Leprosy
Mailing List, August 24th, 2009
Ref.:
We are not going to eliminate leprosy while we do not treat
reservoir cases adequately!
From:
Ganapati R.,
Munbay
,
India
Dear
Dr Warren,
Many
knowledgeable clinicians will definitely like to join your cry in the
wilderness (ref LML, August 20, 2009). Your
views on “reservoir cases” representing the very basis of leprosy
transmission have been deliberately ignored by the guardians of public
health since the advent of MDT. In
their attempt to over- simply the complex clinical facets of the
disease, they devised a “made easy” solution for collecting
statistics and have painted a rosy picture.
Many are still gloating over the success of reaching the goal
of 1 case per 10,000 population. Over
this long period the science of clinical leprology unfortunately
has been sidelined.
In
our experience in Bombay, true relapses in multibacillary leprosy with
bacterial positivity are encountered as late as 10 to 15 years after
stopping treatment (irrespective of the treatment regimens and
duration of therapy) raising the possibility of recycling of
transmission of the disease. Poorly
managed type 1 and 2 reactions with uncontrolled neuritis are
thronging our referral centres.
It
is a paradox that donors are made to believe that leprosy is
eradicated. NGOs solely
depending upon public donations are virtually deprived of money and
manpower.
Your
emphatic reference to the prevailing poor knowledge about relapses and
nerve damage due to reaction should be an eye opener to the public
health experts and make them devise a fresh mass strategy to eradicate
the disease before it is too late.
With
regards,
Dr
R Ganapati,
Director
Emeritus,
Bombay
Leprosy Project
