**12. Elimination/prevention**

With MDT, in 1985, with 5.1 million leprosy cases falling to 3.1 million in 1991, WHO aimed to eliminate leprosy worldwide in 2000. Elimination target was 1/10,000. Countries like India and Brazil have been under the target even though the target has been reached substantially around the world. Although Brazil is one of the last countries to reach the goal today, endemic areas like Chhattisgarh, Pará and Madura are still far behind the target. On the other hand, in spite of successful elimination program, WHO declared in 2013 that leprosy control is faltered due to the plateau of the incidence of leprosy until 2005, the new diagnosis of leprosy cases with G2D remain constant between 2010 and 2013, and the number of new cases in children is not decreasing. In addition, late-diagnosis-related disabilityending stigmatization of leprosy patients continued. Epidemiological data showed that the prevalence-based elimination program could not stopped the spreading. The meeting was held in Brazil in 2015 and the strategy was changed. A strategy based on incidence instead of prevalence was identified. Early diagnosis and prompt inclusion of all patients to treatment were aimed [30, 106, 107].

**Author details**

**References**

Nebahat Demet Akpolat<sup>1</sup>

2006;**77**:377-380

142-155

1 Beykoz State Hospital, Istanbul, Turkey 2 Tunceli State Hospital, Tunceli, Turkey

who.int/wer/2012/wer8734.pdf?ua=1

\*, Ayse Akkus<sup>2</sup>

\*Address all correspondence to: drdemetakpolat@gmail.com

and Emre Kaynak<sup>2</sup>

An Update on the Epidemiology, Diagnosis and Treatment of Leprosy

http://dx.doi.org/10.5772/intechopen.80557

53

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[2] Global Leprosy update, 2015: Time for action, accountability and inclusion. Weekly

[3] Smith WC, van Brakel W, Gillis T, Saunderson P, Richardus JH, Soares R.The missing millions: A threat to the elimination of leprosy. PLoS Neglected Tropical Diseases. 2015;**9**(4):e0003658

[4] Lastória JC, Abreu de MAMM. Leprosy: Review of the epidemiological, clinical, and etiopathogenic aspects—Part 1. Anais Brasileiros de Dermatologia. 2014;**89**(2):205-218 [5] International Textbook of Leprosy [Internet]. Available from: http://www.internationaltextbookofLeprosy.org/chapter/epidemiology-Leprosy [Accessed: Sep 22, 2017]

[6] Penna MLF, Oliveira MLW, Carmo EH, Penna GO, Temporão JG.The influence of increased access to basic healthcare on the trends in Hansen's disease detection rate in Brazil from 1980 to 2006. Revista da Sociedade Brasileira de Medicina Tropical. 2008;**41**(Suppl 2):6-10

[7] Moorthy KVK, Desikan KV. Indeterminate leprosy in an infant. Leprosy Review.

[8] Rao PN. Global leprosy strategy 2016-2020: Issues and concerns. Indian Journal of

[9] Job CK, Jayakumar J, Kearney M, Gillis TP. Transmission of leprosy: A study of skin and nasal secretions of household contacts of leprosy patients using PCR. The American

[10] Ghorpade A. Inoculation (tattoo) leprosy: A report of 31 cases. Journal of the European

[11] Bratschi MW, Steinmann P, Nnawickenden A, Gillis T. Current knowledge on Myco bacterium leprae transmission: Asystematic literature review. Leprosy Review. 2015;**86**:

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Living in the same house with a leprosy person increases the risk of spreading by 2–10 fold. Most of the new cases constitute subclinical infection cases in contact and no diagnosed cases. For this reason, for eliminating leprosy, it is very important to detect new cases with effective contact monitoring. The development of diagnostic tests that can detect subclinical infection and separate exposure to and infection with *M. leprae* is very important [101, 108].

#### **12.1. Immunoprophylaxis/chemoprophylaxis**

In fact, BCG, which is tuberculosis specific, is the only vaccine used for leprosy protection. The level of protection, as well as the protection against leprosy is evidenced, varies between 20% and 90% in the literature. Protection level of the vaccine, when vaccinated in first decade, was higher in women and lower socioeconomic individuals [109]. With age, the level of protection decreases [110]. Although it has been shown that revaccination of leprosy patients and contacts with them have been shown to reinforce the protection, this approach is still not common and there is a need for studies evaluating efficacy [39, 111].

Protection of post-contact chemoprophylaxis (PEP) has been shown in clinical trials in a range of 35–57% in patients with asymptomatic contact. Although it is not included in WHO's official recommendations, PEP evaluations rapidly continue with a single dose of rifampin (SDR). One study has shown that the protection of PEP with BCG combination is better in distant-contact individuals [112]. With the cooperation of Novartis agency and Netherlands Leprosy Relief (NLR), Leprosy Post-Exposure Prophylaxis (LPEP) program has been established. A large-scale study was started to investigate the applicability of the use of SDR as a PEP by the program and the impact on the number of new diagnosed cases. It is expected that the first data will be obtained in 2019 [113].

#### **12.2. Prevention of disability**

Permanent nerve damage is a part of the natural process of the disease, and the risk is also quite increased with leprosy reactions. Reducing the stigmatization of leprosy patients and providing mental well-being is possible by preventing nerve damage. Delay in recognition of leprosy and leprosy reactions, and therefore of delay in treatment is the most important factor on permanent nerve damage. Follow-ups should be done in leprosy centers whenever possible. It is important to ensure compliance with treatment and follow-up. Patients should be educated on issues such as care of existing wounds, proper shoe selection, self-examination of hands and feet. Another important point is that the leprosy does not come to mind because of the rare occurrence in some areas and the patients are followed up with false diagnoses. The implementation of information programs for healthcare professionals is also important in this context [114–116].
