Leprosy
Mailing List, August 20th, 2009
Ref.:
We are not going to eliminate leprosy while we do not treat
reservoir cases adequately!
From:
Warren G.,
Sidney
,
Australia
Dear
Salvatore,
Thank
to Dr Pannikar for the latest in WHO statistics (LML Aug. 18th
, 2009). I used to get
them direct but that seems to have ceased. I much preferred to
read the ones from
India
showing how many cases they are finding which somehow do not get on
the register.
Is
there anyway we can get WHO to be more realistic?
One of my objections is that their figures do not come from
every country. Yes, I
know that is the choice of the country to send in or not, but some
countries not there do have considerable case loads, and
many do not want to acknowledge that!
Another
objection is that they record so few relapsed cases.
Yes, easy when the patient I removed from the register when he
has completed the WHO MDT! If he reappears with new lesions
he is a new case! WHO say very few relapses! I hate to
think of the number I personally have seen in the last 20 years.
Patient who have officially completed the WHO MDT.
Next
is that applying the WHO definition eliminates a lot of the early LL
type patients we see on east Asia (especially in Chinese skins). With
over 15 years resident in Hong Kong I know that many LL patients
do not develop sensory abnormalities for 10-20 years during which time
they can be highly infectious, and in a large proportion there
is no obvious skin lesion though if you are very astute you may
realises the skin is infiltrated in very large patches! The
use of slit-skin smears or even nose blows will show these
people with high Bacillary Index. Once
our main proof and very useful is recording progress!
Am
I a voice crying in the wilderness? One
problem is that the general public read the WHO statements and
believing them say that leprosy work no longer requires extra
funding!
Another
is that Countries that use WHO free MDT often do not finish treatment.
Very few true well
established LL patients will be completely "cured" in 12
months, especially if they have had steroids with the MDT. Many
continue with ENL and get progressive nerve involvement, but the
local medicos say: - Oh They have finished MDT- No they are not on it
specific anti-leprotics-
Please
can there be some way of getting this rectified. We
are not going to eliminate leprosy while we do not treat these
reservoir cases adequately!
Grace
Warren.
