Disease Prevention and Control / Communicable Diseases / Leprosy
Multidrug Therapy against Leprosy:
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WHO Report (179 pp, Word, contents below) Introduction 2. The Study Group 3. Implementation of MDT 4. The role of countries 5. The role of international agencies and nongovernmental organizations 6. The role of WHO including TDR 7. Lessons to be learned PAHO Leprosy Page |
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Foreword by Carlos Morel... Multidrug Therapy (MDT) has transformed leprosy from being a scourge of humankind into a curable disease. But unfortunately leprosy still remains a neglected disease. Despite scientific and technological developments, investment in neglected diseases—by the pharmaceutical industry, personnel-training agencies, governments, research institutes, etc.—is still far too small, while important gaps in knowledge still remain, preventing the full deployment of MDT and the development of additional and complementary interventions. In spite of this, the global policy for control of leprosy has had a major impact since 1981, when the World Health Organization (WHO), supported by the WHO Expert Committee on Leprosy, officially recommended that endemic countries adopt MDT. Within the recommendations on use of WHO-MDT was an explicit proposal to reorganize the health services and a great incentive to decentralize leprosy control activities in the general health services. Together, these three actions would greatly benefit leprosy control: use of MDT would address primary and secondary resistance to drug monotherapy and prevent the emergence of resistant Mycobacterium leprae; the second and third actions would allow close monitoring of patient treatment, greater coverage of affected populations by control activities, and hence greater access of leprosy patients to medical care. The first results were so positive that, in 1991, the World Health Assembly approved resolution WHA44.9—Elimination of Leprosy as a Public Health Problem by the Year 2000—elimination being defined as a prevalence rate of less than one patient per 10,000 population. The contribution of research to the development of MDT and to the generation of future interventions cannot be underestimated; it is carefully described in this report and other publications. The first possibility for serious study of M. leprae—a microorganism that does not fulfil Koch's postulates and cannot be grown in vitro—arose with the techniques developed by Shepard and Rees in the 1960s. Since then, advances in the biomedical sciences have radically changed the situation: decoding of the M. leprae genome and its comparison with that of M. tuberculosis have allowed these two pathogens to be studied through genomics and proteomics applications, opening new ways to study disease transmission and pathogenesis, and allowing the development of new diagnostic and therapeutic approaches as well as the management of reversal reactions, powerful triggers of the physical disabilities that constitute such important elements of the disease that lead to patient isolation. This report also demonstrates that many lessons have been learned and great progress has been achieved, both in research and in leprosy control. Although the year 2000 came and went without the originally planned target being met, the huge effort of implementing MDT has been rewarded: more than 12 million patients have been cured. This is the best reward that the thousands of concerned health professionals, nongovernmental organizations, governments, and intergovernmental agencies such as WHO and PAHO could wish for. It is now time to move forward. The lessons of history described in this report should guide us in the discussion and establishment of new goals, priorities, and targets that will shape the continuing battle against leprosy in this new millennium.
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