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BOOK REVIEW
Year : 2014  |  Volume : 139  |  Issue : 2  |  Page : 329-331

WHO Expert Committee on Leprosy


The Leprosy Mission Trust, India

Date of Web Publication9-Apr-2014

Correspondence Address:
P.S.S. Rao
CNI Bhavan 16, Pandit Pant Marg New Delhi 110 001
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Rao P. WHO Expert Committee on Leprosy. Indian J Med Res 2014;139:329-31

How to cite this URL:
Rao P. WHO Expert Committee on Leprosy. Indian J Med Res [serial online] 2014 [cited 2019 Aug 24];139:329-31. Available from: http://www.ijmr.org.in/text.asp?2014/139/2/329/130312

Eighth Report, WHO Technical Report Series, No. 968 (World Health Organization, Geneva, Switzerland) 2012. 68 pages. Price: CHF 20.00 / US$ 24.00; in developing countries: CHF 14.00 / US$ 16.80

ISBN 978-92-4-120968-7

The WHO Expert Committee on Leprosy held its eighth meeting in Geneva, Switzerland from October 12 to 19, 2010. The last meeting of this committee was held in 1997, when multi-drug therapy (MDT) was just being introduced worldwide, and governments of various countries were looking forward to finally conquering the dreaded disease.

The Expert Committee was constituted of ten members experienced in leprosy work worldwide, five temporary advisors, three representatives from other international leprosy organizations, and a secretariat of two. The members reviewed the progress made so far since the last meeting, interesting developments in various countries (including India, a major contributor of leprosy cases) and critically analyzed the successes and failures. The Eighth report is presented in nine chapters, apart from acknowledgements and references.

Chapter 1 is a preamble which states that despite significant progress in controlling the disease and reducing the disease burden, much still remains to be done to sustain the gains and further reduce the impact of leprosy, especially in terms of its physical, mental and socio-economic consequences for those affected and their families. The major purposes of the meeting were to analyze the global situation by reviewing the current status of developments in areas such as the treatment of leprosy and its various complications, to consider the results of research and experience in leprosy control since the previous meeting and to review existing indicators of progress to determine whether better indicators could be introduced; and finally to advise on technical and operational issues relating to efforts aimed at further reducing the burden due to leprosy.

Chapter 2 summarizes the leprosy scenario in the world referring to various published statistics and cautioning the reader to make careful interpretations of time trends and geographical variables due to many operational differences between various national programmes and the fact that the data cover different time periods. Nevertheless, the information provided gives valuable clues on the trends in leprosy control, using prevalence and incidence statistics. The Committee concludes that the disease remains endemic in all the countries of the African and South-East Asia regions and in most countries of the East Mediterranean region. However, there have been tremendous declines in registered prevalence since 1980 in all countries, largely due to the aggressive implementations of MDT. Likewise, the case detection rates have also shown steady declines reflecting both the improvements in the socio-economic conditions and the effects of leprosy programmes. The Committee observed that the steady fall in case detection has not been uniform, neither among the countries nor over the years and the fluctuations have occurred as a result of special case detection campaigns and other operational factors. The findings are aptly condensed in three tables and a global map of case detection rates in 2009.

Chapter 3 outlines the epidemiology of leprosy starting with basic definitions, standard classifications, issues in transmission, risk factors, incubation period and infectiousness, as well as geographical variations. There are no new findings and this chapter ends with a note on the possible interaction between HIV infection and leprosy.

Chapter 4 deals with Chemotherapy and Management reviewing standard regimes and existing second line anti-leprosy drugs such as ofloxacin, minocycline and clarithromycin and promising new anti-leprosy drugs such as moxifloxacin, rifapentine and diarylquinoline. The Committee mentions that no firm conclusions can yet be drawn on the shortened uniform multi-drug therapy regimen. Suggestions have been made for patients who cannot take rifampicin or dapsone. One section deals extensively on management of leprosy reactions and neuritis, emphasizing the key role of corticosteroids. Guidelines for management of severe reactions mainly emphasize the role of clofazimine with no new recommendations. The Committee discussed the need for greater emphasis on disability management and rehabilitation, and reviewed existing practices.

Chapter 5 deals with social issues not addressed intensively in previous expert committee meetings. It is disappointing that the Committee does not refer to more recent literature or more modern concepts of integrated management of leprosy disability. Chapter 6 covers the wide area of leprosy control and prevention and is probably the most useful chapter in the whole report. It covers the methods to improve the quality of leprosy services, overcoming possible obstacles in integrated leprosy control and general health services, strengthening the referral services, building and maintaining national capacity, community awareness and education, improving case detections, treatment adherences, prophylaxis strategies, surveillance for drug resistance, and finally monitoring and evaluation. Of importance are the new indicators for monitoring progress and evaluating the quality of services including diagnosis, treatment and disability care.

The last three chapters are quite brief dealing with strategy for further reducing the disease burden due to leprosy (Chapter 7), Research priorities (Chapter 8) and Conclusions and Recommendations (Chapter 9). Among the research priorities, the Committee highlights the role of molecular tools and the need to develop and improve diagnostic tests to identify individuals with the disease or those who are at a high risk of developing leprosy. The Committee stresses the need for more research in the area of prevention and management of nerve function impairment, chemoprophylactic and immunoprophylactic tools, operational, epidemiological and implementation research, focussing on stigma and biosocial aspects of leprosy.

About 97 references are cited in the end, many of them are quite outdated. Much more relevant recent literature could have been listed for the benefit of scientists and other readers. Compared to earlier expert committee reports, the current document lacks the depth, insights and more aggressive approach to reducing the burden due to leprosy. Guidelines for management of severe reactions, energizing the integrated system, methodology for monitoring and evaluation and the role of BCG are some examples where one could have benefited by a more open approach by the Committee and more definitive research plans involving global leadership. Nevertheless, this report will still be valuable for all those interested in leprosy control, medical colleges, other academic and research organizations.




 

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