Global elimination of leprosy by 2020: are we on track?
BACKGROUND
Every year more than 200,000 new leprosy cases are registered globally. This number has been fairly stable over the past 8 years. WHO has set a target to interrupt the transmission of leprosy globally by 2020. The aim of this study is to investigate whether this target, interpreted as global elimination, is feasible given the current control strategy. We focus on the three most important endemic countries, India, Brazil and Indonesia, which together account for more than 80 % of all newly registered leprosy cases.


METHODS
We used the existing individual-based model SIMCOLEP to predict future trends of leprosy incidence given the current control strategy in each country. SIMCOLEP simulates the spread of M. leprae in a population that is structured in households. Current control consists of passive and active case detection, and multidrug therapy (MDT). Predictions of leprosy incidence were made for each country as well as for one high-endemic region within each country: Chhattisgarh (India), Pará State (Brazil) and Madura (Indonesia). Data for model quantification came from: National Leprosy Elimination Program (India), SINAN database (Brazil), and Netherlands Leprosy Relief (Indonesia).


RESULTS
Our projections of future leprosy incidence all show a downward trend. In 2020, the country-level leprosy incidence has decreased to 6.2, 6.1 and 3.3 per 100,000 in India, Brazil and Indonesia, respectively, meeting the elimination target of less than 10 per 100,000. However, elimination may not be achieved in time for the high-endemic regions. The leprosy incidence in 2020 is predicted to be 16.2, 21.1 and 19.3 per 100,000 in Chhattisgarh, Pará and Madura, respectively, and the target may only be achieved in another 5 to 10 years.


CONCLUSIONS
Our predictions show that although country-level elimination is reached by 2020, leprosy is likely to remain a problem in the high-endemic regions (i.e. states, districts and provinces with multimillion populations), which account for most of the cases in a country.
Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands. d.j.blok.1@erasmusmc.nl.
David J
DJ
Blok
Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands. s.devlas@erasmusmc.nl.
Sake J
SJ
De Vlas
Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands. j.richardus@erasmusmc.nl.
Jan Hendrik
JH
Richardus
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D060740:Disease Eradication; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000379:methods; D019353:Endemic Diseases; D015994:Incidence; D007194:India / Q000453:epidemiology; D007214:Indonesia / Q000453:epidemiology; D007918:Leprosy / Q000453:epidemiology* / Q000517:prevention & control*; D008962:Models, Theoretical; D014944:World Health Organization
D000900:Anti-Bacterial Agents