Leprosy among inmates of a prison.

A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.

A leprosy survey in a taluk headquarters town and the role of dermatological services and active health education in its success--a preliminary report.

A report of two general surveys done in 1984 and 1987 in Gudiyatham town, is presented. The first survey covered 89.2% and the second survey 82% of the population. The new case detection rate was 3.4 per 1000. The success of the survey was due to the co-operation obtained from the public, most probably because of the intense and sustained health education, combined with leprosy services integrated with a dermatology clinic.

Incidence of "chance" smear positivity among MB leprosy patients after MDT.

Multidrug therapy (MDT) was introduced in 1982. Nine hundred eighty multibacillary (MB) leprosy patients had successfully completed the MDT administered for a minimum of two years or till skin smear negativity, whichever was later, as recommended by the World Health Organisation (WHO). During surveillance, 2.24% of them revealed presence of acid-fast bacilli (AFB) in the skin smear. They did not have any clinical evidence suggestive of relapse. Subsequent followup (without antileprosy chemotherapy) for periods ranging from one to eight years was uneventful. We have called this as "chance smear positivity" where a few bacilli, yet to be cleared by the immune system, were picked up by routine skin smear examination.

An evaluation of the Semmes-Weinstein 6.10 monofilament as compared with 6 nylon in leprosy patients.

In a previous study Birke and Sims (1986) identified the 5.07 (10 y) Semmes-Weinstein monofilament, as the most useful tool, in measuring protective sensation in the sole of the foot of leprosy patients. This study has demonstrated that the standard 6 Nylon being used in Karigiri, is as good as the monofilament, in assessing protective sensation in leprosy patients. However there is a need for standardising procedures for measuring sensory loss in leprosy patients.

Are defaulters with paucibacillary leprosy a problem?

This study examined the risk of relapse in 421 paucibacillary patients who had defaulted after varying periods of dapsone monotherapy; short of the recommended course. The 421 patients contributed a total of 2,162 person years of risk; 10 patients relapsed, giving a relapse rate of 4.6 per 1000 persons years of risk, or a crude relapse rate (RR) of 2.4%. This paper discusses the issue of defaulters with paucibacillary leprosy and the findings of the study suggest that defaulters with paucibacillary leprosy are not a serious problem in terms of leprosy control.

Surveillance in leprosy.

Surveillance in leprosy forms an integral part of leprosy control activities. Usually contact and school surveys are done annually and general population surveys are done once every 3-5 years. Data is presented which suggest that frequently done surveys may not be cost effective as a means of case detection. Carefully done general surveys once every 3 years, covering contacts as well as school children may be adequate and more cost effective in endemic areas, whereas contact surveys, surveys of high risk groups and contact tracing, may be more relevent in low endemic areas.

Time trends in the analysis of incidence rate of leprosy among household contacts.

Analysis of time trends in the Incidence Rates among 9.598 household contacts of 1,614 primary cases of leprosy, showed that the incidence rates (IR) remained high even 10 years after treatment was started in the Primary Case. The IR during the 1st year of follow-up was 3.8 per 1000 person years of risk (PYR) and the IR was 3 per 1000 PYR after 10 or more years of follow-up. The significance of these findings in relationship to the Epidemiology of leprosy among household contacts in an endemic area for leprosy is discussed.

Incidence rates of leprosy among household contacts of "primary cases".

The data consisted of information from 1,564 "Primary cases" of leprosy of all classification and 9,162 of their household contacts. Household contacts of Indeterminate (Ind), Borderline (BL) and Lepromatous (LL), "Primary case" (PC) had an incidence rate (IR) of 5 per 1000 person years of risk (PYR). Household contacts of Tuberculoid (TT) and borderline tuberculoid (BT) patients had an IR of 3.2 and 3.8 per 1000 PYR respectively. Compared with an incidence rate of leprosy of 1.6 per 1000 PYR among individuals not exposed to leprosy in the same area, household contacts of Non-lepromatous patients had a relative risk of twice as high and contacts of lepromatous and borderline lepromatous patients a relative risk of 3 times as high. The incidence rate was higher among household contacts of bacteriologically positive patients, among contacts closely related and in households with multiple cases. The peak age specific incidence rate among household contacts was between the ages 5-9 years of age. The significance of these findings are discussed.