EPIDEMIOLOGICAL - World Health Organization · The objectives of this report are to present the epidemiological data of leprosy for the period 1983-1997, and essential information

EPIDEMIOLOGICAL REVIEW OF

LEPROSY

IN THE WESTERN PACIFIC REGION

1983-1997

World Health Organization Regional Office for the Western Pacific

Manila, Philippines August 1998

II

Acknowledgements

We would like to thank all leprosy programme managers, and statisticians from all the countries and areas of the Western Pacific Region for providing appropriate data for this document.

The designations employed and the presentation of the material in this report do not imply the ex pression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Where the designation "country or area" appears, it covers countries, territories, cities or areas.

Part I: Leprosy data for the Western Pacific Region

1.

2.

3.

4.

5.

Introduction

Methods

2.1 The Western Pacific Region

2.2 Indicators

2.3 Sources of data

Data collection

Epidemiological review

4.1 Registered prevalence and expansion of MDT services

4.2 Detection of leprosy cases (Tables 3 to 5)

4.3 Time trends in case detection and prevalence rates (Tables 4 to 6)

Programme activities

5.1 Leprosy Elimination Campaign (LEC)

5.2 Special Action Project for the Elimination of Leprosy (SAPEL)

5.3 Special projects

5.4 Classification of countries and areas in the Western Pacific Region

according to their current leprosy situation

III

Contents

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IV

Part I Tables

Table I. List of countries and areas with socio-economic indicators in the Western Pacific Region

Table 2. Prevalence of registered leprosy cases and coverage with MDT by WHO region at the end of 1996

Table 3. Latest available data on leprosy by country and area in the Western Pacific Region

Table 4. Time trend of the number of newly detected leprosy cases and case detection rates per 100 000 by country and area in the Western Pacific Region, 1983 to 1996

Table 5. Time trend of the number of registered leprosy cases and prevalence rates per 10000 by country and area in the Western Pacific Region, 1983 to 1996

Table 6. Time trend of the number of registered leprosy cases and newly detected cases in the Western Pacific Region, 1983 to 1996

Part I Figures

Figure I. The Western Pacific Region

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10

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14

IS

Figure 2. Population distribution by country and area in the Western Pacific Region 16

Figure 3. Distribution of the number of registered cases and the prevalence rates in ten countries in the Western Pacific Region (1997)

Figure 4. Distribution of registered leprosy cases in the Western Pacific Region (1996)

Figure S. Distribution of detected cases and detection rates in ten countries in the Western Pacific Region (1997)

Figure 6. Trends of leprosy case detection rates per 100 000 in five countries in the Western Pacific Region (1983-1997)

Figure 7. Trends of leprosy prevalence rates per 10000 population in five countries in the Western Pacific Region, 1983-1996

Figure 8. Leprosy prevalence rates and multidrug therapy coverage in the Western Pacific Region (1988-1997)

Figure 9. Number of countries reporting the leprosy essential indicators in the Western Pacific Region (1983-1997)

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v

Part II: Leprosy data for each country and area in the Western Pacific Region

American Samoa 24 Australia 26 Brunei Darussalam 28 Cambodia 30 China 36 Cook Islands 42 Fiji 44 French Polynesia 46 Guam 48 Hong Kong, China 50

Japan 52

Kiribati 54 Lao People's Democratic Republic 56 Macao 58 Malaysia 60 Northern Mariana Islands 62

Marshall Islands 64

Federated States of Micronesia 66

-Mongolia 68

Nauru 70

New Caledonia 72

New Zealand 74

Niue 76

Palau 78

Papua New Guinea 80

Philippines 84

Republic of Korea 90

Samoa 94

Singapore 96

Solomon Islands 98

Tokelau 100

Tonga 102

Tuvalu 104

Vanuatu 106

VietNam 108

Wallis and Futuna 114

VI

Note on data

In addition to the references specified under each country, data are obtained from the annual submission of national leprosy data by governments to the WHO Western Pacific Regional Office.

Abbreviations

Epidemiology/Programme

GIS Geographical Information System IMR Infant mortality rate LEC Leprosy Elimination Campaign LEM Leprosy Elimination Monitoring MB Multibacillary PAL Person affected by leprosy PB Paucibacillary SAPEL Special Action Project for the Elimination of Leprosy

Treatment

CLO DDS MDT MINO RMP

clofazimine dapsone multidrug therapy minocycline rifampicine

Bacteriology

AFB acid-fast bacilli

Part I

Part I: Leprosy data for the Western Pacific Region

1. Introduction

The prevalence of leprosy has continued to decline in the world in 1997, with the Western Pacific Region reporting considerable progress against the disease. Improvements in programme and multidrug therapy (MDT) coverage have led to improvements in case detection. MDT coverage in the Region has increased from 6% in 1986 to 73% by the end of 1992. and to almost 100% by the end of 1997. Twenty-five out of 36 countries and areas in the Region' have already reached the goal of elimination of leprosy as a public health problem, defined as a prevalence rate of below one case per 10000 population.

As a result of the implementation of the elimination strategy at various levels, information collected on the magnitude of leprosy has improved significantly. Statistical information on cases has improved through the extensive use of standardized operational definitions. In some endemic countries, however, leprosy patients are still under-reported and under-registered, and efforts must be made to improve programme coverage, particularly in areas difficult to reach. In other countries where leprosy is no longer a public health problem, available information is often not accurate and is out of date, but this has a negligible influence on the regional figures.

The objectives of this report are to present the epidemiological data of leprosy for the period 1983-1997, and essential information on national leprosy control programmes from each country and area in the Region, and to evaluate and analyse these data. The report consists of two parts: Part II is an overall epidemiological review of leprosy in the region, while Part III deals with data for each country and area in the Region with reference to its national control programme.

2. Methods

2.1 The Western Pacific Region

The Western Pacific Region comprises 36 countries and areas (Table I). with a population of approximately 1634 million. Geographically. the countries and areas in the region are scattered in the north, west, central and south Pacific (Figure I).

The Region contains some very large, and very small, countries and areas: seven each have a population of more than 10 million (Figure 2), and seven have a popUlation of between I and 10 million. The remaining 22 have a total popUlation of only 3.2 million. Seven Pacific Island countries and areas each have a population of less than 20 000.

I Pitcairn Islands data arc not included in thIS review.

2 Part I

Several socioeconomic and health indicators for each of the 36 countries and areas are presented in Table 1. The annual population growth rate ranges from 5.6% in the Northern Mariana Islands and 3.8% in the Marshall Islands to small decreases in Niue and Tokelau. Ten countries have an infant mortality rate (IMR) equal to or higher than 40 per 1000 births.

2.2 Indicators

The Seventh WHO Expert Committee on Leprosy, which was convened in May-June 1997, concluded that single-lesion paucibacillary (PB) patients can be treated with a single dose of a combination of rifampicine, ofloxacin and minocycline, and that MB patients can be treated with standard MDT for one year instead of two. A large number of the 36 countries and areas of the Western Pacific region are implementing shorter regimens, including Cambodia, Papua New Guinea and the Philippines.

Prevalence (registered cases)

The point prevalence rate is defined as the number of cases registered for chemotherapy at the end of the year, divided by the population in which the cases have occurred. This indicator reflects the magnitude of the problem and helps in planning and evaluating control measures. The prevalence is expressed using absolute numbers and the rate per 10 000 population.

Detection (newly detected cases)

This is defined as the number of new cases detected during the year divided by the population in which the cases have occurred. This indicator is the most appropriate for estimating the true incidence of the disease in a given population when analysed in conjunction with the proportion of disabled patients (grade 2) among newly detected cases. It is expressed using both absolute numbers and the rate per 100 000 population.

Proportion of MB patients among new cases

This is defined as the proportion of MB cases among the total number of newly detected cases during the year.

Proportion of patients with grade 2 disability among new cases

This is defined as the proportion of newly detected cases with grade 2 disability among the total number of newly detected cases during the year. This indicator is intended to reflect the effectiveness of the programme in terms of early case-finding and the level of community awareness of the disease.

Proportion of children among new cases

This is defined as the proportion of cases aged less than IS years old among the total number of newly detected cases during the year. This indicator reflects the level of transmission of the disease over the last few years.

MDT coverage

This is defined as the proportion of cases receiving MDT at any time during the year among the total number of cases appearing on the register during the year. This indicator reflects the programme performance in achieving full MDT coverage.

Proportion of patients who have received adequate treatment (cured cases, MDT compLeted)

This is defined as the proportion of patients who have completed adequate MDT treatment among all patients who have completed MDT during the year. Adequate treatment is defined as six months

Part I 3

of chemotherapy completed within nine months for paucibacillary (PB) patients and 24 months of chemotherapy completed within 36 months for MB patients. This operational indicator reflects the efficacy of treatment services.

Number of relapsed cases

This comprises only the absolute number of relapsed cases occurring during the year, after the completion of MDT or DDS treatment.

Prevalenceldetection ratio

This is the ratio of the prevalence divided by the number of cases detected during that year, expressed as a single number. It reflects the mean duration of registration of leprosy patients. Theoretically, if all patients were MB cases and received their 24 monthly doses of MDT within 36 months, the ratio of prevalence to detection would never exceed 3. A higher value for this ratio indicates that patients are treated longer than necessary, do not receive adequate treatment, or that registers are not updated. In 1997, one-year fixed duration MDT was introduced in the Region. Most countries had adopted this regimen by 1998. A ratio of I is expected where MB patients receive one-year MDT.

2.3 Sources of data

The main sources of data are:

• Officially published reports, including the World Health Statistics Annual (WHO Geneva), Country Health Information Profiles (WHO Regional Office for the Western Pacific), and national reports.

• Documents in the WHO Regional Office for the Western Pacific, including the Western Pacific Region data bank on socioeconomic and health indicators. Extensive use was made of the assignment reports to the WHO Regional Office on leprosy in most countries for the period 1983-1997. Annual statistics on leprosy are requested from each country and area in the Region.

• Articles in medical journals. The number of relevant papers in international journals is limited. References are given in Part III of this report, under each country profile.

• Unpublished reports. Unpublished data on leprosy collected by WHO, particularly during international meetings, have been used and are sometimes the only source of data.

4 Part I

3. Data collection

The data on leprosy are a key to the evaluation of the situation of the disease and of control measures. The quantity and quality of the data are directly related to the quality of the reporting system in use; availability of data is itself an indicator of the level attained by the control programme. Information and reporting systems should allow the compilation of the indicators listed above. The major constraint of this study, carried out over a IS-year period (1983-1997), is the availability and consistency of data. In the following tables, a blank entry means that there are no data available. The data most frequently available were the numbers of newly detected cases; data on the numbers of registered cases were less extensive. There is a need to strengthen data reporting and collection for their appraisal nationally and internationally. Each country should be encouraged to report without excessive delay the leprosy indicators listed above.

The second major constraint of the present study is the quality of data. Comparison and analysis within and between countries and areas are based on the officially reported figures and on the assumption that these figures are reliable and reflect the actual situation. However, it is very likely that the gap between the actual situation and the data varies with time in a given country, and may vary between countries. A major difficulty, particularly in the context of leprosy elimination, is to assess the proportion of the population covered by the programme. The reported data on detection and prevalence reflect the coverage and quality of the case-finding and registration activities. Inaccuracy in the numbers of registered patients is sometimes an issue, and one may find a large proportion of registered patients that should not be registered for various reasons: death, lost from sight, or maintained on the register after completion of MDT either because they are still being followed-up or are receiving dapsone (DDS) after MDT. In countries where high MDT coverage is seen, this latter situation can easily be assessed by calculating the ratio of prevalence to detection. The difference in diagnostic criteria also affects comparisons between countries, especially for the MB proportion and the disability proportion.

4. Epidemiological review

4.1 Registered prevalence and expansion of MDT services

The prevalence of leprosy continued to show a declining trend in 1997, and most of the countries endemic for leprosy have reported considerable progress against the disease. Table 2 shows the prevalence rates and MDT coverage in five WHO regions. The total number of registered cases in the world at the end of 1996 was 920 581 (prevalence rate 1.67 per 10000), of whom 26576 came from the Western Pacific Region (prevalence rate 0.16). The Western Pacific Region recorded the lowest prevalence rate after the European Region (which had an estimated number of cases of less than 1000), and the highest MDT coverage (99% as against 91 % worldwide). The highest prevalence rate are seen in the Marshall Islands and in the Federated States of Micronesia. along with the highest case detection rate (Tables 3 and 4). The highest number of registered cases is in the Philippines (8749), followed by Viet Nam (4676), China (4045) Cambodia (1921), Malaysia (1181) and Papua New Guinea (1004), as shown in Figures 3 and 4. In these countries, leprosy control services have improved dramatically over the last few years, and the national programmes

Part J 5

now cover almost the whole population, In total. 25 of the Region's 36 countries and areas have achieved the WHO target of elimination of leprosy, i.e., less than one registered case per 10 000 population.

4.2 Detection of leprosy cases (Tables 3 to 5)

The highest number of newly detected cases in 1997 was 4942 in the Philippines and 2808 in Viet Nam. The leprosy pattern is uneven in Asian countries, with a case detection rate per 100 000 of 22.8 in Cambodia, compared with 0.15 in China. The leprosy case detection rates per 100 000 in the central Pacific countries (Federated States of Micronesia: 112, Kiribati: 98.7 in 1996 and the Marshall Islands: 112) are still very high compared with south Pacific countries, some of which have already eliminated leprosy as a public health problem. The explanation for this is not clear.

4.3 Time trends in case detection and prevalence rates (Tables 4 to 6)

The prevalence of leprosy in the world has been reduced by more than 85% in the period 1982-1997. In the Western Pacific Region, the prevalence rate has fallen from 0.97 per 10000 in 1988 (140 000 registered cases) to 0.15 per 10 000 in 1997 (24339 registered cases), an 85% reduction in ten years. The question that now arises is how to demonstrate whether or not this reduction in prevalence has had an impact on the transmission of the disease. Unfortunately, dependable tools for measuring infection and for monitoring incidence trends in leprosy are not available. Intensification of leprosy control activities through expansion of MDT services to every available health facility is an important step towards elimination. However, the availability of health services and their capacity to implement MDT services for leprosy vary widely. In theory, it' all the cases were to be detected within the first year of onset of disease and treated with MDT. the impact on transmission should be visible within a few years. In practice, the detection of leprosy has slightly increased over the past ten years in contrast to the observed steep reduction in prevalence: in the Region, the case detection rate was 0.71 per 100000 in 1988 (10282 newly detected cases) and 0.83 per 100000 in 1997 (13 567 newly detected cases), The extent to which this can be attributed to the level of transmission. improved case-finding, expansion of health services (particularly in difficult to reach areas). increased population at risk, or a combination of these factors is not clear.

From 1988 to 1997, MDT was gradually implemented widely to reach a coverage of 99'7c of all registered cases in the region (Figure 8). As a result of this. the average duration of the disease from diagnosis to cure was reduced to between 2 and 4 years and is now being reduced to between one and two years due to the wide implementation of one-year fixed duration MB MDT. Detection and prevalence are now converging, and it is becoming increasingly obvious that detection. to a large extent, reflects a hidden prevalence which was not very well perceived before, Many of the newly detected cases currently consist of cases accumulated over a period of time. The increase in the case detection rate should not be interpreted as a weakness of the elimination strategy but is rather related to expanding geographical coverage of leprosy services through dynamic national elimination programmes and more recently. introduction of elimination campaigns and special action projects with the specific aim of reaching uncovered areas and underserved populations. If elimination campaigns and community awareness activities continue at their present levels. a reduction in the case detection rate in the next two or three years should be seen.

6 Part I

5. Programme activities

The Forty-fourth World Health Assembly, in May 1991, adopted resolution WHA44.9 on the 'elimination of leprosy as a public health problem in the world by the year 2000. The overall elimination strategy is based on: (i) timely case detection; (ii) cure of all diagnosed cases with fixed duration MDT; (iii) simplified case-management; and (iv) monitoring progress through appropriate information systems. The policy of the WHO Regional Office for the Western Pacific addresses the issue of elimination in 11 countries which have not reached the elimination target of less than one case per 10 000 population, and among them, of four countries which still have high prevalence rates. WHO, in collaboration with national programmes, is promoting new initiatives such as Leprosy Elimination Monitoring (LEM) and the use of the GIS with the objective of identifying difficult operational and/or epidemiological situations calling for special intensified efforts.

5.1 Leprosy Elimination Campaign (LEC)

The Leprosy Elimination Campaign is a strategy which aims at providing the national programmes with additional external inputs to intensify elimination activities. It is a national activity, implemented by the national personnel with technical cooperation from WHO and other agencies. The main objective of the elimination campaign is to detect leprosy cases, particularly "cases of consequence", defined as "skin-smear positive cases and cases with more than five skin lesions", that have remained undetected in the community and to put them on MDT promptly, Activities carried out include: workshops to improve the diagnostic and treatment services provided by local health workers; orientation courses for volunteers; creating community awareness by using various media and information sessions; and case-finding. mainly through self-reporting and prompt treatment with MDT. The effect of the activities are expected to last beyond the short period of the actual campaign and it is hoped that new patients will continue to self-report.

