Analysis of newly detected leprosy in Sohag Governorate, Upper Egypt, 2004-2008.

INTRODUCTION: Leprosy is a chronic and complex infectious illness; the new-case detection rate is better than prevalence as an indicator of disease trends. This study presents an analysis of pattern of new cases of leprosy detected annually from 2004 to 2008 in Sohag Governorate, Upper Egypt. PATIENTS AND METHODS: Data about patients with newly diagnosed leprosy were collected from Sohag leprosy hospital, the main referral centre in the governorate. Case detection rates (CDR) were calculated for each year by dividing the newly diagnosed cases by mid-year populations for the same year. RESULTS: 587 patients were newly diagnosed between 2004 and 2008. The mean age of patients at diagnosis was 34 years, 62% were males, and 11% were children below 15 years of age. The overall leprosy case detection rate was 3-1/100,000 population and it decreased from 3.4/100,000 population in 2004 to 2.8/100,000 population in 2008. Ninety three percent were classified as multibacillary, and 20.4% had Grade 2 disability at diagnosis. CONCLUSIONS: Leprosy remains a health problem in Sohag Governorate. It is possible that new cases are being detected late owing to inadequate community awareness of the disease. Leprosy control activities should be provided in primary health care units in order to detect new cases, and continued surveillance is required to detect relapses and to ensure good patient compliance with treatment.

Epidemiological trends of leprosy in an urban leprosy centre of Delhi: a retrospective study of 16 years.

This study was done by collecting the retrospective data from 1994 to 2009 of patients attending the urban leprosy centre attached to the department of dermatology, STD & leprosy of PGIMER & Dr. R M L Hospital, New Delhi. The data was analysed according to age, sex, type of leprosy, leprosy reactions, deformities and relapse and compared with the national figures by comparison of proportions after taking the national data per 10,000 population. A total of 3659 patients attended our ULC (Urban Leprosy Centre) among which 2741 were male and 945 females (M:F-3:1). 669 patients (18.2%) were children. The data analysed show a gradual decline in new case detection rate with a marginal rise in 2005 and 2008. Percentage of MB cases was falling consistently till 2005 after which it showed an abrupt rise. The incidence of type 1 reaction varied from 21% in 1994 to 10% in 2009 in PB patients and from 6% in 1994 to 8% in 2009 in MB patients. The trend of type 2 reactions in MB patients showed a slow declining trend. MDT completion rate showed an impressive improvement from 56% in 1994 to 90% in 2009. The number of patients revisiting the ULC with features of relapse also showed a decrease in number. The pattern of visible deformities showed an almost constant trend similar to national figures. Improved MDT completion rate helps in reducing the disease transmission, severity, reactions and disabilities.

Newer trends in the management of genital herpes.

Management of genital herpes is complex. Apart from using the standard antivirals, an ideal management protocol also needs to address various aspects of the disease, including the psychological morbidity. Oral acyclovir, valacyclovir or famciclovir are recommended for routine use. Long-term suppressive therapy is effective in reducing the number of recurrences and the risk of transmission to others. Severe or disseminated disease may require intravenous therapy. Resistant cases are managed with foscarnet or cidofovir. Genital herpes in human immunodeficiency virus-infected individuals usually needs a longer duration of antiviral therapy along with continuation of highly active anti retroviral therapy (HAART). Genital herpes in late pregnancy increases the risk of neonatal herpes. Antiviral therapy and/or cesarean delivery are indicated depending on the clinical circumstance. Acyclovir appears to be safe in pregnancy. But, there is limited data regarding the use of valacyclovir and famciclovir in pregnancy. Neonatal herpes requires a higher dose of acyclovir given intravenously for a longer duration. Management of the sex partner, counseling and prevention advice are equally important in appropriate management of genital herpes. Vaccines till date have been marginally effective. Helicase-primase inhibitors, needle-free mucosal vaccine and a new microbicide product named VivaGel may become promising treatment options in the future.

A review of trends in new case-detection in Subarnapur district of Orissa.

