epidemiological review of leprosy 1983–2018 · 2021. 2. 11. · epidemiological review of leprosy...

Epidemiological Review of Leprosy in the Western Pacific Region

1983–2018

World Health OrganizationRegional Office for the Western Pacific

Manila, Philippines

Epidemiological review of leprosy in the Western Pacific Region: 1983-2018

© World Health Organization 2021

ISBN 978 92 9061 938 3

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Suggested citation Epidemiological review of leprosy in the Western Pacific Region: 1983-2018. Manila: World Health Organization

Regional Office for the Western Pacific; 2021. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. 1.Leprosy – epidemiology, prevention and control. 2. Research report. I. World Health

Organization Regional Office for the Western Pacific. (NLM Classification: WC335).

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iii

Contents

Acknowledgement .............................................................................................................. ix

A note on the data ................................................................................................................ x

Abbreviations ...................................................................................................................... xi

Executive summary ........................................................................................................... xiii

Part I. Epidemiological situation of leprosy in the Western Pacific Region ...................... 1

1. Brief description of leprosy .............................................................................................................................................. 1

2. Introduction .............................................................................................................................................................................. 1

3. Epidemiological situation ................................................................................................................................................. 2

3.1 Global leprosy status ............................................................................................................................................... 2

3.2 Summary data for the Western Pacific Region ........................................................................................ 3

3.3 Prevalence ...................................................................................................................................................................... 6

3.4 New case detection ................................................................................................................................................. 6

3.5 Other key monitoring indicators .................................................................................................................. 12

4. Legislation related to discrimination ...................................................................................................................... 20

4.1 Background ................................................................................................................................................................ 20

4.2 Rationale ...................................................................................................................................................................... 21

4.3 Segregation law and policy ............................................................................................................................. 22

4.4 Immigration laws and policies ....................................................................................................................... 22

4.5 Other laws ................................................................................................................................................................... 22

4.6 Limitations and way forward .......................................................................................................................... 23

Part II. Country profiles ...................................................................................................... 25

American Samoa............................................................................................................................................................................. 25

Australia ................................................................................................................................................................................................ 28

Brunei Darussalam ......................................................................................................................................................................... 31

Cambodia ............................................................................................................................................................................................ 34

China ...................................................................................................................................................................................................... 37

China, Hong Kong SAR ............................................................................................................................................................... 40

China, Macao SAR .......................................................................................................................................................................... 43

Cook Islands ....................................................................................................................................................................................... 46

iv

EPIDEMIOLOGICAL REVIEW OF LEPROSY IN THE WESTERN PACIFIC REGION 1983–2018

Fiji ............................................................................................................................................................................................................. 49

French Polynesia ............................................................................................................................................................................. 52

Guam...................................................................................................................................................................................................... 55

Japan ...................................................................................................................................................................................................... 58

Kiribati .................................................................................................................................................................................................... 61

Lao People’s Democratic Republic ...................................................................................................................................... 64

Malaysia ................................................................................................................................................................................................ 67

Marshall Islands ................................................................................................................................................................................ 70

Micronesia (Federated States of ) .......................................................................................................................................... 73

Mongolia .............................................................................................................................................................................................. 76

Nauru ..................................................................................................................................................................................................... 79

New Caledonia ................................................................................................................................................................................. 82

New Zealand ..................................................................................................................................................................................... 85

Niue ......................................................................................................................................................................................................... 88

Northern Mariana Islands (Commonwealth of the) .................................................................................................. 91

Palau ....................................................................................................................................................................................................... 94

Papua New Guinea ........................................................................................................................................................................ 97

Philippines ....................................................................................................................................................................................... 100

Republic of Korea ........................................................................................................................................................................ 103

Samoa ................................................................................................................................................................................................. 106

Singapore ......................................................................................................................................................................................... 109

Solomon Islands ........................................................................................................................................................................... 112

Tokelau ............................................................................................................................................................................................... 115

