1. Introduction

Leprosy or Hansen disease is caused by an infection of Mycobacterium leprae, an acid-fast, rodshaped bacillus, usually acquired through contact with an infected person. However, not every person exposed to an infected contact will develop leprosy [1]. M. leprae multiplies slowly, and the incubation period of the disease, on average, is 5 years. In some cases, symptoms may occur within 1 year but can also take as long as 20 years to occur. Clinical presentation depends on the patients' immune status at the time of infection and during the course of disease. Leprosy is associated with disability and marginalization [2].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fourteen countries reported more than 1000 new cases, of which three countries—India, Brazil, and Indonesia—account for more than 80% of all the cases in the world [2]. The World Health Organization (WHO) reported that there were approximately 213,899 newly diagnosed patients in 2014 (a detection rate of 3.0/100,000 population), with 94% of LPs located in only 13 countries, one of which was Indonesia [3]. Indonesia's Ministry of Health reported 16,131 newly diagnosed cases of leprosy in 2014. On the other hand, the Department of Health found 498 cases of pauci-bacillary leprosy and 3337 cases of multi-bacillary leprosy [2]; the highest number of which were found in the Jember district. The Global Leprosy Strategy 2016–2020 released in April 2016 underscored its goal of "accelerating towards a leprosy-free world" and its commitment to an approach based on the principles of initiating action, ensuring accountability, and promoting inclusion [4]. The Global Leprosy 2016–2020 aims to detect early leprosy and prompt treatment to prevent disability and reduce transmission of infection in the community. The proportion of G2D cases (2 degree disability) among newly diagnosed patients and G2D levels in a population indicates the efficiency of early leprosy detection. They also showed indirectly the level of awareness of early signs of leprosy, access to leprosy services, and the skills of health care staff in diagnosing leprosy. This strategy is designed to achieve the long-term goal of a "leprosy free world," which refers to situations where societies are free of morbidity, disability, and social consequences due to leprosy [3]. Since 1980 era, Leprosy remains a problem in public health in Indonesia. The program implemented in Indonesia reduced the prevalence to 17,539 cases in 2000. The prevalence was 86% decreased in a 15-year period. It has been noted that a significant increase in leprosy control is due to the large-scale promotion of leprosy prevention and multidrug therapy (MDT) in more than 5600 primary health centers in Indonesia [5].

Over the past 20 years, more than 16 million leprosy patients have been treated. The prevalence rate of the disease has declined by 99%: from 21.1 cases per 10,000 people in 1983 to 0.2 cases per 10,000 people by 2015. According to official reports received from 138 countries from all WHO regions, the global prevalence of leprosy by the end of 2015 was 176,176 cases (0.18 cases per 10,000 people). The number of new cases reported globally over the last 3 years is as follows: 2015: 211,973 (0.21 new cases per 10,000 people), 2014: 213,899 new cases, and 2013:

Leprosy: The Ancient and Stubborn Disease http://dx.doi.org/10.5772/intechopen.79984 5

As can be seen from the above table, only three countries reported more than 10,000 cases in 2015: India, Brazil, and Indonesia. With 127,326 new cases, India accounted for 60% of the global new cases; Brazil reported 26.395 new cases, representing 13% of the global new cases; and Indonesia reported 17,202 new cases, 8% of the global case load. In 2016, WHO has launched "Global Leprosy Strategy 2016–2020: Accelerate towards a leprosy-free world" aimed at reviving leprosy control efforts and to avoid disability, especially among children affected by disease in endemic countries. This strategy emphasizes the need for ongoing expertise and increases the number of skilled leprosy staff, increases the participation of affected people in leprosy services, and reduces visible abnormalities—also called G2D defects—as well as the stigma associated with the disease. The targets of the new global

215,656 new cases (Figures 1–4; Table 1) [8].

strategy to be met by 2020 are [8]:

1. Without a disability among new pediatric patients.

Figure 1. Madarosis on facial region in Lucio phenomenon's patient.

2. The level of class-2 disability is less than 1 case per 1 million people.

3. Zero countries with laws that allow discrimination on the basis of leprosy.
