January 28 – World Leprosy Day

January 23, 2024

        Since 1954, on the initiative of WHO, the World Leprosy Day has been celebrated annually on the last Sunday of January.

Within the framework of this day, various educational and charitable events are held in our country through the efforts of the society of dermatovenerologists, dermatocosmetologists and leprologists in order to draw the attention of the general public and medical workers to the problem of social protection of leprosy patients, their rehabilitation and readaptation, and assistance to low-income families with leprosy patients.

       WHO classifies leprosy as one of the twenty neglected trophic diseases (ZTB). Like other ZTB, its occurrence is often associated with poor socio-economic conditions.

      Leprosy is an infectious disease with a long incubation period, the causative agent of which is Mycobacterium leprae. Leprosy is transmitted through droplets secreted from the nose and mouth, with prolonged and close contact with infected people who are not receiving treatment. This disease affects the skin and peripheral nerves, without treatment it can progress to irreversible lesions of the skin, nerves, face, arms and legs, as well as lead to profound disability and social isolation. For thousands of years, stigma and discrimination have played a major role in relation to leprosy, overcoming which is important to achieve zero disease rates.

        After the successful introduction of combined drug therapy (CLT) in 1981, WHO strategies focused on reducing the prevalence of this disease first to below 1 per 10,000 population, and then on further reducing the incidence of new cases (especially among children). Some countries have already reached a very low number of cases, and may have provided a break in sustained community-based transmission.

     In 2019, more than 200,000 cases of leprosy were detected in 116 countries around the world. About 5% of cases had visible deformities at the time of diagnosis, which is 1.4 cases per million of the population – this is 40% less than in 2014. Globally, the detection rate of new cases among children was 7.9 per million, which is a significant improvement on the 2014 figure of 10.1.

At the same time, in the European region, which includes Kazakhstan, the number of identified patients increased from 18 in 2015 to 42 in 2019. During 2015-2019, 17 countries in the region reported at least one active case of the disease. It is noteworthy that non-autochthonous cases accounted for more than half of the new cases of leprosy. In the context of increasing migration processes in Europe, this underscores the need to strengthen surveillance to ensure that health systems are prepared to respond effectively and sensitively to cases of leprosy among migrants.

          The WHO Global Leprosy Strategy 2021-2030, which was developed in consultation with all key stakeholders, reflects these epidemiological developments. While previous strategies focused on "eliminating leprosy as a public health problem," the new strategy focuses on interrupting transmission and achieving zero rates of autochthonous (local) cases. Thus, the strategy aims to encourage countries with a heavy burden of the disease to step up their activities, and countries with a low burden to complete the unfinished task, making sure that leprosy remains only in history. The strategy is aligned with broader global health trends, including the move towards integrating services across a wide range of diseases, digitalization and accountability, and covers key issues such as human resources, epidemiological surveillance and antimicrobial resistance. The strategy promotes innovative approaches, including targeted active case detection and the possible introduction of a safe and effective vaccine. Calls on countries to develop "roadmaps to achieve zero leprosy rates" and to provide chemoprophylaxis to all people who have been in contact with confirmed cases of the disease.

      The implementation of the Global Leprosy Control Strategy for 2021-2030 will contribute to rapid and sustainable progress in all leprosy-endemic countries, contributing to the successful implementation of the WHO Roadmap to Combat Neglected Tropical Diseases for 2021-2030 and the achievement of targets set by the Sustainable Development Goals.

       A world with zero rates of leprosy infection and disease, without disability, without stigma and discrimination associated with leprosy is possible.

     In the Republic of Kazakhstan today, leprosy is actually eliminated. Kazakhstan belongs to countries with a low burden of the disease, but sporadic cases of the disease persist.

     For the first time, information about leprosy on the territory of Kazakhstan, among the Ural Cossacks, was described by P.S.Pallas in 1769.

       In Kazakhstan, leprosy began to be practiced since 1929, when a decision was made by the Council of People's Commissars of the USSR to organize a leprosarium in the Kazakh SSR.

      Annual mass examinations of leprosy foci made it possible to register almost all patients. The number of registered patients reached its maximum in the 50s of the last century. Since the mid-50s, the number of patients discharged from the leprosarium for outpatient treatment began to increase sharply, which is associated with the introduction of sulfone therapy. A total of 3,612 leprosy patients have been found on the territory of Kazakhstan since 1929.

        Since the 60s of the last century, the total number of patients has been decreasing. This is due to the predominance of natural loss over morbidity. At the beginning of 2024, 246 patients and 222 contact persons live in Kazakhstan. 

  It should be noted that the achieved reduction in morbidity in Kazakhstan is sustainable. In recent years, the registration of isolated, sporadic cases of leprosy has continued, 3 patients have been newly identified over 10 years, and 2 patients with relapse of the disease.

        There are no children and adolescents among the identified leprosy patients. Today, only the elderly population suffers from leprosy, which is typical, according to scientists, for the fading foci of this infection.  

       The low level of infection of the population of Kazakhstan with M.leprae also corresponds to a relatively low proportion of patients with tuberculoid type of leprosy (TT) in the incidence structure. Leprosy in Kazakhstan today affects, first of all, the predisposed to the disease, and not the stable population, which is also characteristic of dying foci. Thus, at present, Kazakhstan as a whole maintains a relatively favorable situation in the incidence of leprosy.

           In the country, the Kazakh Republican Leprosarium is the center for the treatment of patients and anti-epidemic measures. The leprosarium is located in Kyzylorda, designed for 75 beds, and there are also two dispensary departments in the cities of Aralsk and in Kyzylorda (villageTasbuget). The leprosarium is a modern medical organization providing qualified, specialized medical care and providing certain types of social services to patients with leprosy, with a strong material and technical base and human resources. In addition to special treatment, patients receive all necessary medical care (surgical, ophthalmological, dental, therapeutic, etc.) and rehabilitation.

         X-rays, ultrasound, ECG, etc. are performed. types of research. A physical laboratory and a pharmacy are successfully operating, clinical and biochemical laboratories are functioning, equipped with all necessary medical equipment.

          Currently, the leprosarium is not a place to isolate leprosy patients. Patients who are registered for leprosy have the opportunity to receive therapeutic and rehabilitation measures in other medical organizations of the country.

        Work is underway to provide assistance to patients with disabilities under the social rehabilitation program. In accordance with the individual rehabilitation program (IPR), disabled patients are provided with prosthetic and orthopedic, sign language, typhlotechnical, special walking aids, etc.

       Successful control of leprosy is impossible without the participation of local health authorities. Our leprosarium has based its activities on dispensary methods of work and established cooperation with skin and venereological institutions. This allowed us to establish constant epidemiological control over leprosy and conduct joint preventive examinations of the population.

        Leprosy is a social disease, therefore, in addition to specific prevention, much attention is paid to social prevention. Improving working and living conditions, improving the material well-being and sanitary culture of the population is the key to reducing the incidence of leprosy.

         Thus, the history of the development of the leprosy service fully reflects the vital tasks that the healthcare of Kazakhstan faced at different times. If initially the primary task of practical leprology was to carry out measures to isolate patients, then later the task of chemotherapy came to the fore.  Currently, another priority task is being put forward concerning the already tertiary prevention of leprosy – the prevention of disability and rehabilitation of patients, the elimination of developed physical disabilities, chemoprophylaxis of contact.

M.Seitaliev, J.Sarsenbayev, T.Abubakir,

State Institution "Kazakh Republican Leprosarium" of the Ministry of Health of the Republic of Kazakhstan

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