Ten LECs were conducted in Cambodia and the Philippines. They helped to detect 1158 cases in a population of 7.4 million (case detection 15.6 per 100 000). In 1998. 16 LECs are planned in the Philippines, three in Viet Nam, two in Papua New Guinea. and one in Cambodia.

5.2 Special Action Project for the Elimination of Leprosy (SAPEL)

A substantial number of patients do not have easy access to diagnosis and treatment of leprosy. Many of them live in such remote areas that they may not even be aware that leprosy is a curable disease. Activities for reaching every village will focus on those patients and populations that so far have not been reached. To do this, WHO headquarters has formulated the Special Action Project for the Elimination of Leprosy aiming at the identification and treatment of patients living in certain conditions. i.e., where it is not possible to implement routine leprosy control programmes. Three basic strategies are being used: (i) lay supervised WHO MDT in which community leaders. or others without formal health training are trained to assist in case detection and supervision of the monthly doses of MDT; (ii) unsupervised MDT (more than a month's supply of MDT drugs is provided to the patients who are then responsible for their own treatment over a period of months); and (iii) use of new drug regimens.

Seven SAPELs were implemented in difficult to reach areas in China. Cambodia. the Philippines. and Viet Nam. They helped to detect 455 cases in a total population of 1.5 million inhabitants (case detection 30 per 100 000). In 1998, five SAPELs are planned in Viet Nam. four in China, two in the Philippines. two in Papua New Guinea, and one in Cambodia.

Part I 7

5.3 Special projects

The Federated States of Micronesia, with 30 cases per 10 000 population, had the highest prevalence of leprosy in the region in 1995. A survey of selected villages conducted in 1995 reported a new case detection rate of 680 per 100000 in Chuuk and 560 per 100000 in Pohnpei. These alarming figures prompted the Government and WHO to launch a special leprosy elimination project in March 1996, in order to accelerate and achieve the leprosy elimination goal by the year 2000. The project was of two years duration with two rounds of screening of the entire population in order to: (i) detect, treat and cure all the existing cases using the WHO MDT regimen; and (ii) administer preventive therapy to all healthy people to prevent the development of the disease In

those infected.

The preventive therapy consisted of a combination of rifampicine, ofloxacin and minocycline (ROM) for adults and rifampicine alone for children aged less than 15 years old. Drugs were administered twice in a single dose, a dose during each round of the project. Regimen and doses for preventive therapy were discussed and agreed upon during a technical meeting held in November 1995 in the Regional Office which convened international experts on chemotherapy. The first round ended in June 1997. The second round started in March 1997 and was completed by the end of May 1998.

During the first round, 71 % of the population was screened and 68% received preventive therapy. In total, 258 new leprosy cases were detected while 59 other cases self-reported. As at the end of January 1998, 71 % of the population received preventive therapy, 45 new leprosy cases were detected while 35 cases self-reported. In total, 83% of the population received at least one dose, and 53% received two doses of preventive therapy. The number of newly detected cases is expected to reach 9S by the end of the second round. This represents a reduction in case detection from the first to the second round of 70%, mostly attributable to the large proportion of backlog cases detected during the first round.

A mass screening of the population with MDT treatment of newly detected leprosy cases started in May 1997 in Kiribati. The screening covered 91% of the population. Out of a total of 64704 individuals examined, 128 leprosy cases (13% MB) were detected.

5.4 Classification of countries and areas in the Western Pacific Region according to their

current leprosy situation

Countries and areas in the Western Pacific Region may be divided into four groups, according to their current leprosy situation.

Group 1. Comprises 2S countries and areas which have reached the elimination target of less than one case per 10 000 population. These countries are Australia, Brunei Darussalam, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong, China, Japan, Macao, Malaysia, Mongolia, New Caledonia, New Zealand, Niue. Northern Mariana Islands, Republic of Korea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu. Vanuatu, Viet Nam. and Wallis and Futuna.

Group 2. Comprises two countries and one area that have very small populations and fewer than ten cases of leprosy: American Samoa, Nauru and Palau.

Group 3. Comprises four countries that have not reached the elimination target but, with sustained efforts, should reach it by the end of 1998. These are: Cambodia, Lao People's Democratic RepUblic, Philippines and Singapore.

8 Part I

Group 4. Comprises four countries that still have high prevalence rates: Kiribati, Federated States of Micronesia, Marshall Islands and Papua New Guinea.

Part I 9

Table 1. Socioeconomic indicators by country and area in the Western Pacific Region

Population Country/Area (OOOs)

American Samoa 56 Australia 18289 Brunei Darussalam 296 Cambodia 10 702 China 1 223890 Cook Islands 19 Fiji 796 French Polynesia 220 Guam 158 Hong Kong, China 6311 Japan 124299 Kiribati 79 Lao P.D.R. 4575 Macao 416 Malaysia 21 168 N. Mariana Islands 59 Marshall Islands 56 Micronesia, F.S. 122 Mongolia 2400 Nauru 11

New Caledonia 185 New Zealand 3614 Niue 2 Palau 17 Papua New Guinea 4226 Philippines 70247 Republic of Korea 45248 Samoa 166 Singapore 3 185 Solomon Islands 394 Tokelau 2 Tonga 98 Tuvalu 10 Vanuatu 169 VietNam 76700 Wallis and Futuna 14

I Gross national product. , Infant mortality rate per 1000 births. J Gross domestic product (GOP).

Annual pop. Year growth rate Year IMR'

%

1995 1.9 1995 13 1996 1.3 1995-96 I

1995 3.0 1995 8 1996 2.6 1996 90 1996 1.0 1995 36 1995 1.1 1995 4 1996 1.5 1996 21 1995 2.1 1995 12 1997 0.8 1991 9 1996 2.5 1995 4 1995 0.2 1995 4 1996 1.4 1995 54 1995 2.6 1995 104 1996 0.2 1996 5 1996 2.3 1995 12 1995 5.6 1996 7 1995 3.8 1994 26 1995 3.5 1994 25 1996 1.5 1996 40 1995 1.4 1994 26 1995 1.8 1995 14 1996 1.2 1995 7 1995 -0.2 1996 0 1995 3.2 1996 20 1995 2.3 1995 82 1995 2.4 1995 49 1996 0.9 1995 9 1996 0.3 1994 20 1997 2.0 1996 4

1995 3.5 1994 26 1996 -1.3 1992 16 1995 0.5 1995 6 1996 1.7 1995 49 1995 2.4 1996 41 1997 2.0 1996 45 1994 1.1 1995 40

Source: Western Pacific Region data bank on socioeconomic and health indicators.

10 Part 1

Table 2. Prevalence of registered leprosy cases and coverage with MDT by WHO Region (1996)

Registered Prevalence Estimated MDT Cured with Newly Detection

WHO Region cases rate prevalence coverage MDT detected rale

per 10000 rate % (cumulative) cases per 100 000

Africa 95901 1.77 3.2 91.5 443610 46489 7H

Americas 123 537 1.64 2.2 75.3 225450 43483 5.59

Eastern Mediterranean 23005 0.54 1.0 83.0 52784 5761 1.25

South-East Asia 651 562 4.72 6.0 93.7 7059925 457 921 32.4

Western Pacitic 26576 0.16 0.3 99.0 206635 13 027 O.R

Total 920581 1.67 2 91.0 7 9RB 404 566 fiR I ')X4

Source: WHO, Wkly Epidem. Rec., 1997, 72: 165-172.

Table 3. Latest available data on leprosy by country and area in the Western Pacific Region (detection rates per 100000 population, prevalence rates per 10 000 population)

Country/Area Year Population Newly detected cases Treated MDT Relapse Registered Prevalence Prevalence! (OOOs) Total Rate MB Disability Children MDT completed end of year rate detection

American Samoa 1996 55 3 5.46 2 15 R 0 7 1.27 2.3 Australia 1995 18088 9 0.05 0 10 0.01 1.1 Brunei 1997 305 2 0.66 2 0 0 2 6 0.19 3 Cambodia 1997 IO 706 2438 22.8 1263 418 268 5519 3364 0 1921 1.79 0.8 China 1997 I 236000 1854 0.15 1508 394 80 6028 2 160 188 4045 0.03 2.2 Cook Islands 1997 19 0 0 0 0 0 0 0 0 0 0 -Fiji 1996 796 6 0.75 3 0 0 12 0 17 0.21 2.8 French Polynesia 1997 220 5 2.27 I 0 0 19 6 0 13 0.59 2.6 Guam 1997 158 6 4 4 () I 20 1.26 3.3 Hong Kong. China 1997 6502 11 0.17 3 0 0 II 0 54 0.08 4.9 Japan 1993 125095 8 0.01 200 0.02 25 Kiribati 1996 79 78 98.7 42 5.32 0.5 Lao P.D.R. 1997 4846 256 5.28 169 63 <) 811 278 0 533 1.1 2.1 Macao 1997 500 0 0 0 0 0 0 0 0 0 0 -Malaysia 1997 21665 277 1.28 188 9 15 237 0 1181 0.54 4.3 N. Mariana Islands 1997 64 5 7.84 3 I 0 14 10 1 4 0.63 0.8 Marshall Islands 1997 61 68 112 27 25 230 61 0 163 26.8 2.4 Micronesia. F.S. 1997 110 123 112 35 54 490 315 0 163 14.8 1.3 Mongolia 1997 2400 0 0 0 0 0 0 0 0 0 0 -Nauru 1996 11 2 18 0 0 0 4 3.6 2 New Caledonia 1995 181 7 3.87 5 2 I 25 12 0 13 0.72 1.9 New Zealand 1997 3696 2 0.05 2 0.005 1 Niue 1997 2 0 0 0 0 0 0 0 0 0 0 -Palau 1997 19 1 5.3 0 0 () 8 5 0 2 1.1 2 Papua New Guinea 1997 4533 547 12.1 309 65 178 1676 672 I 1004 2.2 1.8 Philippines 1997 71 389 4942 6.92 3983 252 393 12916 3513 21 8749 1.22 1.8 Republic of Korea 1997 45991 34 0.Q7 27 I 0 I 106 399 0 707 0.15 21 Samoa 1997 167 13 7.78 7 0 I 31 15 0 16 0.95 1.2 Singapore 1997 3185 10 0.3 4 0 0 38 210 I 44 0.15 4.4 Solomon Islands 1997 425 21 4.94 10 I 7 5 0 42 0.99 2 Tokelau 1995 2 0 0 0 0 0 () 0 0 0 0 -Tonga 1997 98 I 1.02 1 0 0 I 0 0 1 0.1 1 Tuvalu 1996 IO 1 IO I 0 0 4 3 0 1 I 1 Vanuatu 1997 173 6 3.47 4 I I 25 17 0 8 0.5 J.3 Viet Nam 1997 76900 2808 3.65 I 798 854 159 7349 2669 17 4676 0.61 1.7 Wallis and Futuna 1994 14 0 0 0 0 0 0 0 0 0 0

Total 1634465 13 544 0.83 23648 0.15 1.8

2' :::; ---

12 Part 1

Table 4. Time trend of the number of newly detected leprosy cases and case detection rates per 100 000 population by country and area in the Western Pacific Region (1983-1997)

Country! Area 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

Am. Samoa 15 9 II 13 7 6 9 9 7 4 4 3 44.1 25.7 30.6 35.1 18.9 16.2 19.6 19.2 14.6 S 7.41 5.46

Australia 28 38 27 30 20 16 0 9 0.18 0.24 0.17 0.19 0.12 0.09 0 0.05

Brunei I 0 3 6 0 0 0.44 0 1.05 2.1 0.68 0

Cambodia 704 549 545 706 789 574 415 617 945 1644 2219 2404 8.6 6.5 6.4 8.1 8.8 7.03 4.96 7.19 10.5 18.3 21.65 23.02

China 4945 4042 3837 3303 3345 3400 2728 2191 2096 I 895 1845 0.47 0.38 0.35 0.3 0.3 0.3 0.23 0.19 0.17 0.16 0.15

Cook Islands 6 0 2 0 0 0 I 35.3 0 11.8 0 0 0 5.26

Fiji 36 25 22 20 19 17 16 26 6 II 7 9 6 6 5.37 3.57 3.1 2.77 2.53 2.34 2.16 3.51 0.8 1.46 0.91 1.17 0.77 0.75

French Polynesia 24 12 II 14 19 10 3 8 5 12 7 9 6 6 15.3 7.5 6.88 7.82 10.6 5.29 1.56 4.08 2.49 5.83 3.38 4.25 2.71 2.73

Guam 3 4 3 4 2 5 7 4 6 6 2.65 3.28 2.4 3.23 1.59 3.94 5 2.8 4.2 4

Hong Kong, China 26 20 0.44 0.33

Japan 30 42 42 15 33 26 12 17 15 8 0.03 0.03 0.03 0.01 0.03 0.02 0.01 0.01 0.01 0.01

Kiribati 28 63 28 59 33 41 17 16 78 4D.6 88.7 38.3 79.7 44 54 22.1 2D.25 98.73

Lao P.O.R. 307 426 702 168 264 371 340 317 234 304 298 270 8.56 11.5 18.3 4.25 6.48 8.83 8.1 7.27 5.23 6.62 (1.1 5.53

Macao 2 2 I 0 0.43 0.41 0.2 Il

Malaysia 313 348 311 329 296 315 220 330 293 273 2.0 2.08 1.83 1.9 1.69 1.79 1.22 1.74 1.45 1.29

N. Mariana Islands 3 2 3 2 4 3 I 3 8 4 3 I 6 6 17.7 10.5 15 10 I 1.1 7.89 2.63 6.82 17.8 8.7 6 1.75 12.77 9.6X

Marshall Islands 2 5 7 13 10 19 24 26 32 21 20 8 18 112 6.06 14.3 25 44.8 33.3 44.2 60 56.5 68.1 42.9 37 14.3 32.73 219.6

Micronesia, ES. 177 87 96 80 84 90 220 95 206 188 89.7 101 79.2 80.8 84.1 202 84.8 169

Mongolia 0 0 0 0 0 II

Nauru I I 3 0 3 3 2 7 2 2 3 2 2 2 12.5 12.5 37.5 0 37.5 37.5 22.2 77.7 22.2 22.2 30 20 18.IS 18.18

New Caledonia 23 20 20 32 22 14 I) 16 13 10 10 9 7 15.9 13.2 13.3 21.6 14.3 8.75 9.38 9.76 7.78 5.85 5.75 4.86 3.87

New Zealand I 4 I I 10 0.03 0.12 0.03 0.1n 0.27

Niue 0 0 0 0 (I 0 0 0 0 0 0 ()

Palau 7 2 2 I 3 3 I 5 6 2 4 6 <) 4 50 154 16.7 7.14 214 21.4 8.33 41.7 50 16.7 26.7 35.3 52.94 :.U

Papua N. Guinea 912 683 773 568 579 652 544 512 519 219 519 345 231 699 26 21 23 16.6 16.2 18.2 13.9 13.7 13.6 5.61 13.6 8.51 5.:17 l6.')

Philippines 1730 1726 I 139 2 185 2748 2442 4 163 5725 7 169 5896 3442 4450 3988 4051 3.32 3.23 2.08 3.9 4.68 4.11 6.93 9.31 11.4 9.16 5.29 6.85 5.9 5.8

Republic of Korea 345 293 195 142 131 157 157 136 130 113 :W 19 0.86 0.72 0.47 0.34 0.31 0.37 0.36 0.31 0.3 0.25 0.0<) (1.09

Samoa 51 15 15 16 19 II 18 13 10 9 5 10 13 13 31.6 9.38 938 10.1 11.8 6.83 10.6 8.02 6.13 5.52 301 6.17 7.6 7.78

Singapore 36 13 41 24 1? 1.33 048 1.48 084 1.16

Solomon 1~land~ 21 23 24 14 19 21 I) 8 10 <) 24 7.34 7.96 7.84 4.38 5.97 6.36 4.4 2.25 2.64 2.20 'i.86

Tokelau 0 I I 0 0 50 'i0 0

Tonga 0 I 0 2 0 2 I I I 0 0 ()

0 104 0 2.06 0 2.08 1.02 1.03 1.03 0 0 (I

Tuvalu 0 0 0 2 3 I 0 0 0 22.2 23.09 10

Vanuatu 31 28 21 15 II II 7 10 7 17 14 3 14 7 25 22.1 16.2 11.3 8.09 7.91 4.93 6.85 4.79 II 8.7 1.83 8.28 4.0

Viet Nam 2021 2103 2062 2292 2 183 1847 2073 1995 2500 3142 3 185 3173 2576 2883 3.74 3.77 3.59 3.88 3.61 2.98 3.26 3.47 3.69 4.53 4.38 4.29 3.42 3.83

Wallis and Futuna 0 0 ()

0 0 0

Above: number of newly detected cases: below: case detection rates per 100000 population.

