of new patients with positive skin smear gradually increased and the rate of disability grade two reached 20% and more. The average age of new patients upon diagnosis was 45 years old in the east coastal provinces but only 38 years old in the southwest provinces. A new finding was that some new patients detected in the east coastal provinces were immigrants from the southwestern provinces. CONCLUSION: With continuous socio-economic development and active efforts on leprosy control, the prevalence of leprosy gradually declined despite the long evolution period. Some negative events seemed to have influenced the trend of case detection.

Studies on risk of leprosy relapses in China: relapses after treatment with dapsone monotherapy

Based upon the data from the Chinese National System for Leprosy Surveillance, this paper reports on the relapses in 297,343 leprosy patients [multibacillary (MB) 106,518, paucibacillary (PB) 190,825] cured by dapsone monotherapy. A total of 11,055 (MB 8675, PB 2380) patients relapsed during an accumulated follow-up period of 4,229,050 patient-years (PY), giving an overall relapse rate of 3.72 per 100 cases or 2.61 per 1000 PY, i.e., 8.14% or 5.91 per 1000 PY over an average follow-up period of 13.8 +/- 8.4 years in MB patients and 1.25% or 0.86 per 1000 PY over an average period of 14.5 +/- 8.9 years in PB patients. For either the overall relapse rate per 100 cases or per 1000 PY, the differences between MB and PB patients were statistically significant, except during 36-40 years of follow up. For both MB and PB patients, the relapse rates showed consistently significant decreases year by year, particularly in PB patients whose relapse rate per 1000 PY was 1.21 in year 10 of follow up; whereas it remained more than 10 per 1000 PY in MB patients. In view of that, the overall relapse rates in MB and PB patients cured by dapsone monotherapy were acceptably low, and most of these patients have been followed up for more than a mean incubation period of observed dapsone relapse. Along with the further extension of follow up, the risk of relapse in dapsone-cured patients will not be expected to increase. This conclusion should be considered when planning policy for the management of patients released from dapsone monotherapy.