Tonga .................................................................................................................................................................................................. 118

Tuvalu.................................................................................................................................................................................................. 121

Vanuatu .............................................................................................................................................................................................. 124

Viet Nam ............................................................................................................................................................................................ 127

Wallis and Futuna ........................................................................................................................................................................ 130

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Contents

Part III. Web-based Leprosy Dashboard ........................................................................ 133

1. Overview ............................................................................................................................................................................... 133

2. Description of the Leprosy Dashboard .............................................................................................................. 133

3. How to use the web-based Dashboard ............................................................................................................ 134

Annexes ........................................................................................................................... 141

Annex 1. Definitions................................................................................................................................................................... 141

Annex 2. Source of the data.................................................................................................................................................. 143

Annex 3. List of countries/areas for which leprosy data were not available .......................................... 144

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Figures and tablesFig. 1. Distribution of new cases of leprosy by WHO Region, 2018 ................................................................... 3

Fig. 2. Prevalence rate of leprosy in the Western Pacific Region, 1983–2018 .............................................. 6

Fig. 3. New case detection rate in the Western Pacific Region, 1983–2018 ................................................. 7

Fig. 4. Map showing new case detection rate in the Western Pacific Region, 2018 ............................... 7

Fig. 5. New case detection rate for countries that reported at least one case in 2018 ......................... 8

Fig. 6. New case detection rate and number for top 10 countries in the Western Pacific Region, 2018 ........................................................................................................................ 9

Fig. 7. New case detection rate vs number, 2018 ......................................................................................................... 9

Fig. 8. Level of leprosy incidence and annual change ............................................................................................ 10

Fig. 9. Trend in number of new cases in top 6 countries in numbers, 1983–2018 ............................... 11

Fig. 10. Trend in new case detection rate in top 6 countries in numbers, 1983–2018 ......................... 11

Fig. 11. New case detection rate by disease type in the Western Pacific Region, 1983–2018 ......... 12

Fig. 12. Proportion of MB leprosy cases by country and area, 2014–2018 ................................................... 13

Fig. 13. New case detection rate among children in the Western Pacific Region, 1983–2018 ........ 14

Fig. 14. Proportion of child cases by country and area, 2014–2018 ................................................................. 14

Fig. 15. Number of new cases, child vs all cases (left) and new case detection rate among children (right), 2018 ................................................................................................................................... 15

Fig. 16. Proportion of female cases by country and area, 2014–2018 ............................................................. 16

Fig. 17. New case detection rate for cases with Grade 2 disability .................................................................... 16

Fig. 18. Proportion of cases with Grade 2 disability .................................................................................................... 17

Fig. 19. Change in Grade 2 disability rate from 2016 to 2018 ............................................................................... 20

Fig. 20. Top page of the web-based Leprosy Dashboard ...................................................................................... 134

Fig. 21a. Customization of the Profile tab of the Leprosy Dashboard .............................................................. 135

Fig. 21b. Customization of the Profile tab of the Leprosy Dashboard .............................................................. 135

Fig. 21c. Customization of the Profile tab of the Leprosy Dashboard .............................................................. 136

Fig. 22. Snapshot of the Dashboard tab of the Leprosy Dashboard ............................................................... 137

Fig. 23. Snapshot of the Table tab of the Leprosy Dashboard ............................................................................ 137

Fig. 24a. Customization of the Table tab of the Leprosy Dashboard ................................................................ 138

Fig. 24b. Customization of the Table tab of the Leprosy Dashboard ................................................................ 138

Fig. 24c. Customization of the Table tab of the Leprosy Dashboard ................................................................ 139

Fig. 25. Snapshot of the Comparison tab of the Leprosy Dashboard .......................................................... 139

Fig. 26a. Customization of the Comparison tab of the Leprosy Dashboard ................................................ 140

Fig. 26b. Customization of the Comparison tab of the Leprosy Dashboard ................................................ 140

vii

Contents

Table 1. Number of new cases of leprosy by WHO Region, 2014–2018 .............................................................. 3