1997

~ 0.66

2438 22.g

I 854 0.15

(I

(I

5 2.27

6 4

II 0.17

256 5."8

(I

II 277 1./:'-;

)

7.S4 7D

114.9 123 112

(I

(I

2 0.0)

(I

()

I S.l 547 12.1

4942 6.(-.P

34 0.07

13 7.g 10

0 . .1 21

4.94

I I

6 3.5

2808 3.6)

Part I 13

TableS. Time trend of the number of registered leprosy cases and prevalence rates per 10 000 population by country and area in the Western Pacific Region (1983-1997)

Country! Area 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Am. Samoa 70 49 21 I J 7

20.6 10.4 4.2 2.41 t .27

Australia 2661 62 10 10 1.7 0.Q4 0.01 0.01

Brunei ] ] ] 6 6 1 0.1] 0.12 0.1 0.2 0.2 0.1

Cambodia 649 742 1742 1]]4 I 170 I 156 1669 1627 2038 2461 2886 2960 0.8 0.9 2.0 1.5 1.1 1.42 1.99 1.9 2.26 2.73 2.82 2.83

China 100000 70000 55240 40000 ]0000 20003 8470 6055 5655 48JJ 4474 1.0 0.66 0.5 0.]6 0.26 0.17 0.07 0.05 0.05 0.04 004

Cook lslands 26 15 16 0 2 0 0 0 I 15.] 7.5 9.41 0 1.18 0 0 0 0.5]

Fiji 455 444 367 2H3 24J 204 147 109 86 49 J9 J9 24 17 6.79 6.34 5.17 J.91 1.24 2.81 1.99 1.47 1.15 0.65 0.51 0.51 0.31 0.21

French Polynesia 29.5 9 18 18 II 12 14 17.7 0.45 0.87 0.87 0.52 0.55 0.64-

Guam 34 20 23 24 10 8 2.8 1.57 1.64 1.68 07 0.53

Hong Kong, China 16]8 65 47 2.9 0.11 008

Japan 884 768 200 0.1 0.06 0.02

Kiribati 118 J] 80 46 13 42 19 4.5 9.5 5.97 lAO;; ') 12

Ll0 P.D.R. 2988 :1 152 :'> 381 2353 1955 I 376 2529 I ]9] I ]61 1085 967 694 574 8.3 8.79 9.1: 6.14 4.94 3.38 0.02 3.32 3.12 2.43 2.11 1.42 I 18

Macao 96 18 15 11 7 2.8 0.39 0.21 0.26 0.17

Malaysia :'i 730 6373 ;) 723 .') 031 4- 149 3439 1823 I 561 I :1 1-1 3.6 3.81 3.37 2,9 2.36 1.% 0.96 0.78 0,62

N. Mariana Islands 4 " , II

0.87 1.58 1.49 1.77

Marshall Islands 50 20 '8 46 x5 10.6 ]7 1.43 8.36 16.67

Microne.~ia. ES. 851 782 658 628 501 ]49 362 290 .168 90.5 80.6 69.~ 62.2 48.2 32.6 :n.2 25.9 30.16

Mongolia 0 0 0 0 0 0

Nauru 40 42 14 8 X 4 .17.1 46.7 15.6 8 7 :!.7 4

New Caledonia 163 JJ4 liS :126 ])9 :IS] 70 90 48 64 22 27 13 25 .22 21 11 " 11 4.38 5.49 2.87 3.74 I 26 IA6 0.72

New Zealand .1 0 I I 0.01 0 0 0

Niue 0 0 0 ()

0 0 0 ()

P<]lau 16 I' ~ , 1.\ .. ' 1.06 -I- 71 ::.9

P"pua N. Guinea 9752 8715 8203 7581 7465 ~ 163 :'i I~S -I- .\.'() ~ 964 2755 2167 I 318 I 105 27.8 26.8 24.4 22.2 20.H 12.H I.U 11.6 7.75 J.D5 5.3-1- HI6 2.6

Philippine~ .17323 )7377 38814 )8570 35281 .16972 :I 19-1-7 20280 17 :1-1-7 15 :117 15 -1-41 16.J.86 11 67.J. 8664 7.17 7 7.1 6.89 6.01 6.22 .'U2 U 2.76 2 . .18 2 . .17 2.5-1- l.n 1.24

Republic of Korea 2762 I 637 1 -169 I 309 I 209 I 126 I on 0.67 O.3S O.J.J. 0 . .1 (L~7 0.25 0.24

Samoa 274 LB 118 72 75 52 50 36 34 25 14 20 21 23 17 8.2 7 4.4 4.6 3.2 .1.1 2.22 2.09 1.5.1 0.84 1 '.I 1. '") 1 1.38

Singapore 2145 1406 I 171 106:'- 747 8.) 5.14 -+.23 3.7 2.62

Solomon Islands 700 115 140 66 40 24 26 11.7 ).48 -1-.24 1.86 1.06 O.6i 0.6-+

Tokelau 0 I I (I

0 5 5 !)

Tonga II I 2 I I 2 1.1 0.1 0.21 0.1 01 O.:?

Tuvalu JO 0 () 2 2 .1 I 14.] 0 0 2.22 2.21 .1.:13 I

Vanuatu 226 15 13 29 1(, 20 :?O 17.7 1.()3 1.49 1.8 0.98 1.18 I 15

Viet Nam 36616 34240 10750 28240 26750 24150 D46J 20997 18342 9449 7 :no 7419 SIll -I-N? 6.78 6.14 5.36 4.79 4.42 ).9 3.69 165 2.71 1.:16 101 I 0.68 0.6?-

Wallis and Futuna 0 0 0 0 0 0 0 0

Above: number of registered cases; below: prevalence rates per 10 000 population.

1997

[,

0.2

I 92 J

1.79

4-04.") 0.03

()

()

13 0.59

20 1.2()

54-(Un

'::;,1

I I ()

()

I lSI 0.::;4-

4 iJ.«'

Ihh 277

16_' I-I-.~

II 0

4 \(13

, (l.OOS

II 0

2

~ I 004

' , --

X 1-1-9 1.22

707 0.15

1(, O.l)5

44 0.1')

4' O.l)l)

I 0.1

s 0 . ."

-+ h7(, (l.61

14 Part /

Table 6.

Year

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Time trend of the number of registered leprosy cases and the number of newly detected cases in the Western Pacific Region (1988-1997)

Regional Reuis(ered cases Newly detected cases population (OOOs) Number Rate per 10 000 Number Rate per 100 000

I 446939 140000 (0.97) 10282 (0.71 ) 1468180 113000 (0.77) I I 768 (O.SO)

1497093 88545 (059) 13294 (0.89)

1515579 69804 (0.46) 15164 (1.00)

1537199 45845 (0.30) 13610 (0.89)

I 560521 39835 (0.26) I 1052 to.71) I 580357 40085 (0.25) 12730 (0.81 ) 1610291 30812 (0.19) 11941 (0.74) 1 628600 26576 (0.16) 13027 (0.80)

1 634465 23648 (0.15) 13544 (0.83)

Note: standard case definition has heen applied throughout the table (Expert Committee on Leprosy, Sixth report. WHO Technical Series 1988; 76&).

, ..... -.. --"---->.---~----"-.--.-----'---... ,---".-.--.- _. __ . __ ._- .,--- -.-~-----.. -.-.---

PqIe, AIpdbIoofQlna

p-D.~ Rep\IbIi:. i Japan Korea '

. ' . . ' "

" ,

Hongkoog

PhUlpplno

,1 ,- . VlaIHtwn ,

~:::;r- ~."

Legend

~ Less 1han 1 Case per 10 000 (25 COtlI1Uies ) less 1han 10 Cases (3 COIIIIIries ) 1-2 cases per 10 000 (4 oounIries l

. GrealBr than 2 Cases per 10 000 (4 00IIl1ries )

1bI detfg IIIi:iuwi on" mapdo AOlImfaly the ........ of ... _ ... IJo poII<l1Jo RogiooaI DhcIof -.iIIu'" 1IcIoI-.<I ... ......., .. IOnIIooy ...... -, <1 __ .

I 1'tC_<l_noIlo_

i L-__ . ____ . __ ~ ______ .. ________ . ___ . ________ ~._

N!if1hem MIrianB Is,

Guam

';i.

o

VtIIUtJ/IJ ~ ".

Wortd Health Organization RegiOnal Office for the Western Pacific

CCO 8) ~

Figure 1.

Leprosy Situation in the Western Pacific Region

April 1998 "-' ,';,',"'1

- .

... Tokelau Co!* I8Iands OF, ,:

New Caledonia

W·L~ .. F~ PcIyneIia

NU TC111g8

)ja~

(l HOff; ____ IIoW'HOc"""'"

...... --

16 Part 1

Figure 2. Population distribution by country and area in the Western Pacific Region

Japan 8%

Philippines VietNam 4%

5%

China 75%

Republic of Korea

Others 50/0

Figure 3. Distribution of the number of registered cases and the prevalence' rates per 10 000 population in ten countries in the Western Pacific Region (1997)

Cambodia

China

Kinbati

Lao P.D.R.

Malaysia

Micronesia, F.S.

Papua New Guinea

Philippines

Marshall Islands

Viet Nam

10 5 o Registered cases (000s)

5 10 15 20 25 30

Prevalence rate per 10 000 population

Part f 17

Figure 4. Distribution of registered leprosy cases in the Western Pacific Region (1996)

Malaysia 5%

Cambodia 7%

Others 14%

China 17%

Viet Nam 19%

Papua New Guinea

4%

Philippines 34%

Figure 5. Distribution of detected cases and detection rates per 100000 in ten countries in the Western Pacific Region (1997)

Cambodia

China

Kiribati

Lao P.D.R.

Malaysia

Micronesia, F.S.

Papua New Guinea

Philippines

Marshall Islands

Viet Nam

I 'T' I I

I I

I I

"'.; .• : .... 11 I , *,:L;-~ ,

t I I

! I

I ,

i •

I -""" ;'·\~!;j:h";'~iill~~.t%~;; \;rH :;~:~j: "'''?~HP9t

,

! I I I

1

I ~ I

i

il I i I I 1 I

I

I i I

I ! ! i i

~i;iHi,;;' , ~~Af: ':h;;iVittm-i;;'~~

I . I !

I

I I

I ! !

':1 I I _+H ::::. ! , I

t !

I I

I !

! I

I I

~ ,

•

i :

F ' :,:,;;,,,,,;,;~ "";,,;;; '''iii;;;

" I

I I I

I I . i j

55 45 35 25 15 5 5 15 25 35 45 55 65 75 85 95 105 115 125

Detected cases (hundreds)

Detection rate per 100000

18 Part I

Figure 6. Trends of leprosy case detection rates per 100000 population in five countries in the Western Pacific Region (1983-1997)

1000

100

0 0 0 0 0 ~

Q; Q.

" ~ '" II:

10

1

\ I\A

, , 'A _ - ,0., ....

. A

::1 :II. - - 6 - - . , 11, '/),.- - 6- - 6

A /),.

. -- _. ----.,./

./ ,/ .~ /' "" / .. \. ./'"

/ "-/ Il. Y ~ ..",

~ E--lI:: ~ /

"""'" ~ ..:x: ~ 7'0

V ~

~ M M M " M ~ 00 ~ ~ ~ ~ ~ ~ "

Year

~Micronesia,

F.S.

--"-Cambodia

- - -tr - -Papua New Guinea

__ Philippines

~VietNam

Part I 19

Figure 7. Trends of leprosy prevalence rates per 10 000 population in five countries in the Western Pacific Region (1983-1997)

100

o o o o ~

~ ! co cr

10

0.1

-'" " ".---. -. -t:. ... 4

-·-I1".A , . '" '¥""'" ,

". ,

A. -. to.. ,

, -.

~ - - . ~ 'x ..... ~ .'\ '-

~ ' .. \'- ....-~

. .~ ..

/,'Y ~ ~

~ M ~ 00 ~ ~ ~ 00 ~ ~ ~ ~ ~ ~ ~

Year

• Micronesia, F.S.

. - . 6· _. Papua New Guinea

• Cambodia

• Philippines

u VietNam

20 Part I

Figure 8. Leprosy prevalence rates and multidrug therapy coverage in the Western Pacific Region (1988-) 997)

1.6 100

1.4 90

c 0

:::0 80 S 1.2 ::s a. 0 70 a.

C> C> C>

60 C> -~ 0.8 .. 50 a. S f! 0.6

(%j 40 ..

u c 30 .. 0.4 iii

> l!! 20 0..

0.2 10

0 0 88 89 90 91 92 93 94 95 96 97

Year

-+--Prevalence rate

-o-MDT coverage

Part I 21

Figure 9. Number of countries reporting the leprosy indicators in the Western Pacific Region ( 11)83-1997)

35

30

~ 25 1:: .. ...-...- Prevalence

'" .. .. to 20 ~Detection

§ .. ... --5 indicators ... v.; .. .. .. ... B = 10 :z:

5

0

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97'

Year

Five indicators: Case detection rate, prevalence rate, deformity rate, child rate, and MDT completed.

*1997: Data available as at April 1998.

Part II 23

Part II: Leprosy data for each country and area in the Western Pacific Region

24 Part II

American Samoa

1996 Prevalence New cases Cured Relapsed

Population: 55 000

Epidemiology: The case detection rate has decreased steadily since 1983.

Programme: Vertical. The leprosy unit is part of the Department of Health which has implemented the leprosy control programme. Several health centres contribute to screening and referring suspected cascs to the leprosy unit.

Case-finding: Mainly passive. Contacts of active cases are listed for systematic examination but compliance with systematic examinations of contacts is partial.

Diagnosis: Mainly based on clinical examination of patients.

Laboratory: Until 1993, reports the absence or presence of AFB. There is no quality testing. Skin biopsies are sent to Carville, Los Angeles or Hawaii.

Treatment: MDT was implemented in 1986.

Prevalence/detection ratio: 2.3

Rehabilitation:

Retreatment of cases previously treated with DDS and discharged:

Achievements:

References:

Farrugia R. (WHO). Report on a field visit to American Samoa, April 1994.

Farrugia R. (WHO), Report on a field visit to American Samoa, September 1996.

Farrugia R. (WHO), Report on a field visit to American Samoa, May 1997.

Lynch MJ. (WHO), Report on laboratory diagnosis of leprosy and tuberculosis in American Samoa, April 1994.

Leprosy indicators in American Samoa (1983-1996):

Year Population (000s)

1983 34 1984 35 1985 35 1986 36 1987 37 1988 37 1989 37 1990 46 1991 47 1992 48 1993 50 1994 52 1995 54 1996 55 1997

Rate per 10 000

Registered Prevalence New New cases cases

70

49

21

13 7

per 10 000 cases per 100000 20.6 15 44.12

9 25.71 11 30.56 13 35.14 7 18.92 6 16.22 9 19.57

10.43 9 19.15 7 14.58

4.20 4 8.00

2.41 4 7.41 1.27 3 5.46

Leprosy prewlence and case detection rates per IO 000 (1983 - 1996)

MB %

60

56 45 31

83 89 89 29

100

50 66

25~---------------------------------------------,

20~~------------------------------------------~

15+-----------~~c_----------------------------~

10+-------------------------~ __ ----------------_i

5~--------------------------~~--------~

Year

Part 1/ 25

Disability Child % %

0 20

22 11 0 27 8 23

33 0 0 11 0 0 0 14 0 0

0 0

__ Prev. rate

-0- Detee. rate

26 Pan Il

Australia

1995 Prevalence per 10 000

Population: 18 088 000

Grade 2 Cured cases

Relapsed cases

Epidemiology: Leprosy is unevenly distributed in the country. It has been present over the past IS years in the Northern Territory and Western Australia, and, to a lesser extent, in Queensland. At-risk groups comprise migrants in New South Wales and Victoria, and the Aboriginal population in the Northern Territory, in whom detection rates have fallen since the early 1950s from 270 to 15 per 100 000 population.

Programme: There is no national standardized control policy, and no national register.

Case-finding: Mainly passive, with occasional community surveys in endemic pockets, and contact surveys.

Diagnosis: Based on clinical and bacteriological examination.

Laboratory: Biopsies are sent to University College, London where mouse foot pad inoculation IS

performed.

Treatment: All cases receive MDT, which was implemented in 1982.

Prevalence/detection ratio:

Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Australia.

References:

Ree G.H. Pattern ofleprosy in Queensland, Australia, 1955-1990. Lepr Rev. 1991; 62: 420-430.

Information from Communicable Disease and International Health Branch, Canberra, September 1991.

Ree G.H. Country Report: Leprosy in Australia, June 1992.

Information from Specialized Health Services, Brisbane, August 1991.

