03040nas a2200409   4500000000100000008004100001260001300042653001100055653001300066653002300079653003300102653002100135653001100156653001600167653001800183653002100201653001100222653001000233653002300243653001200266653000900278653002800287653001500315653001500330653003000345653003000375100001200405700001700417700001400434245005900448856005100507300001000558490000700568050001500575520202600590022001402616       2004                            d  c2004 Mar10aAfrica10aAmericas10aAsia, Southeastern10aCommunicable Disease Control10aEndemic Diseases10aFemale10aForecasting10aGlobal health10aHealth Promotion10aHumans10aIndia10aLeprostatic Agents10aleprosy10aMale10aPopulation Surveillance10aPrevalence10aRegistries10aSeverity of Illness Index10aWorld Health Organization1 aMeima A1 aRichardus JH1 aHabbema D00aTrends in leprosy case detection worldwide since 1985.  uhttps://leprosyreview.org/article/75/1/01-9033  a19-330 v75  aMEIMA 20043 a<p>Trends in case detection and case detection rate (CDR) since 1985 are described at regional and national levels. Annual case detection by WHO Region was available for 1994-2000. Using different sources, complete time series for case detection were constructed for 1985-1998 for a group of 33 endemic countries cumulatively (top 33), and for 14 individual countries (top 14). Population statistics were used to derive CDRs. India contributed 79% to global case detection in 1998. Africa, the Americas and South-East Asia each contributed about 30% when India is excluded. During 1994-2000, case detection did not decrease in these three WHO Regions. The 33 countries contributed 99% and 98% to global case detection in 1994 and 1998, respectively. Cumulative case detection for the top 33 minus India gradually increased, overall almost doubling. The contribution of the top 14 to case detection of the top 33 hardly changed over time, equalling 96% in 1998 (81% when India is excluded). In terms of annual case detection, Brazil was always ranked second after India; it accounted for 27% of 1998 case detection in the top 33 except India. In 1998, seven of the top 14 countries--including India and Brazil--had CDRs above 2 per 10,000. The CDR did not exceed 1 per 10,000 for the other half. Decreasing tendencies in CDR, either for the whole period or in the 1990s, are observed for four of the top 14 countries (Guinea and three Western Pacific countries: China, Vietnam and the Philippines). In conclusion, there is no general decline in case detection to date, and several important countries still have high CDRs. Prevalence is an irrelevant indicator for monitoring epidemiological changes in leprosy. Trends in the transmission and incidence of leprosy are still completely unclear, necessitating further research. The target to eliminate leprosy as a public health problem, defined as a prevalence of less than 1 per 10,000, is therefore also an inadequate yardstick for decision making on leprosy control.</p>  a0305-7518