Table 2. Leprosy cases and monitoring indicators in the Western Pacific Region, 1983–2018.............. 4

Table 3. Leprosy cases and monitoring indicators in countries and areas in the Western Pacific Region, 2018 ......................................................................................................................... 5

Table 4. Progress against the global target of a zero Grade 2 disability among paediatric leprosy patients by 2020 compared to 2016 level (mid-term assessment) ................................. 18

Table 5. Progress against the global target of reduction in new cases with Grade 2 disability to less than one case per million population by 2020 compared to 2016 level (mid-term assessment) ................................................................................................................................................. 19

viii


Lead authors and contributors

The lead authors of this report are Tauhid Islam, Kalpeshsinh Rahevar, Fukushi Morishita and Nobuyuki Nishikiori (former staff member) from the End TB and Leprosy Elimination unit at the World Health Organization (WHO) Regional Office for the Western Pacific, and Rie Yotsu, a WHO consultant. Masashi Teshima and Masato Yamauchi, WHO volunteers, supported the data management and analyses.

WHO staff members in regional and country offices

Cornelia Hennig, Gemma Cabanos, Shalala Ahmadova, Tom Hiatt, Anuzaya Purevdagva, Padmasiri Eswara, Lepaitai Hansell, Narantuya Jadambaa, Ridha Jebeniani, Katsunori Osuga, Khanh Pham, Fabio Scano, Yanni Sun, Jacques Sebert, Mathida Thongseng, Subhash Yadav, Rajendra-Prasad Yadav, Dumawat Concepcion, Luciano Tuseo, Vilath Seevisay, Hieu Vu, Anupama Hazarika, Chen Zhongdan, Eunyoung Ko, Uhjin Kim and Chun Paul Soo.

National leprosy focal persons and national respondents who contributed to reporting and data verification

Sharmaine Mageo, Saipale Fuimaono, Christina Barry, Cindy Toms, Noraskhin Hj Mohd Fadillah, Hajah Maslina bt Hj Mohsin, Kyaw Thu, Lai Ky, Du Xin, Chi Kuen Chan, Chou Kuok Hei, Edwina Tangaroa, Sambath Lay, Alumita, Mike Kama, Chima Mbakwem, Ken Jetton, Ludovic Floury, Waimanu Pulu, Marcelina Rabauliman, Yasunori Ichimura, Phonenaly Chittamany, Connie Bien Olikong, Margaret Kal, Yu Meiwen, Nukutau Pokura, Sakiusa Mainiwalala, Nguyen Ngoc Lam, Cecilia Arciaga, Darwin Mak, Norihisa Ishii, Erei Rimon, Kyung Eun, In Hyekyung, Nguyen Viet Nhung, Bounpheng Sodouangdenh, Danjaad Enkhmandakh, Lei Chin Ion, Muhamad Ismail, Chan Soi Fan, Hillia Langrine, Mayleen Jack Ekiek, J. Tsolmon, Jane Dowabobo, Julie Mart C. Rubite, Mme Oksana Segur, Alison Roberts, Andrea McNeill, Maina Pulu, Daniel C. Lamar, Helen Harding, Clarette Matlab, Miriam Pahun, Ernesto Villalon III, Robert Edward Thomsen, Lameka Sale, Christine Lefuka, Daniel Houillon, Connie Bien Olikong, Wang Yee Tang, Zhang Yiwen, Noel Itogo, Oliver Mapela, Tekie Iosefa, Malakai’ Ake, Louis Fonua, Nese Conway, Temilo Seono, Markleen Tagaro, Saen Fanai, Tran Hau Khang and Laurent Morisse.

ix

AcknowledgementWe would like to thank all leprosy programme managers and statisticians from the countries and areas of the Western Pacific Region who provided valuable data and programmatic information for the compilation of this document.