Leprosy indicators in Australia (1983-1995);

Year Population Registered Prevalence New New cases (OOOs) cases per 10000 cases per 100 000

1983 15379 1984 15519 28 0.18 1985 15859 2661 1.7 38 0.24 1986 16018 27 0.17 1987 16100 30 0.19 1988 16358 20 0.12 1989 16833 1990 16873 62 0.04 16 0.09 1991 17143 1992 17417 1993 17630 1994 17843 10 0.01 0 0.00 1995 18088 9 0.05 1996 18289 1997

Leprosy prevalence and case detection Rate PeT 10000

0.045

1 7 (";~~ rates per 10 000 (1983 - 1995)

0.04

0.035

0.03

0.025

0.02

0.015

0.01

0.005

o

/\ c( ~

------- "\ \

\ \

\ h- ~ ~

'-:-../

MB %

~ ~ M ~ U ~ $ 00 91 ~ ~ ~ % % ~

Year

Part /I 27


0

--+- Prevo rate

-0- Detec. rate

28 Part 1/

Brunei Darussalam

1997

Population: 305 100

Epidemiology:

Programme:

Case-finding:

Diagnosis:

Laboratory:

New cases Cured Relapsed

Treatment: MDT was implemented in 1985, and every newly detected case receives MDT.

Prevalence/detection ratio: 3

Rehabilitation:


Aehievements: Leprosy as a public health problem has been eliminated from Brunei Darussalam.

References:

Information from the Ministry of Health. Brunei Darussalam, January 1992.

Leprosy indicators in Brunei Darussalam (1983-1997):

Year Population

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

(000s)

250 269 224 226 235 241 248 256 264 272 285 285 296 314 305

Registered Prevalence New New cases cases per 10 000 cases per 100000

3 0.13 1 0.44

3 0.12 0 0.00

3 0.10 3 1.05 6 0.21 6 2.1 6 0.2 2 0.68 3 0.1 0 0 6 0.2 2 0.66

Leprosy prevalence and case detection rates per 10 000 (1983 - 1997)

MB %

67 67 50 -

100

0.25,--------------------_

0.2 t------------------I:r-....... ---+

0.15 t-----------------+~\____\-..J_

0.1 t--------------="""J:}.---\---¥--

0.05 t-----r~-------rL_-----+-_I_

Year

Part /I 29


100 0 100 0

- -

0 0

-+- Prevo rate

--fr- Detee. rate

30 Part /I

Cambodia

1997 Cured Relapsed


Epidemiology: The increase in case detection and prevalence rates from 1991 to 1997 can be attributed to the increasing coverage of the leprosy programme, and to the notification of many previously unregistered leprosy cases. The programme is still detecting a large number of backlog cases.

Programme: Leprosy control started again in 1984 in Phnom Penh. There is a National Centre of Dermatology and Leprology and the national leprosy control programme was redesigned and strengthened in 1994, after implementation of a plan of action in 1992, with a document for the programme, technical standards and operations, and a plan of action. The Director of the national tuberculosis programme was made responsible for the national leprosy programme in April 1996. The programme is supported to a considerable extent by the CrOMAL (French Order of Malta). LEC and SAPEL projects cover a population of about 3.8 million. A LEM was conducted in 1997.

Case-finding: Mainly passive. Intensified activities to detect hidden cases started in 1996.

Diagnosis: Based on clinical grounds. Bacteriological examination is not performed on a regular basis.

Laboratory:

Treatment: MDT since 1984. Treatment is delivered at the district level. Drug supply is integrated into the general system of drug supply for the provinces, with a buffer stock of three months kept at the

district level.


Rehabilitation: Carried out in collaboration with Handicap International. Surgery is performed in Phnom Penh (Hopitai des Bonzes).


Achievements: MDT coverage is 100%.

References:

Blanc L. (WHO), Report on a field visit to Cambodia, May 1992.

Blanc L. (WHO), Report on a field visit to Cambodia, June 1995.

Blanc L. (WHO), Report on a lield visit to Cambodia, April 1996.

Blanc L. (WHO), Report on a field visit to Cambodia, November 1996.

Jl.ao P.S. (WHO), Strengthening the leprosy control programme in Cambodia, April-May 1996.

R'ao P.S. (WHO), Leprosy Elimination Campaign, Cambodia, June 1996.

Rao P.S. (WHO), Leprosy Elimination Campaign, Cambodia, September-November 1996.

Rao P.S. (WHO), Leprosy Elimination Campaign. Cambodia. January-May 1997.

Rao P.S. (WHO), Review of Leprosy Elimination Campaigns and SAPEL in Cambodia. October-December 1997.

Rao P.S. (WHO). Review of Leprosy Elimination Campaigns and Special Action Projects for the Elimination of Leprosy

in the Western Pacific Region, June-September 1997. Tin K. (WHO). Evaluation of the leprosy elimination programme using the Leprosy Elimination Monitoring protocol.

April-May 1997.

Leprosy indicators in Cambodia (1983-1997):

Year Population

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

(OOOs)

7087 7219 7439 7624 7837 7939 8046 8168 8372 8582 9000 9000

10251 10442 10 706

Registered Prevalence New New cases cases per 10000 cases per 100 000

649 0.8 704 8.6 742 0.9 549 6.5

1742 2.0 545 6.4 1334 1.5 706 8.1 1 170 1.3 789 8.8 1 156 1.42 574 7.03 1669 1.99 415 4.96 1 627 1.90 617 7.19 2038 2.26 945 10.50 2461 2.73 1644 IR.27 2886 2.82 2219 21.65

2960 2.83 2404 23.02

1921 1.79 2438 22.8

Leprosy prevalence and case detection rates per 10000 (1983 - 1997)

MB %

77

72 64 62 65 55 54 50 52

3,---------------------------------------------

2.5+---------------------------------7L-------~-

2+-----·------·~----------~~~L-----~------~

1.5+---

0.5 +---------------------------'t:F-------------------

Year

ParT /I 31


0 0

17 ')

()

0 14 ')

13 7 11 18 25 ()

21 <)

21 10 16 11 17 11

-+- Prevo rate

-0- Detee. rate

32 Part II

Leprosy indicators by province in Cambodia (1995):

Province Population Registered Prevalence New New cases Prevalence! 1995 (OOOs) cases per 10000 cases per 100000 detection

Banteay Meanchey 507 21 0.41 36 7.1 I.7 Battambang 725 72 0.99 93 13 1.3 Kampong Cham 1542 527 3.4 576 38 1.1

Kampong Chhnang 359 146 4.1 198 55 1.4 Kampong Speu 520 174 3.3 192 37 1.1

Kampong Thorn 572 150 2.6 152 27 I

Kampot 510 42 0.82 82 16 2 Kandal 986 57 0.58 68 6.9 1.2

Kep 28 3 1.1 5 18 1.7

Koh Kong 84 14 I.7 23 27 1.6

Kratie 235 40 1.7 48 20 1.2

Mondulkiri 24 4 I.7 6 25 1.5

Preah Vihear 104 26 4.4 17 16 0.7

Prey Vcng 1015 248 2.4 314 31 1.3

Pursat 330 33 I 40 12 1.2

Rattanakiri 85 45 5.3 97 114 2.2

Rubber Plantation 90 46 5,1 39 43 O,l{

Siem Reap 687 71 I 200 29 2.8

Sihanoukville 126 '1 0,16 2 1.6 I ~

Steung Treng 77 3 0.39 5 6,5 I.7

Svay Rieng 476 21 0,44 43 9 2

Takeo 768 104 1.35 122 16 1.2

Phnom Penh 856 8 0,093 8 0.93 I

National Centre 72 43 0,6

Total 10706 1921 1.79 2438 22.8 1.3

Kir'f'\ WESTERN PACIFIC REGION

CAMBODIA

WESTERN PACIFIC REGION

Dots are randomly distrlbutad within provinces

CAMBODIA

Distribution of leprosy cases registered for treatment (1997)

1 dot • 5 cases

Part /I 35

(This page intentionally left blank.)

36 Part II

China

1997 Cured Relapsed

Population: 1 236 000 000

Epidemiology: There were 4045 registered leprosy cases in 1997, as compared to an estimated 500 000 cases in 1950. The WHO criteria for elimination of leprosy as a public health problem were met in all 30 provinces, direct municipalities and autonomous regions in 1992. Furthermore. leprosy as a public health problem has been eliminated in 97.2% of all counties and cities (there are more than 2500 counties and cities in the country), as compared to 78.5% in 1989. Around 70 counties remain with a leprosy prevalence rate of more than one case per 10000 population, with most cases living in difficult to reach areas. An estimated 70% of all leprosy cases come from the mountainous south-western provinccs.

Programme: Vertical. All activities related to leprosy are performed by the country leprosy doctors. A SAPEL was implemented in Yunnan in 1996.

Case-finding: Mainly passive with intensive health education activities. In some areas, the programme uses a policy of rewarding a health worker who reports a case of leprosy.

Diagnosis: According to clinical findings, bacteriology and histopathology tests.

Laboratory: Available at the provincial level.

Treatment: MDT was implemented in 1982 in Yangzhou Prefecture, Sichuan and Yunnan Provinces. WHO MDT was introduced in 1985 and nationwide implementation began in 1987. Fixed duration treatment is used, but in some areas, MDT is given until skin smears are negative.


Rehabilitation: The rehabilitation programme does not cover all the country. There are no facilities for vocational rehabilitation training of leprosy patients. There are an estimated 120000 disabled people.

Retreatment of cases previously treated with DDS and discharged: An increasing number of patients notified as relapsed cases come from the group of patients treated with DDS and declared cured.

Achievements: MDT coverage is more than 99% in mainland China. Leprosy as a public health problem has been eliminated from China. However, the following provinces still have pockets of high endemicity: Guizhou, Sichuan, Yunnan and Tibet Autonomous Province.

References:

Blanc L. (WHO), Report on a field visit to Yunnan province, China, December 1996.

Blanc L. (WHO), Report on a lield visit to Sichuan province, China, November 1996.

Blanc L., Farrugia R., Jakeman P., Yuasa Y. (WHO), Report on the third evaluation survey of MDT implementation and leprosy control programme in China: Anhui, Gansu, Jiang"i and Shanx.i Provinces, September 1994.

Dai Z-c., "Leprosy control in China", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHF/MDT Series 2, 1991, 1-10.

Glaziou P. (WHO). Report on a field visit to Anhui and Jiangsu provinces, China, May 1997.

WHO, Wkly Epidem. Rec., 1995.25.185-188. Glaziou P .• Tin K .• Loprang F .• Jacobson R. (WHO), Fourth Evaluation of the Leprosy Elimination Programme in China.

October-November 1997.

Leprosy indicators in China (1983-1997):


1983 1024950

1984 1051551

1985 1059521

1986 1 053970

1987 1060013

1988 1096140

1989 1 111 910

1990 1 133682

1991 1 149000

1992 1 165467

1993 1 182 195

1994 1 198744

1995 1 221 462

1996 1235940

1997 1236000

Rate per 10000

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

,

'"


100 000 0.94

4945 0.47

70000 0.66 4042 0.38

55240 0.50 3837 0.35

40000 0.36 3303 0.30

30000 0.26 3345 0.30

20003 0.17 3400 0.30

8470 0.07 2728 0.23

6055 0.05 2191 0.19

5655 0.05 2096 0.17

4833 0.04 1 895 0.16

4474 0.04 1 845 0.15

4045 0.033 1854 0.15

Leprosy prevalence and case detection rates per 10 000 (1983 -1997)

"" " \. "'" "-~

'" n- ~

o

MB %

57

60

74

63

53

57

66

66

69

68

69

81

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

Part II 37


3

3

3

24 3

24 3

21 3

22 3

22 3

21 4

-+- Prevo rate

-{}- Detee. rate

Leprosy indicators by province in China (1997):

Province Population Newly detected cases (OOOs) Total Rate MB Disabilitv

Beijing 65660 Tianjin 9 000 I O.DII I 0 Hebei 62250 I 0.002 I I Shanxi 31 330 Neimengbu 20310 Liaoning 40830 0 0 0 0 Jilin 25920 I 0.039 I 0 Heilongjiang 37520 2 0005 2 2 Shanghai n 050 2 0.015 2 I liangsu 21800 73 0.102 68 32 Zhejiang 44000 II 0.025 9 4 Anhui 64 450 40 0.062 30 4

Fujian 32000 106 0.331 61 15 Jiangxl 41500 73 0.176 62 9

Shandong 88400 66 0.075 59 13 Henan 98000 9 0.009 7 I Hunan 57950 20 0.035 13 5 Hubei 64000 109 0.170 99 15 Guangdong 69290 121 0.175 81 II Guangxi 46330 66 0.142 48 3 Hainan 7430 20 0.249 18 2 Sichuan 83 000 221 0.266 203 55 Chongqing 32000 21 0.066 21 6 Guizhou 34730 242 0.697 211 53 Yunnan 38940 485 1.246 399 131 Tibet 2500 52 2.060 26 6 Shaanxi 35130 30 0.085 30 6 Gansu 24670 35 0.142 34 2 Qinghai 4960 4 0.081 3 2 Ningxia 540 0 0 0 0 Xingjiang 17 170 43 0.250 19 15 Hong Kong! 6502 II 0.17 3 0 Taiwan 21440

Total 1236000 1854 0.15 1508 394

Leprosy data not included in the total (see Hong Kong, China section)

Treated MDT Relapse Children MDT comDleted

0 4 0 0 0 7 2 I

0 23 4 0 0 5 2 0 0 26 3 I 0 10 5 0 0 240 98 6 0 67 33 5 0 97 34 2 5 342 253 8 0 195 48 5 2 242 63 12 4 33 9 0 2 100 35 4 2 349 121 15 8 589 157 23 I 183 50 4 3 76 18 8 6 712 244 18 0 99 26 I 4 795 260 20

26 1377 534 40 I 145 71 0 0 133 40 7 I 55 5 7 I 32 19 0 0 0 0 0

14 92 26 I 0 II 0

80 6028 2160 188

Registered Prevalence end of vear rate

4 0.004 6 0.009

19 0.005 3 0.001 9 0.002 5 0.004

142 0.065 36 0.008 64 0.010

243 0.076 142 0.034 180 0.020 24 0.002 72 0.012

2]3 0.036 432 0.062 134 0.029 55 0.074

483 0.058 77 0.024

541 0.156 848 0.218

73 0.292 88 0025 46 0.019 20 0.040 0 0

66 0.038 54 0.08

4045 0.033

Prevalence! detection

4.0 6.0

3.0 4.5 2.5 1.9 3.3 1.6 2.3 1.9 2.7 2.7 3.6 2.1 3.6 2.0 2.8 2.2 3.7 2.2 1.7 1.4 2.9 1.3 5.0

1.5 4.9

2.2

<..,; 00

;0 :::t ::::

Xinjiang Uygur

Gansu


Leprosy Surveillance Programme

Nei Mongol Zizhiqu

liaoning c. c

"c Ningxia

Beijing /j ~' ..... i ~1{ ,;.~ ~,- :--"

Hebei "' Tianjin' Shanxi c ~""

" "', --~.

S ."

handon,g'"

Qinghai

Hunan

, '., Jiangsu

'Anhui' ... ,~:",>

Shanghai , Cc ~

>Zhejianllj"

,i"c Jiangxi' .. ;

( c

ltI<

" Fujian,J. ", . . ; •. '\ ~~'

~ .p'l' ,~

·Guangdong.. . ..' c' .,JJ:i:.' Hongkong Island

, .......... :: ... 'L. , ... ,..'fI--,jj . \ ( Macau

L ~4'''''''''~'

Hainan ~~ . .,.,-.

0 •. 1- ~ ~ ,:~ ~ Heilongjiang ~..:: - II ~

Jilin -'f,

CHINA

leprosy prevalence rates per 10,000

(1997) .0.1 to OJ , 1 0.05 to 0.049

. 0.01 to 0.049 0.0001 to 0.009 o

1 dot=S cases

Dots are randomly distributed within provinces.

WESTERN PACIFIC REGION Leprosy Surveillance Programme

• ~ . I --. ,-

CHINA Distribution of leprosy cases

registered for treatment (1997)

Part /I 41


42 Part [f

Cook Islands

1997 Prevalence New cases

Population: 19 000

Epidemiology: Leprosy cases have occurred sporadically since 1990.

Programme: Fully integrated, no vertical component, no central leprosy unit.

Case-finding: Passive and through school surveys.

Diagnosis: Based on clinical findings and bacteriological examinations.

Laboratory: There is no quality testing.

Treatment: MDT started in 1986.


Rehabilitation:


Cured Relapsed

Achievements: Leprosy as a public health problem has been eliminated from the Cook Islands.

References:

Jesudasan K.. Glaziou P. (WHO). Report on a held visit to Cook Islands, May 1994.

Leprosy indicators in the Cook Islands (1983-1997);


1983 18

1984 19

1985 20

1986 20

1987 17

1988 17

1989 17

1990 17

1991 17

1992 18

1993 19

1994 19

1995 19

1996 19

1997 19

Rate per 10000

18

r"\. ~ ~

Registered Prevalence New cases New cases cases per 10 000 per 100 000

26 15.3

15 7.50

16 9.41

6 35.29

0 0.00 0 0.00

2 1.18 2 11.76

0 0.00 0 0.00

0 0.00 0 0.00

0 0.00 0 0.00

1 0.53 1 5.26

0 0 0 0.00

Leprosy prevalence and case detection rates per 10 000 (1983·1997)

16

14

12

10

8

6

~A ...

'" '\ '''' ~~ ..n.

