Comprehensive measures succeeded in improving early detection of leprosy cases in post-elimination era: Experience from Shandong province, China

Abstract

Background A few new leprosy cases still can be seen in Shandong province after elimination. In postelimination era, government commitments dwindled and active case-finding activities were seldom done. Most of the cases were detected by passive modes and advanced cases with longer delay and visible disability were common. Materials and methods Comprehensive measures including health promotion, personnel training, reward-offering, symptom surveillance and a powerful referral center were implemented in the past decade. The diagnosis of leprosy was mainly based on three cardinal clinical signs. Two-group classification system developed by the WHO was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. Cases detected during period 2007-2017 were analyzed and associated factors of grade 2 disability (G2D) were explored. Results 231 new leprosy cases detected during 2007-2017 were analyzed. The mean age at diagnosis is 51.7±16.0 years and the number of males, peasants, illiterates, MB cases, G2D cases and immigrants were 130(56.3%), 221(95.7%), 73(31.6%), 184(79.7%), 92(39.8%) and 40(17.3%) respectively. 181(78.4%) cases were reported by skin clinics and 152 (65.8%) cases came from formerly high endemic counties/districts. The annual number of new cases showed a decreasing trend, from 42 cases in 2008 to 13 cases in 2017. 92 (39.8%) cases presented with G2D at diagnosis. The annual proportion of new cases with G2D declined from 50%

Mycobacterium leprae transmission characteristics during the declining stages of leprosy incidence: A systematic review

“…In 1955, a comprehensive leprosy control programme was introduced with the establishment of the Provincial Skin Disease Control Institute and a network of Skin Disease Control Stations and leprosy hospitals [ 13 ]. Since its formation, over 50,000 cases have been registered, which made it one of the most highly endemic provinces in the country up until recently [ 35 ]. The prefecture-level city of Weifang in Shandong for example began to keep leprosy under control before the implementation of MDT, reducing the detection rate from 35.2/100,000 in 1956 to 0.7/100,000 in 1985 and further decreasing with MDT (under 0.1/100,000 in 1993) [ 36 ].…”

“…There are several factors cited which contributed to the decline of leprosy in Shandong: rapid economic development, effective case finding, isolated treatment of patients with MDT (and DDS monotherapy prior to the introduction of MDT) until smear negative, compulsory contact examination and BCG vaccination, which was initiated in the 1970s and reached 90% coverage in new-borns and schoolchildren by 1990 [ 36 – 38 ]. We collected data on 785 leprosy cases diagnosed in Shandong province from 1990 to 2017 [ 35 , 37 , 39 ]. All of the cases reported from these articles were suspected to be autochthonous and the mean case detection delay was 31.7 months.…”

“…All of the cases reported from these articles were suspected to be autochthonous and the mean case detection delay was 31.7 months. From 778 cases in two of the source publications [ 35 , 37 ], a total of 137 (17.6%) reported having a family history of leprosy. Other suspected sources included known contact with a leprosy patient, such as a neighbour or friend.…”

“…The incidence of leprosy in China as a whole is currently low and continuing to decline, with under 1,000 annual cases reported since 2013 for a population of approximately 1.4 billion [ 40 ]. Following the implementation of MDT in 1986, China achieved their goal of elimination (defined as less than one per 100,000) at a national level in 1994 [ 35 ]. From an epidemiological summary of cases in China in 2017, 634 newly detected cases of leprosy were reported, with an uneven distribution observed throughout the country.…”

Factors Influencing Leprosy Incidence: A Comprehensive Analysis of Observations in Wenshan of China, Nepal, and Other Global Epidemic Areas

“…However, some insist that leprosy can be transmitted via skin contact or other means. Infection of M. leprae results in anesthetic skin lesions, enlarged peripheral nerves, and acid-fast bacilli in the skin smear as the typical clinical signs of leprosy (2). Delayed diagnosis and treatment can lead to nerve damage presenting loss of muscle function or paralysis, even permanent disability (3).…”