x


A note on the dataThis epidemiological report on leprosy was developed by compiling historical data for the WHO Western Pacific Region. Leprosy surveillance data are reported annually from countries and areas in the Region to the WHO Regional Office for the Western Pacific and forwarded to the WHO Global Leprosy Programme, where they are consolidated in a global leprosy report. In the process of developing this report, historical leprosy data were reviewed and validated by national leprosy elimination programmes to ensure consistency with the nationally available data. Therefore, the data presented in this report may contradict data presented in previous WHO reports. Further information about the sources of the data can be found in Annex 2.

xi

AbbreviationsBCG bacille Calmette-Guérin

CSV comma-separated values

IEC information, education and communication

IQR interquartile range

LEC leprosy elimination campaign

MB multibacillary

MDT multidrug therapy

NGO nongovernmental organization

PB paucibacillary

P/D prevalence/detection

PICs Pacific island countries and areas

ROM rifampicin-ofloxacin-minocycline

SAPEL special action project for elimination of leprosy

TB tuberculosis

WHO World Health Organization

xii


International Organization for Standardization codes for countries and areas of the Western Pacific Region Used in various figures in this report

ASM American SamoaAUS AustraliaBRN Brunei DarussalamCHN ChinaCOK Cook IslandsFJI FijiFSM Micronesia (Federated States of )GUM GuamHKG Hong Kong SAR (China)JPN JapanKHM CambodiaKIR KiribatiKOR Republic of KoreaLAO Lao People’s Democratic RepublicMAC Macao SAR (China)MHL Marshall IslandsMNG MongoliaMNP Northern Mariana Islands (Commonwealth of the)MYS MalaysiaNCL New CaledoniaNIU NiueNRU NauruNZL New ZealandPHL PhilippinesPLW PalauPNG Papua New GuineaPYF French PolynesiaSGP SingaporeSLB Solomon IslandsTKL TokelauTON TongaTUV TuvaluVNM Viet NamVUT VanuatuWLF Wallis and FutunaWPR Western Pacific Region (not an International Organization for Standardization code)WSM Samoa

xiii

Executive summarySince the adoption of World Health Assembly resolution WHA44.9 in 1991, great progress has been made in the fight against leprosy. However, the historical trends and the current situation for leprosy epidemiology vary substantially across countries in the World Health Organization (WHO) Western Pacific Region. This report, Epidemiological Review of Leprosy in the Western Pacific Region 1983–2018, presents all available historical data for all countries and areas of the Region from1983 to 2018, together with programmatic and policy milestones. It was developed by compiling leprosy surveillance data reported annually from countries and areas in the Region to the WHO Regional Office for the Western Pacific during this time, which were further reviewed and validated by national leprosy elimination programmes to ensure consistency with the nationally available data.

The Western Pacific Region accounted for 4% of new leprosy cases worldwide in 2018. The number of registered cases in the Region decreased by 89.5%, from 68 313 cases in 1991 to 7876 cases in 2018. In 2018, the prevalence rate in the Region was 0.04 per 10 000 population, which was six times lower than the global average. The highest prevalence rate was found in Kiribati with 18.6 per 10 000 population, followed by the Marshall Islands with 11.0 per 10 000 population and the Federated States of Micronesia with 10.7 per 10 000 population. The highest number of registered cases was reported in the Philippines with 4970 cases, followed by China with 970 cases and Papua New Guinea with 626 cases. In 2018, countries and areas for which the prevalence rate was above the elimination level included the following six: American Samoa, Kiribati, the Marshall Islands, the Federated States of Micronesia, Nauru and Tuvalu. The number of new cases detected in the Region decreased by 72.1%, from 15 002 cases in 1991 to 4193 cases in 2018. The countries with the three highest new case detection rates were Kiribati with 149 per 100 000 population, the Federated States of Micronesia with 113 per 100 000 population and the Marshall Islands with 101 per 100 000 population. Of 37 countries and areas in the Region, seven countries and areas (18.9%) did not report new leprosy cases in 2018.