4

2

o

Part II 43

MB Disability Child % % %

0 0 (]

0 0 0

0 0 0

-+-- Prevo rate

-0-- Detee. rate

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

44 Part fI

Fiji

1996 Prevalence New cases Relapsed

Population: 796 000

Epidemiology: The prevalence rates decreased from 6.8 per 10 000 in 1983 to 0.21 per 10 000 in 1996. The detection rates per 100000 decreased from 6.1 in 1982 to 0.75 in 1996 (6 newly detected cases).

Programme: Integrated, with a central unit, including a clinic for leprosy cases at Twomey Memorial Hospital, which is a regional training centre in leprosy for the South Pacific Region.

Case-finding: School surveys are carried out on a regular basis.

Diagnosis: Based on clinical findings and systematic bacteriological examinations.

Laboratory: There is a well-equipped centralized laboratory.

Treatment: WHO MDT was implemented in 1983.


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: Old cases are retreated when signs of relapse occur.

Achievements: Fiji has reached the goal of elimination of leprosy as a public health problem at country level. The Eastern region had a prevalence rate of 1.1 per 10 000 in 1993 while the prevalence rate of leprosy in the other regions was below 1 per 10 000. The MDT coverage is 100%.

References:

Jesudasan K. (WHO), Report on a field visit to Fiji, November 1994.

Leprosy indicators in Fiji (1983-1996):

Year Population Registered Prevalence New New cases (OOOs) cases per 10000 cases per 100000

1983 670 455 6.79 36 5.37 1984 700 444 6.34 25 3.57 1985 710 367 5.17 22 3.10 1986 723 283 3.91 20 2.77 1987 750 243 3.24 19 2.53 1988 727 204 2.81 17 2.34 1989 740 147 1.99 16 2.16 1990 740 109 1.47 26 3.51 1991 747 86 1.15 6 0.80 1992 754 49 0.65 11 1.46 1993 770 39 0.51 7 0.91 1994 771 39 0.51 9 1.17 1995 784 24 0.31 6 0.77 1996 796 17 0.21 6 0.75

Rate per 10 000


8

7

5

~ ~

'" ~ '" ~ 6

4

3

2

1- ...0.. --...

a

Year

Part 1/ 45

MB Disability Child % % % 47 17 52 8 55 14 20 20 68 16 71 24 81 73 50 55 0 57 0 56 78 1 1 33 50 0 0

--Prevo rate

-0- Delee. rate

46 Part Il

French Polynesia

1997 Cured Relapsed

Population: 220000 .

Epidemiology: The prevalence rate per to 000 decreased from 24 in 1946 to 0.59 in 1997 (13 registered cases). The case detection rate was 7.3 per 100000 in 1968 and 2.27 per 100000 in 1997 (5 newly detected cases).

Programme: Mainly vertical. There is a central leprosy unit.

Case-finding: Mainly passive. Active case-finding is systematically performed in contacts of known cases.

Diagnosis: Based on clinical, bacteriological and histological findings.

Laboratory: Quality control measures are undertaken at the central laboratory and skin biopsies are sent to the Pasteur Institute in Paris.

Treatment: Modified WHO MDT was implemented in 1982. Rifampicine is given on a daily basis to both PB and MB patients. Treatment has been of fixed duration since 1982 (two-year MDT for MB patients).


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: Most old cases are retreated with MDT.

Achievements: The MDT coverage is 100%. French Polynesia has reached the goal of elimination of leprosy as a public health problem.

References:

Cartel lL., Boutin J.P., Plichart R., Roux l, Grosset lH., Leprosy in the French Polynesian archipelagos from 1967 to 1987,Bul/ Soc Pathol &ot, 1988; 81, 819-826.

Farrugia R. (WHO), Report on a field visit to French Polynesia, April 1992.

Infonnation from the Institut Malarde, Papeete, French Polynesia, October 1994.

Leprosy indicators in French Polynesia (1983-1997):

Year Population

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

20

18

16

14

12

10

8

6

4

2

o

~

~

(000s)

157 160 160 179 180 189 192 196 201 206 207 212 220 220 220

'" .""

Registered Prevalence New New cases

""

cases per 10 000 cases per 100 000 295 17.7 24 15.29

12 7.50 11 6.88 14 7.82 19 10.56 10 5.29 3 1.56 8 4.08

9 0.45 5 2.49 18 0.87 12 5.83 18 0.87 7 3.38 11 0.52 9 4.25 12 0.55 6 2.73 14 0.64 6 2.73 13 0.59 5 2.27


"" "" "" "" J"1.. ~"

MB % 38 33 0

43 26 60 0 38 60 33 43 56 83 100

20

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

Part II 47

Disability Child % % 13 13 8 17 0 27 7 21 II 42 10 20 33 0 25 13 60 0 8 33

29 14 0 22 0 33 0 33 0 0

-+-- Prevo rate

-0- Detec. rate

48 Part /I

Guam

1997 Prevalence New cases Grade 2 Cured Relapsed

Population: 150 000

Epidemiology: The main at-risk group is migrants, an increasing proportion of whom come from the high endemic Federated States of Micronesia.

Programme: Integrated.

Case-finding: Mainly passive, but contacts of known leprosy cases are screened systematically.

Diagnosis: Based on clinical, bacteriological and histological examinations.

Laboratory: There are quality testing measures. Biopsies are sent to Carville, USA.

Treatment: MDT started in 1988. MDT is given until skin smears are negative.


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: All old cases under DDS mono therapy have been retreated.

Achievements: The MDT coverage has reached 100%. Leprosy as a public health problem has been eliminated from Guam.

References:

Blanc L., (WHO), Report on a field visit to Guam. November 1994.

Blanc L., (WHO), Review of leprosy elimination campaigns and special action projects for elimination of leprosy in the Western Pacific Region, June-September 1997.

Information from the Department of Public Health and Social Services. Guam. October 1994.

Leprosy indicators in Guam (1983-1997):

Year Population Registered Prevalence New New cases MB (ooos) cases per 10 000 cases per 100000 %

1983 113 3 2.65 33 1984 119 1985 120 1986 122 34 2.8 4 3.28 50 1987 125 3 2.40 67 1988 124 4 3.23 75 1989 126 1990 126 2 1.59 100 1991 127 20 1.57 5 3.94 80 1992 140 23 1.64 7 5.00 71 1993 143 24 1.68 4 2.80 100 1994 143 10 0.70 6 4.20 83 1995 150 8 0.53 6 4.00 100 1996 1997 158 20 1.26 6 3.78 67

Rate per 10000

Leprosy prevalence and case detection rates per 10000 (1983 -1997)

3~---------------------------------------------

~ 2.5+-------------~~-------------------------------

2~----------~~----------------

~ ~ -\ 1.5 +------------'----'----\-\--,

~ I 0.5 t----------;:;----=...n..:---Lt~~_::::::o=~~~

-cr O+--+--~~~-r--+--+--~~--~--~-+--+-~--~

Year

Part lJ 49


33 0

0 0 0 0 0 0

0 0 0 0 0 14

25 25

17 0

0 17

-+- Prevo rate

--0- Detee. rate

50 Part II

Hong Kong, China

1997


Epidemiology:

Cured Relapsed

Programme: Part of the Social Hygiene Service of the Department of Health. There is a central inpatient leprosy unit.

Case-finding:

Diagnosis:

Laboratory:

Treatment: WHO MDT was implemented in 1983, but different multidrug regimens have been in use since 1977. Patients receive treatments of extended duration.


Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Hong Kong, China.

References:

WHO. Wkly Epidem. Rec. 1995; 25: 185-188.

Information from the Department of Health, Hong Kong Government, May 1993.

Leprosy indicators in Hong Kong, China (1983-1997):

Year Population

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

3.5

3

(OOOs) 5313 5364 5456 5477 5613 5681 5761 5840 5922 6005 6090 6175 6005

6502

2.5 ~ ~

Registered Prevalence New New cases cases per 10000 cases per 100 000 1638 2.9

65 0.11 26 0.44 47 0.08 20 0.33

54 0.08 II 0.17


~ 2

1.5

~ ~ ~

1

0.5

o

Year

Part II 51


65 20

27 0 0

-+- Prevo rate

-0- Detee. rate

52 Part II

Japan

1993 Grade 2 MDT Cured Relapsed cases cases


Epidemiology: The prevalence rate was 0.02 per 10 000 in 1993 (200 registered cases). The case detection rate has remained lower than 0.04 per 100 000 since 1984, and was 0.0 I per 100 000 in 1993 (8 newly detected cases).

Programme: Vertical. Patients are referred to the National Sanatorium Tama Zenshoen.

Case-finding:

Diagnosis:

Laboratory:

Treatment:


Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Japan.

References:

Information from the Ministry of Health and Welfare, Japan, 1993.

Leprosy indicators in Japan (1984-1993):

Year Population (OOOs)

1984 119492 1985 120760 1986 121 672 1987 121 535 1988 122026 1989 122930 1990 123612 1991 124106 1992 124603 1993 125 103

Rate per 10000

Registered Prevalence New New cases cases per 10 000 cases per 100 000

30 0.03 884 0.1 42 0.03

42 0.03 15 0.01 33 0.03

768 0.06 26 0.02 12 0.01 17 0.01 15 0.01

200 0.02 8 0.01


MB %

0.12.,-----------------------

0.1 +---~~~------------------

0.08 +-------'>..,~~---------------

0.06 +------------->.,~,--------------

0.04 +---------------',.,~~---------

0.02 +----------------....,..------

Year

Part II 53

Disability Child %

__ Prevo rate

-0- Oetec. rate

%

54 Part II

Kiribati

1996

Population: 79000

Cured cases

Relapsed cases

Epidemiology: The leprosy prevalence rate per 10 000 was 6 in 1994 (46 registered cases), and decreased to 1.65 in 1995 (13 registered cases), ·due to the implementation of fixed duration MDT. However, a large number of undetected cases remain·s in the country. Intensive case-finding activities led to the detection of 78 new cases in 1996, the highest number of newly detected cases ever recorded in Kiribati.

Programme: Vertical.

Case-finding: Since 1995, population screening has been done on selected groups, schools, contacts and some villages. From May to December 1997, a systematic survey of the population of Tarawa and several outer islands was conducted, covering 91 % of the estimated population. Out of a total of 64704 individuals examined, 128 leprosy cases (13% MB) were detected.


Laboratory: There is one central laboratory in Tarawa Hospital. There is no quality testing.

Treatment: MDT started in 1988. Since 1990, 100% of new leprosy cases have been put under WHO MDT. Treatment is given until skin smears are negative.


Rehabilitation: There is no programme for rehabilitation of disabled patients

Retreatment of cases previously treated with DDS and discharged: All old cases treated with DDS have been retreated with MDT.

Achievements: The MDT coverage is 100%.

References:

Blanc L. (WHO), Special action project for the elimination of leprosy in Kiribati, February 1997.

Daulako E.C. (WHO), Report on a field visit to Kiribati, December 1996.

Daulako E.C. (WHO), Report on a field visit to Kiribati, February 1997.

Daulako E.C. (WHO), Report on a field visit to Kiribati, May-August 1997.

Daulako E.C. (WHO), Report on a field visit to Kiribati, October-December 1997.

Glaziou P. (WHO), Report on a field visit to Kiribati, April 1995.

Guerrits G. (WHO), Report on a field visit to Kiribati, July 1996.

Leprosy indicators in Kiribati (1983-1996):


1983 61 1984 62 1985 64 1986 65 1987 67 1988 69 1989 71 1990 72 1991 74 1992 75 1993 76 1994 77 1995 79 1996 79

Rate per 10000

Registered Prevalence New New cases cases per 10000 cases per 100 000 118 19

28 40.6 63 88.7

33 4.5 28 38.9 90 9.5 59 79.7

33 44.0 41 54.0

46 5.97 17 22.1 13 1.65 16 20.3 42 5:32 78 98.7


MB %

41 48 20 30 39 65 25

~~----------------------------------------------

18~~------------------------------------------

16+---~-----------------------------------------

14+-----~~----------------------------------~

12+---------~ __ ---------------------------------

10+-------------~----------~--------------~j_--

8+---------------~~~--_A~~~--------_+----

6+-----------------+-~~~--~--~~~----r_~-

4+---------------0-----~----~--~._~_+~---

2+----------------------------------O~~--

O+--+--;_--r__r--+_~--;_~r__r--+_-+--;_~r_~

Year

Part II 55


39 29 12 37 36 27

12 29 38

-+- Prevo rate

--0- Detee. rate

56 Part 1/

Lao People's Democratic Republic

1997 Cured Relapsed


Epidemiology: The prevalence rate has decreased markedly since 1986.

Programme: Vertical at the country and provincial levels and supervised by the Dermatology Centre in Vientiane. There are leprosy clinics at the provincial level. The programme is partially integrated at the district level. There are still leprosy villages in the country, perpetuating the stigma attached to the disease. The leprosy programme is partly supported by the NSL (Netherlands Leprosy Relief Association) for operational activities, and Leprosy Mission International for rehabilitation.

Case-finding: Mainly passive. Active case-finding is limited to areas with a known high number of cases.

Diagnosis: Mainly based on clinical examination.


Treatment: WHO MDT was initiated in 1984. All newly detected cases receive MDT.

Prevalence1detection ratio: 2.1

Rehabilitation: Reconstructive surgery and physiotherapy is performed in Vientiane and Savannakhet.


Achievements: MDT coverage was 86% in 1994 and close to 100% in 1995.

References:

Choulamontry T., "Report on leprosy in Laos", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHFIMDT Series 2, 1991, 110-111.

Farrugia R. (WHO), Lutte contre la lepre, Repuhlique Populaire Democratique Lao, January 1996.

Farrugia R. (WHO), Lutte contre la lepre, Repuhlique Populaire Democratique Lao, November 1996.

Farrugia R. (WHO), Lutte contre la lepre, RepuhJique Populaire Democratique Lao, January 1997.

Farrugia R., Blanc 1. (WHO), Progranune national de lutte contre la lepre, RepubJique Populaire Democratique Lao, June 1996.

Gerrits G., Glaziou P., Quimpo J., Voskens J. (WHO), Report on a field visit to Lao P.D.R., June 1994.

Infonnation from the Centre of Dermatology and Venerology, Vientiane, Lao P.D.R., June 1993.

Leprosy indicators in the Lao People's Democratic Republic (1983-1997):

Year Population Registe~ed Prevalence New New cases

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

10

9

8

7

6

5

4

3

2

1

o

(OOOs) 4209 4315 3585 3708 3831 3954 4077 4200 4200 4360 4474 459] 4882 4882 4846

~

Lor

~

\ \

cases per 10 000 cases per 100000

2988 8.3 3 152 8.79 307 8.56 3381 9.12 426 11.49 2353 6.14 702 18.32 1955 4.94 168 4.25 1376 3.38 264 6.48 2529 6.02 371 8.83 1393 3.32 340 8.10 1 361 3.12 317 7.27 1085 2.43 234 5.23 967 2.ll 304 6.62 694 1.42 298 6.10 574 1.l8 270 5.53 533 1.1 256 5.28

Leprosy prevalence and case detection rates per 10 000 (1983-1997)

\ "'- 1\

"'\. / \ \/ L ... ~

~ "'-b- ,:;-...

Year

Part J[ 57


34 64 30 46 41 43 47 53 34 58 38 75 29 67 25 3 68 29 4 66 25 4

--Prevo rate

-0- Detee. rate

58 Part 1I

Macao

1997

Population: SOO 000

Epidemiology:

Programme:

Case-finding:

Grade 2 Cured

Diagnosis: Bacteriological and histological examinations are performed systematically.

Laboratory:



Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Macao.

References:

Lopez-Bravo L. (WHO), Report on a tield visit to Macao, March 1982.

Relapsed

Leprosy indicators in Macao (1983-1997):

Year Population

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997

Rate per 10000

(OOOs) 304 309 392 417 414 444 460 452 467 482 498 480 424

500

Registered Prevalence New New cases cases per 10 000 cases per 100 000

96 2.8

18 0.39 2 0.43 15 0.21 2 0.41 13 0.26 1 0.20

7 0.17 0 0

0 0 0 0


MB %

50

3r-----------------------------------------------

94 95 96 97

Part II 59


-+- Prevo rate

-0- Detee. rate

60 Part II

Malaysia

1997

Number

Rate

Prevalence per 10000

1181

0.54


New cases per 100 000

277

1.28

Grade 2 disability

MDT coverage

Epidemiology: High-risk groups consist largely of migrant populations.

Cured cases

Relapsed cases

Programme: Coordinated at the Sungei Buloh National Leprosy Control Centre, and partially integrated into the general health care system.

Case-finding: Passive.

Diagnosis: Based on clinical and bacteriological examinations. Skin biopsies are processed occasionally.

Laboratory:

Treatment: MDT was implemented in 1985. Treatment is given until skin smears are negative. Many cases were still under DDS monotherapy as at February 1994.


Rehabilitation:


Achievements: Malaysia has eliminated leprosy as a public health prohlem.

References:

Blanc L. (WHO), Report on a field visit to Malaysia, February 1994.