Trends in new case-detection are analysed by reviewing the demographic and leprosy epidemiological data and current indicators in Subarnapur district, Orissa State and India. Population-specific new case-detection rates were calculated for analysis. The trend of skin-smear positive cases over a period of 10 years was reviewed in respect of smear positive cases of 1991. During the years 2002 to 2004, a sudden fall was noticed in the new cases detected in both India and Orissa state, whereas the decline in Subarnapur district was more gradual. The fall in the female-specific new case-detection rates is found to be rapid from 11 to 2.5 over the last three years. This also indirectly indicated the health-seeking behaviour of women in accessing health services and hence required a changed strategy. A similar rapid decline was observed in child-specific new case-detection rates. On analysiS, the decline of highly bacilliferous cases from 1991 to 2001 was found to be statistically significant. The analysis also brought out the fact that cases with bacterial index of 1+, 2+ and 3+, though small in numbers, were detected during the last three years indicating continued presence of cases with low bacterial density in the community. The review indicates a definite decline in the occurrence of new cases in all groups. Caution needs to be exercised about continued presence of cases with low bacterial index though in small numbers. The rapid decrease of cases in all groups during the years 2004 and 2005 warrants meticulous surveillance. The surveillance activities could include monitoring of population-specific new case-detection rates and skin-smear positive cases at district and state levels in order to advise on leprosy eradication programme strategies.

Trends in leprosy over fifty years in Gudiyatham Taluk, Vellore, Tamil Nadu.

This paper presents epidemiological trends over a fifty-year period observed in a defined population served by the Schieffelin Leprosy Research and Training Centre (SLR & TC), Karigiri, Vellore District in Tamil Nadu. It covers three distinct periods, namely, the pre-MDT era with dapsone monotherapy, the MDT era under a vertical leprosy control programme and the MDT era after leprosy control services were integrated into the general health services. Prevalence rates have declined steadily from 125 per 10,000 population at the time of introduction of MDT in 1982 to 5 per 10,000 at the time of integration in 1997 to less than 1 per 10,000 in 2005. The new case-detection rate was 5.4 per 10,000 when the field programme started in 1962, and held steady at 15-20 per 10,000 between 1970 and 1980. It then showed a gradual fall from 10.8 per 10,000 in 1985 to 3.9 at the time of integration, and continued to fall in the post-integration period and was 0.8 per 10,000 in 2005. The mean age at detection showed a gradual increase from 23.4 years in the dapsone era to 31.2 years in the post-integration period. The male: female ratio showed a preponderance of males almost throughout the reference period. While polar types of leprosy (TT & LL) were common in the dapsone era, more of borderline leprosy (BT & BL) cases was seen more recently. MB rates that were high initially, declined steadily during monotherapy and stabilized between 10% and 12% during the vertical MDT programme and is showing an increase in the post-integration-period. The proportion of cases with Grade 2 disability at registration showed a gradual decline during the monotherapy period, remained relatively unchanged at 8%-10% during the the MDT period, and showed a sharp rise in the immediate post-integration period before falling. Analysis of trends of leprosy in a well-defined geographical population over a fifty-year period gives useful information on how the disease has evolved over the years. It provides opportunities to explore the reasons for the changes observed, though one has to be cautious while interpreting such data due to changes in definition, the play of operational factors, and changes in policies and strategies.

Epidemiological trends of leprosy elimination in CLTRI rural field operation area, Tamil Nadu, India.

The analysis of computerized data of patients in our Rural Field Operation Area (Kunrathur Taluk, Kancheepuram District, Tamil Nadu) from the start of MDT in 1986 has shown a decrease of leprosy prevalence from 275/10000 in 1986 to 0.7/10000 in 2005. Leprosy has been eliminated as a public health problem after 19 years of MDT implementation. Although the control programme was started in 1962, MDT implementation began only in 1986. The new case-detection rate has declined significantly from 27.3 in 1987 to 2.4/10000 in 2005 (y = -1.6x + 2325.1, p = < 0.05). The age-specific cumulative detection rates calculated showed highest case-detection at 10-14 years for total, 10-14 years for PB, 50-54 for MB, and 10-14 for both males and females. MB percentage was more among new cases in the last three years as compared to the initial three years, and this difference was found to be statistically significant, but there was no significant difference between the first three and the last three-year periods in child, male and disability rates (grade +/-2) among new cases. Thus, the declining trend in NCDR has not reflected any change in sex and age-groups of new cases. This analysis strengthens the hypothesis of sub-clinical cases possibly transmitting the disease and MB cases accruing after long incubation period.

Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998.

OBJECTIVE: To assess the structure and performance of and support for five infectious disease surveillance systems in the United Republic of Tanzania: Health Management Information System (HMIS); Infectious Disease Week Ending; Tuberculosis/Leprosy; Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome; and Acute Flaccid Paralysis/Poliomyelitis. METHODS: The systems were assessed by analysing the core activities of surveillance and response and support functions (provision of training, supervision, and resources). Data were collected using questionnaires that involved both interviews and observations at regional, district, and health facility levels in three of the 20 regions in the United Republic of Tanzania. FINDINGS: An HMIS was found at 26 of 32 health facilities (81%) surveyed and at all 14 regional and district medical offices. The four other surveillance systems were found at <20% of health facilities and <75% of medical offices. Standardized case definitions were used for only 3 of 21 infectious diseases. Nineteen (73%) health facilities with HMIS had adequate supplies of forms; 9 (35%) reported on time; and 11 (42%) received supervision or feedback. Four (29%) medical offices with HMIS had population denominators to use for data analyses; 12 (86%) were involved in outbreak investigations; and 11 (79%) had conducted community prevention activities. CONCLUSION: While HMIS could serve as the backbone for IDSR in the United Republic of Tanzania, this will require supervision, standardized case definitions, and improvements in the quality of reporting, analysis, and feedback.