Across the Region, the proportion of multibacillary (MB) leprosy cases among total new cases increased from 69.0% in 1997 to 82.8% in 2018, with wide differences among countries. The number of child leprosy cases decreased by 62.8%, from 1240 cases in 1997 to 450 cases in 2018. Child cases represented 10.7% of total new cases in 2018. In 1998, the Region achieved the global target of reducing the occurrence of new cases with Grade 2 disabilities to less than one case per million population. In 2018, the number of new cases with Grade 2 disabilities was 258, yielding a rate of 0.13 per million in the Region.

In the past, people affected by leprosy were forcibly quarantined by law in isolated hospitals, sanatoria or leprosy colonies. Even today, in some countries, people affected by leprosy and their family members may be directly or indirectly discriminated against in society. Notable areas include marriage, employment, and the use of public places including hotels, restaurants and transport. The United Nations General Assembly has adopted a resolution that calls for the elimination of discrimination against people affected by leprosy and their family members. There is growing international momentum to review the current situation as a first step toward addressing legal discrimination against people affected by leprosy and their family members. A regional review of legislation demonstrated that laws that directly or indirectly discriminate against people affected by leprosy and their family members were in force in the past in some countries and areas of the Western Pacific Region, and that some remain in effect today, regardless of whether they are enforced.

The WHO Regional Office for the Western Pacific has developed a web-based Leprosy Dashboard that enables tabulation and visualization of all indicators and data presented in this epidemiological report. The dashboard is accessible to all and can be customized to suit a user’s preferences. Figures and data generated by the dashboard can be downloaded.

1

Part I. Epidemiological situation of leprosy in the Western Pacific Region

1. Brief description of leprosyLeprosy is a chronic infectious disease caused by Mycobacterium leprae. It usually affects the skin and peripheral nerves but has a wide range of clinical manifestations. The disease is classified as paucibacillary (PB) or multibacillary (MB), depending on the bacillary load. PB leprosy is a milder disease characterized by few (up to five) hypopigmented, anaesthetic skin lesions (pale or reddish). MB leprosy is associated with multiple (more than five) skin lesions, nodules, plaques, thickened dermis or skin infiltration and, in some instances, involvement of the nasal mucosa, resulting in nasal congestion and epistaxis. Involvement of certain peripheral nerves also may be noted, sometimes resulting in the characteristic patterns of disabilities. In most cases of both PB and MB disease, the diagnosis is straightforward. But in a small proportion of cases, those without anaesthetic patches require examination by a specialist to detect other cardinal signs of the disease, including nerve involvement, along with a positive laboratory test (the slit skin smear). Among communicable diseases, leprosy is a leading cause of permanent physical disabilities.

Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disabilities due to leprosy. Effective management of leprosy complications, including reactions and neuritis, can prevent or minimize the onset of further disabilities. The disease and its associated deformities bring social stigma and discrimination against patients and their families in many societies. The mode of transmission of M. leprae remains uncertain, but most investigators believe that it is spread from person to person, primarily as a nasal droplet infection. The incubation period of five to seven years is unusually long for a bacterial disease. The peak age of onset is young adulthood, usually 20–30 years old; the disease is rarely seen in children aged under 5 years. While humans are considered to be the major host and reservoir of M. leprae, other animal sources, including the armadillo, have been incriminated as reservoirs of infection. The epidemiological significance of these findings is unknown but is likely to be very limited, except perhaps in North America. Unlike tuberculosis, there is no evidence to suggest an association between HIV infection and leprosy. Bacille Calmette-Guérin (BCG) vaccination is known to have some protective effect against the disease.