Frankel R., Jacobson R., Revankar c., Viardo C. (WHO), Report on a lield visit to Malaysia. September 1993.

Information from Dr K.K. Lim, Ministry of Health. Kuala Lumpur. Malaysia. April 1993.

Leprosy indicators in Malaysia (1983-1997):

Year Population (()(10s)

1983 14863

1984 15204

1985 15880

1986 16109

1987 16749

1988 16958

1989 17353

1990 17552

1991 17567

1992 18031

1993 18513

1994 18995

1995 20140

1996 21 168

1997 21665

Rate per 10000

4

3.5

3

2.5

2

1.5

0.5

o


5730 3.6 313 2.0

6373 3.81 348 2.08

5723 3.37 311 1.83

5031 2.90 329 1.90

4149 2.36 296 1.69

3439 1.96 315 1.79

220 1.22

1823 0.96 330 1.74

I 561 0.78 293 1.45

1 314 0.62 273 1.29

1 181 0.54 277 1.28


~

'" ~ '" ~ ~

MB %

55

74

73

70

68

~ ~ .

Year

Part II 6/


8

20 9

28 9

23 11

19 5

19

9 7

5 5

3 10

3 5

-+- Prevo rate

-D-Detec. rate

62 Part II

Northern Mariana Islands

1997

Number

Rate

Prevalence per 10 000

4

0.63

Population: 63 763


5

7.84

Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Epidemiology: High-risk groups comprise migrants from the Federated States of Micronesia, Palau and the Philippines.

Programme: Integrated with the tuherculosis control programme, supervised at the Public Health Clinic.


Diagnosis:

Laboratory:

Treatment: Rifampicine was introduced in the treatment regimen in 1980 and MDT started in 1986.


Rehabilitation:



References:

Carillo M. (WHO), Report on a lield visit to Northern Mariana Islands. March 1994.

Jesudasan K. (WHO). Report on a field visit to Northern Mariana Islands. June 1995.

Leprosy indicators in the Nonhern Mariana Islands ( I YR:I- I YY7):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

2

1.8

(OOOs)

17

19

20

20

36

38

38

44

45

46

50

50

47

62

64

Registered Prevalence New New cases cases per 10000 cases per 100000

3 17.65

2 10.53

3 15.00

2 10.00

4 11.11

:I 7.89

1 2.63

3 6.82

8 17.78

4 0.87 4 8.70

3 6.00

9 1.8 I 2.00

7 1.49 6 12.77

\I 1.77 6 9.68

4 0.63 5 7.84


MB %

° 67

75

100

0

67

66

60

1.6 T+--------------H.------I'---~___7''----t_-

1.4 +-\-----;f-\.-----------.~+--___cl-----+-

1.2 +--++--+--------f---+-+--------\--

0.8+--------~---~---~~----_f

0.6 +---------\---~

0.2+-----

O+-~--~--~_+--+__+--~--~_+--+__+--~~~~

Year

ParI 1/ 63


50

33

25

100 25

0 100

0 ()

0 17

20 ()

-+- Prevo rate

-D-Oetec. rate

64 Part II

Marshall Islands

1997

Number

Rate


163

26.8

Population: 61 000

New cases per 100000

68

112

Grade 2 disability

MDT Cured coverage cases

Relapsed cases

Epidemiology: Recent active case-finding activities resulted in the detection of 68 new cases in ]997, as compared to 18 new cases in 1995.

Programme: Partially integrated. A three-year LEC is planned.

Case-finding: Active case-finding activities started in 1996.

Diagnosis: Bacteriological examinations are performed systematically in MB suspected cases. Biopsies are taken in nearly all cases.

Laboratory: Biopsies are sent to Hawaii, USA.

Treatment: MDT was introduced in 1986.


Rehabilitation: There is no programme for rehabilitation.


Achievements: MDT coverage is ]00%.

References:

Jesudasan K. (WHO), Report on a field visit to Marshall Islands, June 1995.

Jesudasan K. (WHO), Report on a field visit to Marshall Islands. March-May 1996.

Information from the Ministry of Health, Marshall Islands, October 1994.

Leprosy indicators in the Republic of Marshall Islands (1983-1997);

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

(000s)

33

35

28

29

30

43

40

46

47

49

54

56

55

51

61

.


2 6.06

5 14.29

7 25.00

13 44.83

10 33.33

19 44.19

24 60.00

26 56.52

50 10.6 32 68.09

21 42.86

20 3.70 20 37.04

8 1.43 8 14.29

46 8.36 18 32.73

85 16.67 112 219.6

163 26.8 68 112


MB %

65

63

78

38

41

30,----------------------------------------------

25+-----------------------------------------------~

~+---------------------------------------~~--

15+-------------------------------------------H---~

10+-------------------------~~----------_f~----

Year

Part II 65


0

13

50

31

36

___ Prevo rate

-0- Detee. rate

66 Parr /I

Federated States of Micronesia

1997

Number

Rate


163

14.8

Population: 110000


123

112

Grade 2 disability

MDT coverage

Cured cases

Epidemiology: Leprosy incidence is unevenly distributed between states and islands.

Relapsed cases

Programme: Tbere is a leprosy and tuberculosis control programme coordinator in cach state. A twoyear programme for mass preventive therapy of leprosy using a single dose of the comhination rifampicine. ofloxacin and minocycline (rifampicine alone for children) once a year for two years started in J 996. The programme included a two-round mass screening of the wholc population and newly detected cases were put under WHO MDT. In total. 317 new cases were detected during the rirst round and 80 during the second round. During 1996-1997 almost 500 patients also completed the treatment.. As at February 1998. preventive therapy coverage was 83% for one dose and 53% for two doses. The proportion of new cases detected during the second round among the persons who have previously received preventive therapy was 38% but it was highly suspected that some of these cases already had lesions when given preventive therapy. The second round was planned to be completed hy May I'I'IX. Details of the programme are presented in Part I.

Case-finding: Aetive from 19'16 to 1998 through mass screenings.

Diagnosis: Based on clinical grounds and often on histological examinations.

Laboratory: Biopsies are sent to Carville. USA. for processing.

Treatment: Rifampicine was introduced in the regimen in 1980 and WHO MDT started in 1984.

Prevalence/detection ratio: I. 3

Rehabilitation: There is no programme for rehabilitation of disabled cases.



References:

Blanc L. (WHO). Leprosy control in the Federated States of Micronesia, December 1995.

Landwehr D. (WHO), Special Action Project for the Elimination of Leprosy in the Federated States of Micronesia, Fehruary-March 1997.

Revankar C.R. (WHO), Report on a held visit to the Federated States of Micronesia, February-June 1995.

Takashima J. (WHO), Report on a lield visit to Federated States of Micronesia, March I 996-January 1997.

Tin Mynt U. (WHO), Implementation, monitoring and evaluation of the special programme on leprosy elimination. Federated States of Micronesia, June 1996-Fehruary 1997.

Diletto C. (WHO), Development of a national leprosy plan of action for the second year of implementation of preventive therapy, Federated States of Micronesia, March-June 1997.

Diletto C. (WHO), Development of a nalional leprosy plan of action for the second year of implementation of prevent, vc therapy, Federated States of Micronesia, July I 997-Fehruary 1998.

•

Leprosy indicators in the Federated States of Micronesia (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

(OOOs)

73

88

91

94

94

97

95

101

104

107

109

112

122

122

110


851 90.53 177 188

782 80.62 87 89.7

658 69.26 96 101

628 62.18 80 79.2

501 48.17 84 80.8

349 32.62 90 84.1

362 33.21 220 201

290 25.89 95 84.8

368 30.16 206 169

163 14.80 123 112


MB %

42

28

100,----------------------------------------------

90+-----------~~-------------------------------

80 +---------

70 +-------

60+-------

50+---------------------------~---------------

40+----------------------------~------------------

30+----·------------------------

20

10 +------------- -

O+-~--~--+-~--~--+_~--~--+__+--~--~_+--~

Year

Part 1I 67


22

44

-+-- Prevo rate

-a- Detee. rate

68 Part II

Mongolia

1997

Number

Rate


o

o


Epidemiology:

Programme:

Case-finding:

Diagnosis:

Laboratory:

Treatment:


Rehabilitation:


o

o

Grade 2 disability

MDT coverage


Cured cases

Achievements: Leprosy as a public health problem has been eliminated from Mongolia.

References:

Relapsed cases

WHO. Bulletin of Regional Health Information. South-East Asia Regional OtTtce, New Delhi, India, 1992.

Part II 69

Leprosy indicators in Mongolia (1983-1997):

Year Population Registered Prevalence New New cases MB Disability Child (OOOs) cases per 10 000 cases per 100000 % % %

1983

1984

1985 1 915

1986

1987

1988

1989

1990 2103

1991

1992

1993

1994 2250 0 0 0 0

1995 2410 0 0 0 0

1996 2400 0 0 0 0

1997 2 400 0 0 0 0

70 Part /I

Nauru

1996

Number

Rate


4

3.6

Population: 11 000


2

18

Grade 2 disability


Relapsed cases

Epidemiology: Since 1982 there has been no evidence of a declining trend in the case detection rate.

Programme: Control activities take place at the Community Health Clinic of the Division of Public Health.

Case-finding: School screenings are performed occasionally.

Diagnosis:

Laboratory:

Treatment: WHO MDT was implemented in 1993.


Rehabilitation:

Retreatrnent of cases previously treated with DDS and discharged:


References:

Daulako E.C. (WHO), Report on a field visit to Nauru, September 1994.

Daulako E.C. (WHO), Report on a field visit to Nauru, April 1995.

Information from Nauru General Hospital, Nauru, November 1994.

Leprosy indicators in Nauru (1983-1996):


1983 8

1984 8

1985 8

1986 8

1987 8

1988 8

1989 9

1990 9

1991 9

1992 9

1993 10

1994 10

1995 11

1996 10

Rate per 10000

60

50

40

30

20

10


40 57.1 1 12.50

1 12.50

3 37.50

0 0.00

3 37.50

3 37.50

2 22.22

42 46.7 1 11.11

2 22.22

14 15.56 2 22.22

3 30.00

8 8.00 2 20.00

8 7.27 2 18.18

4 4 2 20


\ \ \ \ ~

MB %

0

100

33

67

100

100

100

100

67

100

100

0

~/~ ~ .n. ~ o ~ ~ ~ ~ ~ ~ M ~ ~ ~ ~ M ~ ~ ~

Year

Part 1I 71


0

100

33

0

0

50

100

0 0

0

0

0 0

0 0

0

-+- Prevo rate

-0- Detee. rate

72 Part Il

New Caledonia

1995

Number

Rate


13

0.72

Population: 181 000


7

3.87

Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Epidemiology: Since 1983, the case detection rate has declined at a mean annual rate of 13%. Implementation of fixed duration MDT has also led to a marked decrease in the prevalence nHe.

Programme: Coordinated at the Service de Dermatologie of the Centre Hospitalier Territorial.

Case-finding: Mainly passive.

Diagnosis: Bacteriological and histological examinations are performed in all cases.

Laboratory:

Treatment: Modified WHO MDT with fixed duration was implemented in 1983. Rifampicine is given on a daily basis to all cases.


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: Almost all former patients have been retreated with MDT.


References:

Blanc L. (WHO), Report on a tield visit to New Caledonia, June 1996.

Farrugia R. (WHO), Report on a field visit to New Caledonia. May 1993.

Monchy D., Huerre M .. Crouzat M .• Dubourdieu D .. Duval D., Sottil J.P. Leprosy in New Caledonia from 1983 to 1992, Histopathological and epidemiological data, Bull Soc Palhol Exot, 1994,87,28-32.

Information from DTASS, Noumea, New Caledonia, June 1995.

Leprosy indicators in New Caledonia (1983-1995):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

Rate per 10000

(000s)

145

152

150

148

154

160

160

164

167

171

174

185

181


363 25.03 23 15.86

334 21.97 20 13.16

315 21.00 20 13.33

326 22.03 32 21.62

339 22.01 22 14.29

352 22.00 14 8.75

70 4.38 15 9.38

90 5.49 16 9.76

48 2.87 13 7.78

64 3.74 10 5.85

22 1.26 10 5.75

27 1.46 9 4.86

13 0.72 7 3.87

Leprosy prevalence and case detection rates per 10000 (1983 -1995)

MB %

26

35

40

34

41

36

53

38

31

50

60

33

71

~.OO.-------------------------------------------

25.00

0--.-20.00 'I

\ 15.00

\ 10.00

\ 5.00 ... .. ".. ....... ..0.

0.00 n

83 84 85 86 87 88 89 90 91 92 93 94 95

Year

Part /I 73


48

45

25

22

18

21

27

6

23

10

20

0

28 14

-+- Prevo rate

-0- Detee. rate

74 Part II

New Zealand

1997 Prevalence New cases Grade 2 MDT Cured Relapsed per 10000 per 100000 disability coverage cases cases

Number 2 2 ~\iiiF:I\: •.••.. :T ·i. .

. . .....

Rate f). 005 f).05 IOO'!! ........


Epidemiology: Since 1982, most cases have occurred in migrants from the Pacific Islands or from Asia.

Programme: Integrated in the general health services. Information at national level is collected on new cases only.

Case-finding:

Diagnosis:

Laboratory:



Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from New Zealand.

References:

Cornwall J .• Cameron G .. The effects of World Health Organization chemotherapy on imported leprosy in Auckland. New Zealand, 1983-1990, Lepr Rev .. 1993,64.236-249.

Leprosy indicators in New Zealand (1983-1997):


1983 3203

1984 3250

1985 3230

1986 3707

1987 3301

1988 3290

1989 3385

1990 3389

1991 3435

1992 3463

1993 3463

1994 3463

1995 3575

1996 3696

1997 3696

Rate per 10000


3 0.01 1 0.03

0 0.00 4 0.12

1 0.00 1 0.03

1 0.03

10 0.27

2 0.005 2 0.05


MB 0/0

100

0.03 -r-----------------------

0.025 +----------------------1-\--

0.02 +------------------------+-+-

0.015 +---------------------+--\_

0.01 +-------------+----1----''''''-------/---+

0.005 +---------------I'-\------". __ --+----c:fl

O+--+-+--;-;-~-;_-/-~-/_-r-~-+-+_~

Year

Part 1I 75

Disability Child 0/0 0/0

-+- Prevo rate

-0- Detee. rate

76 Part /I

Niue

1997

Number

Rate


o

o

Population: 2 100


o

o

Grade 2 disability

MDT coverage

Cured cases

Epidemiology: No case has been detected since 1992, and there are no registered cases.

Programme:

Case-finding:

Diagnosis:

Laboratory:

Treatment:


Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Niue.

References:

Relapsed cases

Part II 77

Leprosy indicators in Niue (1983-1997):

Year Population Registered Prevalence New New cases MB Disability Child (000s) cases per 10000 cases per 100000 % % %

1983 3

1984 4

1985 3

1986 3

1987 3

1988 3

1989 3

1990 2 0 0

1991 2 0 0

1992 2 0 0 0 0

1993 2

1994 2 0 0 0 0

1995 2 0 0 0 0

1996 2 0 0 0 0

1997 2 0 0 0 0

7S Part II

Palau

1997 Prevalence Cured Relapsed

Population: 17 728

Epidemiology: There has been no apparent decline in the case detection rate since 1983.

Programme: Partially integrated, and coordinated by the Leprosy Control Unit at the Bureau of Public Health Service.


Diagnosis: Bacteriological examinations are systematically performed. Biopsies are taken in some cases.

Laboratory:

Treatment: WHO MDT was implemented in 1982. Treatment is given until skin smears are negative.


Rehabilitation:



References:

Blanc L. (WHO), Report on a field visit to Palau, May 1995.

Blanc L. (WHO), Report on a field visit to Palau, December 1995.

Carillo M. (WHO), Report on a field visit to Palau; April 1994.

Information from the Ministry of Health, Republic of Palau, November 1994.

Leprosy indicators in the Republic of Palau (1983- I 997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

(OOOs)

14

13

12

14

14

14

12

12

12

12

15

17

17

17

17


7 50

2 15.4

2 16.7

1 7.1

3 21.4

3 21.4

I 8.3

5 41.7

16 13.33 6 50

2 16.7

4 26.7

12 7.06 6 35.3

8 4.71 9 52.9

5 2.9 4 23

2 1.1 1 5.3


MB %

71

50

100

100

67

0

0

\00

50

100

75

33

33

25

\00

14~----------------------______________________ __

12t----------------------------~------------------

10t------------------------------~-------------

8t------------------------------~----------

6t--------------------------------~ __ ------

4t\------------------~~~ __ ----~~~\_----

O+-~--~--r__+--+_~--~--r__+--+_~--~--r_~

Vear

Part II 79


0 0

0 0

0 0

0 0

0 33

0 33

0 0

0 20

17 50

0 0

0

0 0

II 22

0 0

0 0

--Prev. rate -0- Detee. rate

80 Part 1/

Papua New Guinea

1997 Prevalence per 10000



Grade 2 MDT Cured Relapsed

Epidemiology: Leprosy has been declining since 1977. The prevalence rate has declined from 30.6 to 2.2 per 10 000 from 1977 to 1997. The disease is unevenly distributed. Eight provinces still have a prevalence rate greater than 2.5 per 10 000.

