Risk of relapse among non-lepromatous patients released from treatment after dapsone monotherapy.

Information on 14,625 non-lepromatous patients released from treatment after dapsone monotherapy and followed up to a maximum of 15 years at the ILEP project. Dharmapuri, India, was analysed to study the pattern of relapses. The overall relapse rate was 5/1000 person years. Males had a higher relapse rate than females. The risk of relapse increased with age, number of lesions and duration of treatment. The risk for relapse remained constant over several years after release from treatment. Even though the absolute risk for relapse after MDT may be different, the pattern of relapses and the factors affecting it may be similar to what has been shown in this study.

Survey of the unexamined population in the villages included in a sample survey of the ELEP Dharmapuri Leprosy Project.

In a sample survey of the ELEP Dharmapuri Leprosy Control Project out of a population of 62984, 51205 was examined i.e. 81.3%. Subsequently out of the enumerated unexamined population of 11779, 5761 were examined and 67 cases were detected giving a prevalence of 11.62 which was less than the prevalence in the sample survey. With an examination of 90.45% of the population there was not much of an alteration in the gross and child prevalence rates as also the lepromatous rate. A sample survey with examination of 80% of the population gives a representative view of the leprosy situation in an area.

A sample survey of leprosy in the ELEP Leprosy Control Project, Dharmapuri, Tamil Nadu.

A sample survey of the Dharmapuri Leprosy Control Project was undertaken in 1983; a population of 60855 was enumerated out of which 51205 was examined. The sampling procedure which was followed consisted of stratifying the sub-centres according to prevalence and classifying the villages by the size of the population. Villages were selected by random allocation. 10 leprosy inspectors participated in the survey examining 626 to 774 persons per day. 859 active cases were detected giving a prevalence of 16.77 per thousand. The child prevalence was 6.19 per thousand. The number of lepromatous and BL cases detected were 70 giving an infectivity rate of 8.15%. The prevalence of leprosy as found in the last survey conducted in the different areas in the project approximate to those of the sample survey. Therefore it could be said that the prevalence has decreased in this project from 19.94 per thousand as observed in the first survey. The child prevalence has likewise decreased from 9.40 to 4.09 in the project.

A study of relapse in non lepromatous and intermediate groups of leprosy.

Dapsone has been used as a monotherapy and in well organised control units, the prevalence of leprosy has come down. The relapse rates presented in this communication are quite low compared with those reported by various authors quoted in this paper. Relapse rates appear to remain steady at about 5/1000 for each following year after R.F.C. for 7 years. This relapse rate does not appear to be related to regularity of treatment. The relapse rate appears that longer the duration of treatment, the earlier relapse due to severity of the disease of those who had longer treatment. Health education for R.F.C. cases on signs of relapse is a must before they are declared R.F.C. The levels of Sulphone in the blood remain above MIC for as much as ten days after the last dose and therefore Dapsone allows self-administration. It is expected that with the introduction of bacteriocidal drugs in the treatment of paucibacillary leprosy, the relapse rates would go down. As observed from a study conducted in Jalma, maintenance treatment as advocated by the NLCP (1964) and WHO (1970) does not seem to be necessary. The necessity of such maintenance treatment may be obviated with the use of multi-drug regimen in paucibacillary leprosy. This would enable a large number of cases to be released from control thereby reducing patient load considerably and making the supervised treatment of multibacillary cases more easy.