La lepra en el país, necesidad diagnóstica / The leprosy in Argentina, diagnosis necessity

Tras una breve reseña de la situación epidemiológica imperante en la Argentina al principio del año 1984, inicio oficial de la implementación del tratamiento Poliquimioterápico Supervisado recomendado por la Organización Mundial de la Salud (TMD/OMS), se menciona la metodología de trabajo de la Asociación Alemana de Asistencia al Enfermo de Lepra (DAHW) y su representante fiduciaria en el país, la Sociedad Alemana de Beneficencia (DWG) en la lucha contra la lepra en las provincias y en Capital Federal y el Gran Buenos Aires (19 partidos), siempre en coordinación con los diferentes programas provinciales y con el Programa Nacional de Control de Lepra (PNL). Se comunica una actualización del estado de la lepra en la República Argentina al 31/12/94 y se realiza un análisis de la importancia de la necesidad de un diagnóstico precoz para posibilitar un tratamiento adecuado, único medio actual de controlar la lepra, cortando su cadena epidemiológica y evitando el tan temido estado de discapacidad hanseniano.

La lepra en el país, necesidad diagnóstica / The leprosy in Argentina, diagnosis necessity

Tras una breve reseña de la situación epidemiológica imperante en la Argentina al principio del año 1984, inicio oficial de la implementación del tratamiento Poliquimioterápico Supervisado recomendado por la Organización Mundial de la Salud (TMD/OMS), se menciona la metodología de trabajo de la Asociación Alemana de Asistencia al Enfermo de Lepra (DAHW) y su representante fiduciaria en el país, la Sociedad Alemana de Beneficencia (DWG) en la lucha contra la lepra en las provincias y en Capital Federal y el Gran Buenos Aires (19 partidos), siempre en coordinación con los diferentes programas provinciales y con el Programa Nacional de Control de Lepra (PNL). Se comunica una actualización del estado de la lepra en la República Argentina al 31/12/94 y se realiza un análisis de la importancia de la necesidad de un diagnóstico precoz para posibilitar un tratamiento adecuado, único medio actual de controlar la lepra, cortando su cadena epidemiológica y evitando el tan temido estado de discapacidad hanseniano. (AU)

Tendência secular da detecçäo da hanseníase no Estado de Säo Paulo (1934-1983) / Secular tendency of Leprosy detection in Säo Paulo state (1934-1983)

A partir de uma amostra de casos de hanseníase detectados no Estado de Säo Paulo entre 1934 e 1983, obtida do Arquivo Central da Divisäo de Hansenologia e Dermatologia Sanitária do Instituto de Saúde, da Secretaria de Estado de Saúde de Säo Paulo, descreve-se e avalia-se a tendência secular da endemia no Estado. É estudada a tendência dos coeficientes de detecçäo brutos e específicos por sexo e grupo etário, bem como das proporçÆes das diversas formas clínicas da doença. A razäo de sexo, a razåo de coeficientes de detecçäo por sexo e grupo etário e os indíces de forma clínica såo discutida em comparaçäo com relatos referentes a outros países ou regiÆes que apresentaram tendência secular semelhante. Como o período abrangido inclui marcos importantes na evoluçäo da terapêutica e do enfoque das políticas de controle da hanseníase, ensaia-se uma interpretaçåo do fenômeno epidemiológico observado em funçäo de características das diversas etapas consideradas. A tendência global das taxas de detecçäo da hanseníase no período estudado é de declínio, notando-se discreta ascensäo apenas nos três últimos quinquenios (1969-1983). O comportamento da tendência dos indicadores específicos mostra que, inclusive por comparaçåo com relatos de outros países e regiöes com incidência em declínio, apenas as duas décadas subsequentes à introduçäo da sulfonoterapia (1949-1968) podem ser consideradas como de queda real de incidência. Os mesmos indicadores revelam que provavelmente a diminuiçäo das taxas de detecçäo correspondentes às décadas de 1930 e 1940 tenha sido devida principalmente a fatores operacionais relacionados às estratégias de implementaçäo da política de controle adotada na época