Programme: Integrated. Implemented in 1991, it covers 19 of the 20 provinces. Bougainville (North Solomon) will be the last province covered. Pockets of uncovered areas remain due to difficult access. Programme activities are supervised by a National Programme Manager, assisted by a Programme Coordinator. There are two specialized teams, one in the southern and one in the northern part of the country. The programme is further organized according to health structures. Extra-governmental support is provided by the Sasakawa Memorial Health Foundation of Japan and Leprosy Mission International.


Diagnosis: Based mainly on clinical signs.

Laboratory:

Treatment: WHO MDT started in 1987 and was implemented in all provinces but one by the end of 1994. Fixed duration MDT was implemented in 1995. The prevalence/detection ratio has decreased since 1983 (10.7), but was still 5.7 in 1995.


Rehabilitation: There is no programme for rehabilitation.


Achievements: The MDT coverage is 100% in the 19 provinces covered by the programme.

References:

Abella J.E., Frankel R., Samson P.O. (WHO). Report on the Joint Evaluation Survey on NLEP-199S. May 1996.

Blanc L. (WHO), Report on the evaluation of leprosy elimination programme in Papua New Guinea. October 1997.

Kyaw, T. (WHO), Report on collaboration with the Government in the implementation of the National Leprosy Elimination Programme, Papua New Guinea, December 1994.

Kyaw T. (WHO), Report on the National Leprosy Elimination Programme. Papua New Guinea, January-April 1997.

Malau c.. "Leprosy programme in Papua New Guinea", in Leprosy profiles wirh special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHF/MDT Series 2, 1991, 32-40.

Tran H.K. (WHO), Report on a country visit in Papua New Guinea, September-November 1997.

Leprosy indicators in Papua New Guinea (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

(OOOs)

3508

3252

3362

3419

3585

3580

3910

3741

3823

3907

3823

4056

4302

4327

4533

Registered Prevalence New cases New cases cases per 10000 per 100000

9752 27.8 912 26

8715 26.8 683 21

8203 24.4 773 23

7583 22.2 568 16.61

7465 20.8 579 16.15

8163 22.8 652 18.21

5 188 13.3 544 13.91

4330 11.6 512 13.69

2964 7.8 519 13.58

2755 7.1 219 5.61

519 13.58

2167 5.3 345 8.51

1 318 3.1 231 5.37

1105 2.6 699 16.2

1004 2.2 547 12.1

Leprosy prevalence and case detection rates per 10000 (1983 - 1997)

MB %

50

52

52

56

~.oo~------------------------------------------

25.00 +--------"'.,..--------------------------------------

20.00 +------------~--__\_--------------------------

15.00 +------~---------\_-----------------------

10.00 +--------------------~------------------

5.00 +---------------------------------"",,-------

Year

Part II 8/

Disability Child %

28

23

6

12

__ Prevo rate

-0- Detee. rate

%

18

20

21

33

82 Part Il

Leprosy indicators by province in Papua New Guinea (1997):

Province! Population Registered Prevalence New New cases Prevalencel Region (OOOs) cases Rate cases per 100000 Detection

Western 140 103 7.3 59 42.1 0.8

Gulf 72 42 5.8 16 22.2 0.3

Central 161 120 7.4 51 32.5 0.2

National Capital 270 101 3.7 20 7.4 0.5

Milne Bay 185 65 3.5 40 21.6 0.2

Oro 113 6 0.5 3 2.7 0.2

Southern Region 941 437 4.6 189 48.5 0.1

Southern Highlands 389 IS 0.3 16 4.1 0.1

Enga 302 10 0.3 I I 3.6 0.1

Western Highlands 391 II 0.2 13 3.3 0.1

Simbu 209 4 0.2 5 2.4 0.1

Eastern Highlands 400 2 0.1 2 0.5 0.2

Highlands Region 1697 42 0.2 47 2.8 0.1

Morobe 438 26 0.6 6 1.4 0.2

Madang 288 99 3.4 66 23.1 0.1

East Sepik 280 107 3.8 54 19.3 0.2

West Sepik 162 138 5.3 13 8 0.7

Monase Region 1168 370 3.1 139 11.9 0.3

Manus 39 5 1.3 5 13 0.1

New Ireland 106 20 1.9 41 38.8 0.05

East New Britain 234 92 3.9 87 37.2 0.1

West New Britain 170 38 2.9 39 22.9 0.1

North Solomon 178 - - - - -

Islands Region 727 ISS 2.1 172 24.5 0.1

Total 4533 1004 2.2 547 12.1 0.2

Part 1/ Xi


84 Part /I

Philippines

1997 Prevalence New cases Grade 2 MDT Cured Relapsed

Population: 7 I 388 899

Epidemiology: Since 1983, there has been a steady decline in the prevalence rate, but no evidence of a declining trend in the case detection rate.

Programme: Integrated. New policies and a new recording and reporting system were implemented in 1995. Four LECs and one SAPEL were conducted between 1996 and 1997.


Diagnosis: Based on clinical findings; skin smears are not carried out routinely.

Laboratory: No quality control at the regional level and no nationwide standardization of procedures.

Treatment: MDT was started in 1983 in Ilocos Norte and Cebu Provinces and implemented nationwide from 1986 to 1989.


Rehabilitation:



References:

Abella J.E., Carillo M.P., "Leprosy Control in the Philippines". in: Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation. SMHF/MDT Series 2. 1991.41-53.

Blanc L. (WHO). Leprosy Elimination Campaign. Philippines. February 1996.

NLCP. Elimination ofleprosy as a public health problem. Plan of Action 1996-1998.

Rao K .• Yuasa Y .. Landwehr D. (WHO). Third WHO-DOH independent evaluation of the NLCP in the Philippines. November 1995.

Rao P.S. (WHO). Review of leprosy elimination campaign and special action projects for elimination of leprosy in the Western Pacitic Region. June-September 1997.

Rao P.S. (WHO). Report on a country visit. Philippines. July-August 1997.

Van der Hoeck W. (WHO). Report on a lield visit, Philippines. February-May 1996.

Leprosy indicators in the Philippines (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

(OOOs)

52055

53395

54668

55980

58721

59456

60097

61481

62895

64 342

65065

65000

67581

69804

71389


37323 7.17 I 730 3.32

37377 7 1726 3.23

38814 7.1 I 139 2.08

38570 6.89 2 185 3.90

35281 6.01 2748 4.68

36972 6.22 2442 4.11

31947 5.32 4163 6.93

20280 3.3 5725 9.31

17347 2.76 7169 11.40

15317 2.38 5896 9.16

15441 2.37 3442 5.29

16486 2.54 4450 6.85

11674 1.73 3988 5.90

8664 1.24 4051 5.X

8749 1.22 4942 6.92


8.00.,----------·---

Year

Part II 85


49 14.6

49 14.5

49 14.3

52 14.5

55 14.5

63 12 9

65 7 6

9 X

1\ l)

8 X

10 10

78 7 8

84 5 8

84 4 <)

81 5 X

--Prevo rate

-0- Detee. rate

Leprosy indicators by province in the Philippines (1997):

Province

CAR

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VB

Region VIII

Region IX

Region X

Region Xl

Region XII

Caraga

ARMM

NCR

Total

CAR: ARMM: NCR:

Population Newly detected cases

(OOOs) Total Rate

1327 59 4.45

3958 519 13.1

2885 270 9.36

7122 322 4.52

q 570 204 2.49

5067 73 1.44

6474 256 3.95

5201 537 10.4

3788 282 7.44

2937 288 5.8

2703 217 803

4476 242 4.1

2260 192 8.5

2 137 108 5.05

2 135 436 18.2

9350 937 10.0

71389 4942 6.92

Cordillera Autonomous Region. Autonomous Region of Muslim Mindanao. National Capital Region.

MB Disability

38 2

324 19

191 28

309 3

174 7

71 7

223 37

445 19

244 13

237 19

181 I

224 IX

154 16

92 7

272 51

804 5

3983 252

Children

15

28

23

14

13

7

23

71

34

32

24

12

14

9

52

22

393

Treated MDT Relapse Registered MDT completed (MDT) end of year

192 85 0 112

1284 297 9 894

660 198 0 444

1 190 392 0 562

732 217 2 494

328 52 0 272

645 180 0 451

1636 365 2 1 248

786 134 0 562

856 206 0 585

664 308 0 356

789 207 0 551

432 124 4 298

317 99 1 219

842 203 0 547

I 563 446 3 I 154

5887 3513 21 3522

Prevalence ratc

0.84

2.26

1.54

0.79

0.56

0.54

0.7

2.4

1.48

1.99

1.32

1.04

1.32

1.02

2.8

1.23

1.22

Prevalence! detection

1.9

1.7

1.6

1.7

2.4

3.7

1.8

2.3

2

2

1.6

2.3

1.6

2

1.3

1.2

1.8 -

% :>

'tl

'" "" --

.. . . .

•


PHILIPPINES

Leprosy prevalence rates per 10.000 population .5 m10 .1 m 4.9

o D.Sm 0.9 00 m 0.4

c· '.l :

.J-

." .. :' ... . ,'

~,., .. ~

1 dotes cases

... .

.. " ~ ~

,i'

WESTERN PAIt:IFlIC Leprosy Surveillance .... rnnr~,mrrlA

PHILIPPINES Distribution of leprosy cases

registered for treatment (1998)

.J-

Dots are randomly distributed within provinces

Part /I 89


90 Part II

Republic of Korea

1997

Number

Rate


707

0.15



34

0.07

Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Epidemiology: Since 1982, there has been a steady decrease in the case detection rate, with a big decrease from 0.25 per 10 000 in 1994 (113 newly detected cases) to 0.07 in 1997 (34 newly detected cases).

Programme: Coordinated by the Korean Leprosy Control Association.

Case-finding:


Laboratory:

Treatment: Modified WHO MDT started in 1982: intensive phase with daily rifampicine and continuation until skin smears are negative. Some patients receive DDS aft~r completion of MDT.


Rehabilitation: Patients requiring care for disabilities are maintained on a register and followed up in settlement villages. There are an estimated 588 disabled individuals.

Retreatment of cases previously treated with DDS and discharged: There is no systematic retreatment of old cases.

Achievements: Leprosy as a public health problem has been eliminated from the Republic of Korea.

References:

Blanc L. (WHO), Attendance at the National Seminar on Leprosy Control, Republic of Korea, October 1995.

Blanc L. (WHO), Report on a field visit to Korea, May 1994.

Farrugia R. (WHO), Report on the attendance at a seminar on leprosy control in Seoul, Republic of Korea, November 1991.

WHO, Report from the major endemic countries, International conference on Elimination of Leprosy, Hanoi, Viet Nam, July 1994.

Information from General Bureau of Public Health. Ministry of Health and Social Affairs. Republic of Korea. July 1991.

Leprosy indicators in the Republic of Korea (1983-1997):

Year Population Registered Prevalence New New cases MB (OOOs) cases per 10000 cases per 100000 %

1983 39951

1984 40578

1985 41208

1986 41 865

1987 42082

1988 41 975

1989 42591

1990 43207

1991 43415

1992 43623

1993 44056

1994 44453

1995 44995

1996 45248

1997 45991

Rate per 10000

0.8

0.7

0.6 '" 0.5

0.4

0.3

0.2

0.1 -n.

o

345 0.86

293 0.72

2762 0.67 195 0.47

142 0.34

131 0.31

157 0.37

1637 0.38 157 0.36

1469 0.34 136 0.31

1309 0.30 130 0.30

1209 0.27 113 0.25

1126 0.25 39 0.09

1072 0.24 39 0.09

707 0.15 34 0.Q7

Leprosy prevalence and case detection rates per 10 000 (1983-1997)

~ ~ ~ --- ...

~

Year

59

62

75

64

63

67

59

79

"' "'.

Part II 91


23 I

12

5

12 1

15

5

3 0

-+- Prevo rate

-0- Detec. rate

92 Part II

Leprosy indicators by province in the Republic of Korea (1997):

Province/ Population Registered Prevalence New New cases Prevalence/ Region (000s) cases per 10 000 cases per 100 000 Detection

Seoul Metropolitan City 10547 53 0.05 2 0.02 27

Pursan Metro City 3932 151 0.38 0 0 -

Taegu Metro City 2525 110 0.44 13 0.51 8.5

Inchon Metro City 2380 0 0 0 0 -

Kwangju Metro City 1297 13 0.1 2 0.15 6.5

Taejon Metro City 1 311 3 0.02 1 0.076 3

Uisan Metro City 997 1 0.01 0 0 -

Kyonggi Province 7888 169 0.21 2 0.025 85

Kangwon Province 1 513 14 0.09 0 0 -

Chungchongbuk Prov 1439 23 0.16 4 0.28 5.8

Chungchongnam Prov 1822 4 0.02 1 0.054 4

Chollabuk Province 1 961 44 0.22 0 0 -

Chollanam Province 2 131 48 0.23 4 0.19 12

Kyongsangbuk Prov 2759 46 0.17 4 0.14 12

Kyongsangnam Prov 2968 23 0.08 1 0.034 23

Cheju Province 521 5 0.1 0 0 -

Total 45991 707 0.15 34 0.07 21

Part II 93


94 Part II

Samoa

1997

Number

Rate


16

0.95

Population: 167000

Epidemiology:


13

7.8

Gradel disability

MDT coverage

Cured cases

Relapsed cases

Programme: Partially integrated, supervised by the TuberculosisJLeprosy Section of the Public Health Division of the Ministry of Health.


Diagnosis: Based on clinical findings and bacteriological examinations, which are performed systematically.

Laboratory: There is no quality control.

Treatment: WHO MDT was implemented in 1985, and is given until skin smears are negative.

Prevalenceldetection ratio: 1.2

Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: There is no patient under DDS monotherapy.


References:

Farrugia R. (WHO), Report on a field visit to Samoa, September 1996.

Farrugia R. (WHO), Report on a field visit to Samoa, May I ~95.

Farrugia R. (WHO), Report on a field visit to Samoa, April 1996.

Farrugia R. (WHO), Report on a field visit to Samoa, May 1997.

Jesudasan K. (WHO), Report on a field visit to Samoa, February 1997.

Lynch M.J. (WHO), Report on laboratory diagnosis of leprosy and tuberculosis in Samoa, April 1994.

Leprosy indicators in Samoa (1983-1997):

Year Population Registered Prevalence New New cases

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

18

16

1\ \ \

(OOOs)

161

163

160

159

161

161

170

162

163

163

166

162

1.7 1

167

167

14

12

10

8 ~ 6

4

2

o

[\.. '" '\.

'\..

cases per 10000 cases per 100000

274 17 51 31.6

133 8.2 15 9.38

118 7 15 9.4

72 4.4 16 10.1

75 4.6 19 11.8

52 3.2 I 1 6.8

50 3.1 18 10.6

36 2.22 13 8

34 2.09 10 6.1

25 1.53 9 5.5

14 0.84 5 3

20 1.23 10 6.2

21 1.23 13 7.6

23 1.38 13 7.8

16 0.95 13 7.8

Leprosy prevalence and case detection rates per 10000 (1983-1997)

-....... ...............

-n. J"\. ---Y

MB %

53

63

58

27

28

15

40

78

60

70

77

92

54

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

Part Il 95


20

6

5

9

17

38

20

0

0

0

31 15

23 8

0 8

__ Prevo rate

-0- Detee. rate

96 Part /I

Singapore

1997 Prevalence Per 10000

Number 44

Rate 0.15


Epidemiology:

Programme:

Case-finding:

Diagnosis:

Laboratory:


Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Treatment: MDT started in 1982. Many patients receive DDS monotherapy after completion of MDT.


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: In 1993, 688 of the 1063 cases under treatment (65%) were still under DDS monotherapy.

Achievements: Leprosy prevalence is still high in Singapore.

References:

Blanc L. (WHO). Report on a field visit to Singapore. February 1994.

Leprosy indicators in Singapore (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

9

(OOOs)

2502

2540

2558

2588

2613

2647

2685

2700

2735

2771

2870

2880

2848

3185


2145 8.3 39 1.5

36 1.33

1406 5.14 13 0.48

I 171 4.23 41 1.48

1063 3.70 24 0.84

747 2.62 33 1.16

10 0.3


MB %

61

46

42

48

40

8 ~~~-------------------------------------------

7~-~------=-~.----------------------------------6~-------~--~-=----------------------.. 5

4~---------------------· ~

3t-------------------------------------~~==~~ "\

2~--------------------------~\~

o~~~~~~~~~~~~~~~\~· 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

Part 1/ 97


6

4

0 :>

0

-+--- Prevo rate

-0- Detee. rate

98 Part /I

Solomon Islands

1997

Population: 425 078

Epidemiology:

Cured ~Iapsed

Programme: Integrated into the general health services, with a vertical component at both national and provincial levels.


Diagnosis:


Treatment: WHO MDT was introduced in 1986.