2. IntroductionThe World Health Organization (WHO) Western Pacific Region comprises 37 countries and areas with a total population of approximately 1.9 billion people,1 more than one quarter of the world’s population. The Region is one of the most diverse WHO regions geographically and economically. It stretches over a vast area, from China in the north and west, to New Zealand in the south and French Polynesia in the east. It includes developed countries such as Australia, Japan, New Zealand, the Republic of Korea and Singapore, as well as countries with the fastest growing economies such as China, Viet Nam, and more recently Mongolia, Papua New Guinea and the Lao People’s Democratic Republic.2 Of the 37 countries and areas in the Region, 21 are small Pacific island countries and areas (PICs) that account for 0.17% of the total population.1

Globally, the prevalence of leprosy decreased from more than 5 million cases in the mid-1980s to less than 200 000 cases by 2018.3 The development of multidrug therapy (MDT) to treat leprosy in the early 1980s

1 Population Division [website]. New York: United Nations; 2018 (https://www.un.org/development/desa/pd/, accessed on 10 September 2018).2 World Economic Outlook Databases [website]. Washington DC: International Monetary Fund; 2015 (https://www.imf.org/en/Publications/SPROLLs/world-economic-

outlook-databases#sort=%40imfdate%20descending, accessed on 10 October 2015). 3 Weekly epidemiological record. No. 35/36 Geneva: World Health Organization; 2019; 94: 389-412.

2


represented an important step forward in the fight against the disease. MDT was first introduced in 1982 and was administered worldwide by 1990. A considerable reduction in prevalence was achieved during this phase. At the Forty-fourth World Health Assembly in 1991, a resolution was adopted that aimed for the global elimination of leprosy as a public health problem by the year 2000.4 Elimination as a public health problem was defined as reaching a prevalence of less than 1 per 10 000 population. The elimination campaign provided an opportunity to increase political commitment, mobilize resources and intensify activities. The elimination target was achieved at a global level by the end of 2000. With few exceptions, all countries reached the goal of elimination at national level by 2005.5

From 2000 to 2020, four five-year global leprosy strategies were implemented, aiming at improving availability and accessibility of leprosy services, ensuring programme sustainability and controlling morbidity.6 These implementation strategies, in combination with effective chemotherapy, made remarkable contributions to a continued decline in the global burden of leprosy after the millennium. Over the past 20 years, more than 14 million leprosy patients have been cured, about 4 million of them since 2000.7

In the Western Pacific Region, MDT implementation began in 1985. It reached 10% coverage in 1988 and almost 100% by 1994.8 Elimination of leprosy was achieved at the regional level and in 15 countries at the national level in 1991.8 Today, Kiribati, the Marshall Islands and the Federated States of Micronesia are regarded as countries yet to eliminate leprosy as a public health problem. From 2000 to 2018, several countries that had achieved the elimination level sporadically returned to a pre-elimination level, mainly due to relatively small population sizes and cases of foreign origin. They included American Samoa, Nauru, Palau and Tuvalu.

3. Epidemiological situation

3.1 Global leprosy status

Across the world there has been an enormous reduction in the number of patients registered for treatment, but new leprosy cases continue to occur. In order to identify and keep track of the global leprosy status, leprosy surveillance data are reported annually from countries and areas in the Region to the WHO Regional Office and forwarded to the WHO Global Leprosy Programme, where they are consolidated in a global leprosy report.

In 2018, there were 184 212 registered cases3 and 208 619 new cases9 of leprosy worldwide (Table 1). The prevalence rate was recorded at 0.24 per 10 000 population, and the new case detection rate was 2.74 per 100 000 population at global level.3 The WHO South-East Asia Region accounted for 71.2% of the global new caseload, followed by the Region of the Americas (14.8%) and the African Region (9.9%) (Fig. 1). The Western Pacific Region accounted for 2.0% of new leprosy cases. In 2018, the country reporting the highest number of new leprosy case was India with 120 334 cases, followed by Brazil with 28 660 cases and Indonesia with 17 017 cases. These three countries accounted for more than 80% of the global leprosy burden. Of 159 countries that submitted data in 2018, 15 reported more than 1000 new cases. In the Western Pacific Region, only the Philippines reported more than 1000 new cases.

