Nepal could be inching towards a leprosy resurgence, a decade after it declared elimination of the disease.
The situation in Nepal mirrors that of its neighbour to the south. India, too, declared eradication of leprosy. Yet, in recent years, the disease has displayed symptoms of a resurgence. The 2017-18 period saw 90,709 leprosy cases reported – an increase from the 2013-14 period, when 86,147 cases were reported. This has frustrated efforts by the Centre to eradicate the disease entirely, missing a target of doing so by 2018.
In Nepal, the prevalence of leprosy currently stands at 0.94 percent according to health officials. This represents an increase from 2017, when prevalence stood at 0.92 percent to 0.89 percent in 2016. The upward trajectory of Nepal’s leprosy incidence in recent years exposes the frailty of disease elimination.
“Disease elimination is undoubtedly a public health achievement…however, for as long as a disease is eliminated, it still maintains a presence. Without sufficient controls…resurgence is an ever-present threat”
Disease elimination is undoubtedly a public achievement, one which positions a country closer to eradication of a disease altogether. However, for as long as a disease is eliminated, it still maintains a presence. Without sufficient controls to prevent the disease from spreading, resurgence is an ever-present threat.
In a country as populous as India, disease elimination is an even more precarious position. The acceptable prevalence to qualify for disease elimination could still denote significant numbers of cases. Leprosy is an apposite example. Even after having eliminated leprosy in 2005, India continues to diagnose a case of leprosy every four minutes and accounts for more than fifty percent of new leprosy cases recorded every year.
“The true burden of leprosy in India could be higher than what official figures suggest”
This is bearing in mind the possibility that the true burden of leprosy in India could be higher than what official figures suggest. What this could entail is that India is already over the threshold for leprosy elimination: less than one case per 10,000 cases.
As Anil Kumar, deputy director general for leprosy at the Union Ministry of Health and Family Welfare, told IndiaSpend, “leprosy is not rising in India, the numbers are rising because we are detecting more cases.” In years to come, numbers could very well increase again – not necessarily indicating a spike, but rather reflecting hitherto unreported cases that are now coming to the surface.
This is the reality in Nepal. “It will take only a few years to reach one percent if this upward trend continues,” Dr Rabindra Baskota, chief of the Leprosy Control and Disability section of Epidemiology and Disease Control Division of Department of Health Services in Nepal, told The Kathmandu Post.
Leprosy has been an often neglected disease throughout history. Achieving elimination of the disease is an accomplishment, but one which requires continued management and vigilance to prevent a resurgence above elimination levels. The situations in India and Nepal serve as reminders of this frailty.