Rehabilitation: Disabled patients come under the care of the new Community-based Rehabilitation Programme. Reconstructive surgery and physiotherapy are available in Honiara.

Retreatment of cases previously treated with DDS and discharged: By the end of 1994, I casc out of 36 registered cases was still under DDS monotherapy. In March 1994, 13 cases under DDS mono therapy were found free of signs of active disease, were given a single dose of 600 mg of rifampicine, and subsequently released from treatment and control.

Achievements: The MDT coverage was 97% at the end of 1994. The Solomon Islands has reached the goal of elimination of leprosy as a public health problem.

References:

Franckcl R. (WHO). Report on a Ileid visit to Solomon Islands. April 1995.

Franckel R. (WHO), Report on a field visit to Solomon Islands. September-Octoher 1996.

Information from the Directorate of Health and Medical Services. Honiara. December 1994.

Leprosy indicators in Solomon Islands (1983-1997):


1983 259

1984 269

1985 270

1986 286

1987 289

1988 306

1989 320

1990 318

1991 330

1992 341

1993 356

1994 379

1995 394

1996 409

1997 425

Rate per 10000

30

~ 25

~ 20

15

10

5


700 31.7

21 7.34

23 7.96

24 7.84

14 4.38

116 3.48 19 5.97

140 4.24 21 6.36

IS 4.40

66 1.86 8 2.25

40 1.06 10 2.64

24 0.61 9 2.29

26 0.64 24 5.86

42 0.99 21 4.94


~ ~ ~

..-

MB %

52

52

54

71

84

82

80

50

90

78

58

47

O+--r--~~~~~~F=~~~~~;=~~~~=~¢ 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year

Part /I 99


19

4

4

14

II

5

7

0

0 10

0 22

8 29

5 33

--Prevo rate

--0- Detec. rate

100 Part II

Tokelau

1995

Number

Rate


o

o

Population: 2000

Epidemiology:


Case-finding:


o

o

Diagnosis: Based on clinical findings.

Laboratory:

Grade 2 disability



Rehabilitation:

MDT coverage


Achievements:

References:

Information from the Office for Tokelau Affairs. Apia. Samoa. April 1992.

Cured cases

Relapsed cases

Leprosy indicators in Tokelau (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

Rate per 10000

6

5

4

3

2

o

(OOOs)

2

3

2

2

2

2

2

2

2

2

2

2

2


0 0 0 0

1 5 1 50

1 5 1 50

0 0 0 0


T \ I \ I \ I \

\ Year

Part Jl fOf


0

0

-+- Prevo rate

-{]- Detee. rate

I ()2 Part /I

Tonga



~----~--------+---------~ Number

Rate 0.1

Population: 98 077

Epidemiology:

Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Programme: Integrated into the activities of the General Hospital. The Medical Officer for Communicable Diseases has responsibility for the leprosy control programme.


Diagnosis: Based on clinical findings. Bacteriological examinations are carried out in most cases.

Laboratory: There is no quality control.

Treatment: WHO MDT was implemented in 1986. The treatment is of fixed duration.

Prevalence/detection ratio: I

Rehabilitation: There is no specific programme for rehabilitation of disabled individuals.

Retreatment of cases previously treated with DDS and discharged: All old cases were retreated with MDT.

Achievements: Leprosy as a public health problem has been eliminated from Tonga.

References:

Glaziou P. (WHO). Report on a lield visit to Tonga, June 1994.

i'

Leprosy indicators in Tonga (1983-1997):


1983 98

1984 96

1985 96

1986 97

1987 95

1988 96

1989 98

1990 97

1991 97

1992 98

1993 98

1994 98

1995 99

1996 98

1997 98

Rate per 10000


0 0

1 1.04

0 0

11 l.l 2 2.06

0 0

2 2.08

1 1.02

1 0.1 1 1.03

2 0.21 1 1.03

1 0,1 0 0

1 0,1 0 0

2 0.2 0 0

1 0,1 1 1


MB %

100

100

1.2~---------------------------------------------

0.8t-------------~-------------------------------

0.6+---------------~-----------------------------

0.4t-----------------~~-------------------------

0.2 +----------,~----_j_J< __ --~___:7'"_;;:__--------~ ..... ::::_---

O~~--~--+_~r_~--+_~--~~o_~r_~--O=~--~

~ M ~ ~ ~ ~ ~ 00 ~ ~ ~ ~ ~ ~ ~

Year

Part /I 103


100 0

__ Prevo rate

-o-Detec. rate

IO..J Part I!

Tuvalu



r-----+-------r--------h Number

Rate

Population: 10 000

Epidemiology:


10

Grade 2 disability

MDT coverage

Cured cases

Relapsed cases

Case-finding: Active case-finding occasionally takes place in schools and on highly endemic islands.

Diagnosis: Based on clinical findings and bacteriological examinations.

Laboratory:

Treatment: WHO MDT started in 1984.

Prevalence/detection ratio: I

Rehabilitation:



References:

Daulako E.C. (WHO). Report on a field visit to Tuvalu; August 1993.

Daulako E.C. (WHO), Report on a field visit to Tuvalu; April 1995.

Daulako E.C. (WHO). Report on a field visit to Tuvalu; December 1996.

Information from the Ministry of Health. Tuvalu. September 1994.

'i

Leprosy indicators in Tuvalu (1983-1996):


1983 8

1984 8

1985 8

1986 8

1987 8

1988 8

1989 8

1990 9

1991 9

1992 9

1993 9

1994 13

1995 13

1996 10

Rate per 10000

16

8

.~

"" ~ 14

12

10

6

4

2

o


10 14.3

0 0 0 0

0 0 0 0

2 2.22 0 0

2 2.22 2 22.22

3 2.31 3 23.1

1 1 1 10


"" ~ ~ .....

."" /./ ~

MB %

100

100

~ M ~ $ ~ M 00 00 ~ ~ ~ M % % W

Year

Part /I 105


33 0

0 0

-+- Prevo rate

-0- Detee. rate

106 Part II

Vanuatu

1997

Number

Rate


8

0.5

Population: 173 000

Epidemiology:


6

3.5

Grade 2 disability

MDT coverage

Cured Relapsed cases cases

Programme: Vertical at the national and district levels (there are five districts in Vanuatu). Partially integrated at the provincial level.

Case-finding: Mainly passive. There are occasional community surveys.

Diagnosis: Based on clinical findings.

Laboratory: Not available or not functional at the district level.

Treatment: MDT started in 1983. In 1992, a modified WHO MDT without DDS was introduced due to the high level of DDS intolerance in Vanuatu. PB cases receive six monthly supervised doses of the combination RMP plus CLO, in addition to daily CLO. MB cases receive two monthly doses of RMP and CLO, in addition to daily doses of CLO plus MINO, followed by 22 monthly supervised doses of RMP plus CLO plus MINO in addition to daily doses of CLO.


Rehabilitation:

Retreatment of cases previously treated with DDS and discharged: By the end of 1994, 22 out of 67 selected unregistered patients under DDS monotherapy had started MDT retreatment. By the end of 1995, all registered patients were under MDT.

Achievements: Vanuatu is reaching the goal of elimination of leprosy as a public health problem.

References:

Blanc L. (WHO), Report on a field visit to Vanuatu, December 1994.

Frankel R. (WHO), Report on a field visit to Vanuatu, October· November 1997.

Gerrits G. (WHO). Report on a field visit to Vanuatu. December 1994.

Gerrits G. (WHO). Report on a field visit to Vanuatu. November 1995.

Landwehr D., Gerrits G. (WHO), Report on a field visit to Vanuatu. April 1995.

Montaville B., Bouree P., Leprosy in Vanuatu, Bull Soc Pathol Exot, 1989,82,351·358.

Information from the Ministry of Health, Vanuatu. November 1994.

Leprosy indicators in Vanuatu (1983-1997):

Year Population

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Rate per 10000

20

18

16

14

12

10

~

(000s)

124

127

130

133

136

139

142

146

146

154

161

164

169

170

173

"'" "'" 8

6

4

2

o

~

u-

Registered Prevalence New New cases

'"

cases per 10000 cases per 100000

226 17.7 31 25

28 22.1

21 16.2

15 11.3

11 8.1

11 7.9

7 4.9

10 6.9

15 1.03 7 4.8

23 1.49 17 11

29 1.80 14 8.7

16 0.98 3 1.8

20 1.18 14 8.3

20 1.15

8 0.5 6 3.5


"'" "'" "'" "'" "- ....,

Year

MB %

29

53

14

67

36

67

~

Part II 107


0

6 6

0 7

0 33

7 14

17 17

__ Prevo rate

-0- Detee. rate

108 Pan IJ

VietNam

1997

Number

Rate


4676

0.61

Population: 76900 000


2808

3.65

Grade 2 disability

MDT coverage

Cured Relapsed cases cases

Epidemiology: Leprosy cases are unevenly distributed: 12 provinces in mountainous areas and four provinces on the high plateau are still considered as highly endemic, while the elimination goal has been attained in 38 of the 53 provinces (as at September 1996). A total of 7360 cases were estimated in the IS provinces where the prevalence rate is higher than I per 10 000 (5301 cases are currently under treatment).

Programme: Vertical. The responsible unit at the central level is the National Institute of Demmtology and Venereology in Hanoi. Activities are integrated into the general health system at the village level. There are several leprosaria in the country. Two SAPELs were introduced in 1995 in Kon Tum and Lamdong provinces and led to case detection rates which were much lower than expected. The plan of action to reach the elimination goal at district level includes 12 SAPELs and two LECs.

Case-rmding: Mainly active, through mass, contact and group screening.

Diagnosis: Based on clinical findings and bacteriological examination. Confirmation of the diagnosis is made by a specialist dermatologist of the provincial dispensary of dermatology and venereology.

Laboratory: Available at the provincial or district level.

Treatment: WHO MDT has been gradually implemented from 1982.


Rehabilitation: There were an estimated II 300 disabled individuals in 1995.


Achievements: The leprosy programme has achieved the goal of elimination of leprosy as a public health problem at national level and in most provinces. However, there are 16 provinces with areas of difficult access where MDT coverage and detection are not satisfactory.

References:

Blanc L. (WHO), Report on a field visit to Viet Nam, November 1996.

Blanc L. (WHO), Review of special action projects for the elimination ofleprosy. February-March 1997.

Cabanos G., Landwehr D., Yuasa Y. (WHO), Evaluation of the leprosy control programme in Viet Nam, November 1996.

Dai Z-C, "Leprosy control in China", in Leprosy profiles with special attention to MDT implementation, Sasakawa Memorial Health Foundation, SMHFIMDT Series 2, 1991, 1-10.

WHO, Report from the major endemic countries, International Conference on Elimination of Leprosy, Hanoi. Viet Nam, July 1994.

Leclerc E. (Damien Foundation, Belgium), Report of a mission to Viet Nam, September 1994.

Lienhardt C. (WHO), SAPEL in Kon Tum province, Viet Nam, May 1995.

Information from the National Institute of Dermatology and Venereology, Hanoi, November 1994.

Leprosy indicators in Viet Nam (1983-1997):


1983 54000

1984 55 800

1985 57400

1986 59000

1987 60500

1988 62000

1989 63 500

1990 67514

1991 67774

1992 69306

1993 72 771

1994 74000

1995 75350

1996 75310

1997 76900

Rate per 10000

8

7

~

"" 6


36616 6.78 2021 3.74

34240 6.14 2103 3.77

30750 5.36 2062 3.59

28240 4.79 2292 3.88

26750 4.42 2183 3.61

24 ISO 3.9 I 847 2.98

23463 3.69 2073 3.26

20997 3.65 1995 3.47

18342 2.71 2 500 3.69

9449 1.36 3 142 4.53

7320 1.01 3 185 4.38

7419 1 3173 4.29

5277 0.70 2591 3.44

4743 0.63 2883 3.83

4676 0.61 2808 3.65


5

~ 4 ~

~

"" " "'.-. 3

2

o

Year

MB %

45

44

41

54

57

40

56

68

55

66

65

63

64

Part /I 109

-Disability Child % %

41 6

30 4

32 7

30 8

28 9

28 8

28 6

28 7

24 3

22 8

18 7

20 5

31 9

32 7

30 6

__ Prevo rate

-G-.Detec. rate

110 Part 1/

Leprosy indicators in Viet Nam by province (1997):

Province Population Registered Prevalence New New cases Prevalence! 1996 (000,) cases per 10 000 cases per 100000 detection

An giang 2188 180 0.82 76 ,5 2.4 Sa ria Vung tau 739 107 1.45 54 7.3 2 Bac can 291 II 0.38 5 1.7 2.2 Bae giang 1456 12 0.08 4 0.27 .1 Bac lieu 772 81 1.05 36 4.7 2':-Bac ninh 1060 II 0.1 4 0.38 2.8 Ben tre I 397 30 0.21 20 1.4 1.5 Binh dinh 1459 148 1.0 I 86 5.9 17 Binh ducng 985 81 I 18 62 6.3 U Binh phuoe 573 108 1.88 76 I, 14 Sinh thuan 995 424 4.26 270 2.7 1.6 ea mau I 105 150 U6 80 7.2 1.9 Can tho 2007 102 0.51 60 3 1.7 Cao bang 559 17 03 19 3.4 0.9 Oa nang 680 43 0.63 30 4.4 1.4 Dae lac 662 192 29 41 6.2 4.7 Dong nai 1991 226 I 14 157 7.9 1.4 Dong thap 1647 66 0.4 48 2.9 1.4 Gia lai 875 174 1.99 74 8.5 2.4 Ha giang 601 II 0.18 I 0.17 II Ha nam 864 13 015 I 0.12 1.1 Ha noi 2465 6 0.02 2 0.081 .1 Ha tay 2358 25 0.11 14 0.59 1.8 Ha tinh 1345 23 0.17 15 1.1 1.5 Hai duong 1764 10 0.06 7 0.4 1.4 Hai phong 1759 5 00.1 0 0 Ho Chi Minh 5032 424 0.84 282 5.6 J)

Hun binh 786 3 0.04 3 0.38 I

Hong yen I 182 7 0.06 0 0 Khanh hua 995 149 15 95 9.5 1.6

Kien giang 1459 292 2 168 12 1.7

Kon tum 287 82 2.86 51 1.8 I /1

La chau 589 28 0.47 32 5.4 0.9 Lam dong 850 69 0.81 56 6.6 1.2 Lang an I 364 III 0.81 72 5.3 1.5

Lang soa 788 13 016 10 U U Lao cai 658 12 0.18 8 1.2 U

Nan binh 1962 21 0.11 4 0.2 5 .. 1

Nghe an 2892 40 0.14 21 0.73 1.9

Ninh binh 971 3 0.03 I 0.1 .1

Ninh thuan 499 149 2.99 186 37 0.8

Phu tho I 253 14 0.11 8 0.64 1.8

Phu yen 797 64 0.8 41 5.1 1.6

Quang binh 858 9 0.1 20 2.3 05

Quang nam I 495 25 0.17 24 1.6 I

Quang ngai I 197 96 0.8 48 4 2.()

Quang ninh 99, 0 0 I 0.1 0

Quang tri 641 12 0.19 7 1.1 1.7

Soc trang 1272 50 039 33 2.6 1.5

Son la 886 35 04 17 1.9 2.1

Tay ninh 897 293 J27 145 16 2

Thai binh 1875 14 0.07 5 027 2.R

Thai nguyen 1095 15 0.14 12 1.1 U

Than hoa J 669 45 0.12 17 046 2.6

Thun thien Hue 1069 45 0.42 19 1.8 2.4

Tieu giang 1699 110 0.65 54 l' 2

Tra vinh 1025 59 0.58 35 3.4 1.7

Tuyen Quang 698 10 0.14 5 0.72 2

Vinh long 1093 98 0.9 68 6.2 14

Vinh phue 1096 15 0.14 13 12 1.2

Yeu bai 679 8 0.12 5 0.73 1.6

Total 76900 4676 0.61 2808 3.7 1.7


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VIETNAM Distribution of leprosy cas .. registered for treatment (1997)

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Part 1/ 113


114 Part /I

Wallis and Futuna


New cases Per 100 000

Grade 2 disability


Relapsed cases

---+-----1 Number o o

Rate o o

Population: 14 000

Epidemiology: No leprosy case has been detected in Wallis and Futuna since 1992.

Programme: There is no leprosy control programme. Any case occurring in Wallis and Futuna would he handled according to the current leprosy control programme procedures in New Caledonia.


Diagnosis:

Laboratory:

Treatment:


Rehabilitation:


Achievements: Leprosy as a public health problem has been eliminated from Wallis and Futuna.

References:

InformaCion from DTASS. Noumea, New Caledonia. July 1993.

Part 1/ 115

Leprosy indicators in Wallis and Futuna (1983-1997):

Year Population Registered Prevalence New New cases MB Disability Child (OOOs) cases per 10000 cases per 100 000 % % %

1983 10

1984 10

1985 12

1986 12

1987 14

1988 12

1989 14

1990 14

1991 14 0 0

1992 14 0 0 0 0

1993 14 0 0 0 0

1994 15 0 0 0 0

1995 14

1996

1997