The following sections of this report provide analysis of leprosy surveillance data reported annually from countries and areas in the Western Pacific Region to the WHO Regional Office from 1983 to 2018, which were reviewed and validated by national leprosy elimination programmes to ensure consistency with the

4 WHA 44.9 Leprosy, HbK Res, Vol. III (2nd ed.), 1.16.8: Eleventh Plenary meeting, 13 May 1991.5 Weekly epidemiological record. No. 32. Geneva: World Health Organization; 2006: 309-316.6 Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015): plan period: 2011-2015). New Delhi: WHO Regional Office for South-

East Asia; 2009 (https://apps.who.int/iris/handle/10665/205004).7 Leprosy [website]. Geneva: World Health Organization; 2019 (http://www.who.int/mediacentre/factsheets/fs101/en/, accessed on 10 September 2019).8 Overview and epidemiological review of leprosy in the WHO Western Pacific Region 1991 - 2001. Manila: WHO Regional Office for the Western Pacific; 2003 (https://

apps.who.int/iris/handle/10665/206979).9 Updated/validated data were used for the Western Pacific Region. Data for other regions (excluding WHO European Region) were taken from Weekly epidemiological

record. No. 32. Geneva: World Health Organization; 2006: 309-316.

3

Part I. ePIdemIologICal sItuatIon of leProsy In the Western PaCIfIC regIon

nationally available data. Therefore, the data presented in this report may contradict data presented in previous WHO reports. Further information about the sources of the data can be found in Annex 2.

Table 1. Number of new cases of leprosy by WHO Region, 2014–2018

WHO Region 2014 2015 2016 2017 2018

No. % No. % No. % No. % No. %

Africa 18 280 8.6 21 219 10.0 20 705 9.5 20 828 9.9 20 586 9.9

Americas 33 276 15.6 28 806 13.6 27 368 12.6 29 127 13.8 30 957 14.8

Eastern Mediterranean

2 342 1.1 2 167 1.0 2 858 1.3 3 563 1.7 4 338 2.1

Europe 18 0.0 32 0.0 37 0.0 50 0.0

South-East Asia 154 834 72.7 156 118 73.6 163 094 74.8 153 487 72.7 148 495 71.2

Western Pacific 4 335 2.0 3 645 1.7 3 914 1.8 4 140 2.0 4 193 2.0

Total 213 067 211 973 217 971 211 182 208 619

Source: WHO, Weekly epidemiological record. No. 35/36 2019, 94, 389-412. Data for the Western Pacific Region were updated using new data updated/validated by countries.

Fig. 1. Distribution of new cases of leprosy by WHO Region, 2018

Africa Americas Eastern MediterraneanEurope South East-Asia Western Pacific

14.8%

9.9%

2.1%

2.0%

71.2%

3.2 Summary data for the Western Pacific Region

Table 2 shows key leprosy monitoring indicators for the Western Pacific Region from 1983 to 2018. Table 3 shows key leprosy monitoring indicators for countries and areas in the Region in 2018. In the Region, leprosy surveillance data have been available since 1983. However, the number of reporting countries and areas varies across different years. In particular, the data were not available in many countries and areas in the early years. Missing data for a few countries with large populations and/or a large number of registered and new cases between 1983 and 1986 considerably affected and distorted the regional trend, especially for prevalence and new case detection rates. Other data disaggregated by demography (cases among children and women), disease type (MB and PB cases) and disability status (cases with Grade 2 disability) were also influenced by the gradual increase in the reporting coverage, as well as the availability of data within individual countries and areas. These points should be noted as limitations to the regional analysis. Figures presented in the later sections of this report omit some data from the early years that were most probably distorted by the reporting coverage.

