‘Elimination’ of leprosy and the need to sustain leprosy services, expectations, predictions and reality

The International Leprosy Association (ILA) Technical Forum report, The Current Leprosy Situation, Epidemiology and Control and the Organization of Leprosy Services, gives a lot of attention to the goal for elimination of leprosy as a public health problem. In 1991, this was defined by the World Health Organization (WHO) as a prevalence smaller than one per 10,000 population. Underlying this elimination strategy was the hypothesis that because leprosy patients are assumed to be the sole source of infection, early detection and treatment with multidrug therapy (MDT) would reduce transmission of Mycobacterium leprae. It was expected that once the prevalence fell below this level, the chain of transmission would be broken, and leprosy would disappear naturally. In 1993, WHO made predictions regarding the expected trends of the prevalence, number of registered cases, incidence, and number of cases detected till the year 2000 (Fig. 1) (12). The expectation was that by the end of the year 2000, the prevalence and incidence would both be about 200,000. But, what was the actual situation by the end of 2000