Clinical and Epidemiological Characteristics of Leprosy Patients in the Post Elimination Era: We Need to be Vigilant

After 15 years post elimination it is perhaps an opportune time for an appraisal of newly detected leprosy cases. The medical records of leprosy patients registered from 2009 to 2020 at Dermatology Clinic of Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh were analyzed retrospectively. The 381 (M:F 2.8:1) patients were aged between 5 and 90 years (mean 43.4 years). The majority, 76.9% patients were aged 21-60 years and 1.3% were children aged <15 years. Only 13.1% patients were migrants from other states. The MB leproasy was seen in 80.8% comprising mainly patients with BL (41.5%) and LL (31%). The 19.8% patients with PB leprosy had 17% in BT and 2% in TT spectrum. Fewer patients had pure polyneuritic (3.9%) and histoid (2.6%) leprosy in the MB spectrum. Lepra reactions occurred in 157(41.2%) patients and 85(54.1%) of them had recurrent type-2 lepra reaction with MB spectrum and 72(45.9%) patients in PB spectrum had type-1 lepra reaction. More 62.2% patients had grade-2 disabilities compared to 49.6% patients having grade-1 disabilities of hands and feet. Ocular and nasal disabilities happened in 3.9% and 1.3% patients, respectively. Perforation of the hard palate occurred in 1% patients. Relapse occurred 1.3% patients and 1.8% patients required extended MDT due to high MI even after 12 months' MDT. Our observations of high proportion of MB cases remain a major concern as it reflects delayed diagnosis, risk for disabilities /complications, magnitude of community infection, and poor access to the services. It belies the expectations of recognizing early signs of the disease and self-reporting by the patients during the integration of vertical control program with general health services. Frequent active case detection campaigns at national level especially in high endemic pockets will perhaps help in their early detection. We must remain vigilant and not be complacent of declared leprosy elimination. It is perhaps too complex a disease to eliminate with treatment alone.