4


Table 2. Leprosy cases and monitoring indicators in the Western Pacific Region, 1983–2018

YearPopulation

(000)Registered

casesPrevalence per 10 000

New cases

Detection per 100 000

MB %

Child % Female %

Disability %

Disability per million

1983 159 509 84 509 5.30 5 229 3.28 18.1 7.8 0.2 15.9 5.221984 297 833 81 110 2.72 5 018 1.68 18.1 7.1 0.3 12.7 2.131985 1 366 618 182 250 1.33 5 443 0.40 13.7 6.0 0.2 12.2 0.491986 1 391 015 79 103 0.57 11 357 0.82 37.9 4.6 0.1 6.1 0.501987 1 433 140 150 816 1.05 11 670 0.81 39.8 6.0 0.1 6.1 0.491988 1 459 926 134 875 0.92 10 442 0.72 44.1 3.0 0.1 5.9 0.421989 1 426 553 109 050 0.76 11 814 0.83 42.2 1.6 0.2 5.7 0.471990 1 506 375 86 534 0.57 13 302 0.88 19.3 2.6 0.2 5.4 0.481991 1 467 438 68 313 0.47 15 002 1.02 16.3 1.2 0.1 4.8 0.491992 1 526 864 44 785 0.29 13 768 0.90 34.8 3.4 0.3 11.5 1.041993 1 545 616 40 737 0.26 11 392 0.74 36.0 2.7 0.2 12.6 0.931994 1 460 290 38 767 0.27 12 771 0.87 41.4 3.8 0.2 13.0 1.131995 1 477 929 30 722 0.21 11 943 0.81 67.4 4.9 8.0 15.4 1.241996 1 618 583 25 453 0.16 13 114 0.81 65.9 8.6 8.0 12.5 1.011997 1 506 621 23 309 0.15 13 608 0.90 69.0 9.1 7.8 15.2 1.371998 1 522 207 19 132 0.13 10 616 0.70 68.3 8.4 8.0 14.3 1.001999 1 666 566 14 187 0.09 9 529 0.57 70.6 9.4 7.5 12.4 0.712000 1 680 646 12 371 0.07 8 406 0.50 75.2 7.8 7.3 12.4 0.622001 1 693 748 11 757 0.07 7 417 0.44 77.3 6.7 9.7 11.6 0.512002 1 582 255 11 036 0.07 7 210 0.46 77.0 7.0 9.1 11.3 0.522003 1 720 239 10 456 0.06 6 208 0.36 78.1 7.1 8.1 11.3 0.412004 1 728 766 9 947 0.06 6 220 0.36 77.8 8.2 20.5 12.2 0.442005 1 742 574 9 463 0.05 7 196 0.41 81.3 7.4 16.4 9.4 0.392006 1 747 097 9 808 0.06 6 042 0.35 80.1 7.6 17.6 10.9 0.382007 1 757 936 8 124 0.05 5 863 0.33 68.3 5.6 26.8 10.2 0.342008 1 772 064 9 762 0.06 5 876 0.33 82.4 7.0 24.5 10.1 0.342009 1 787 621 13 403 0.07 5 333 0.30 80.8 8.8 32.3 12.2 0.362010 1 798 335 8 237 0.05 5 058 0.28 82.3 7.8 26.3 10.4 0.292011 1 808 508 7 380 0.04 4 790 0.26 79.4 9.6 34.2 11.5 0.312012 1 818 996 7 357 0.04 5 419 0.30 76.3 9.4 33.2 10.5 0.312013 1 828 251 7 070 0.04 4 613 0.25 78.8 9.9 32.3 8.5 0.212014 1 837 692 7 322 0.04 4 439 0.24 78.9 11.1 32.1 7.5 0.182015 1 828 563 5 773 0.03 3 645 0.20 82.2 10.8 32.5 8.6 0.172016 1 900 819 5 820 0.03 3 914 0.21 79.1 9.5 34.6 9.2 0.192017 1 911 643 7 104 0.04 4 140 0.22 80.3 12.0 34.4 7.2 0.162018 1 921 989 7 876 0.04 4 193 0.22 82.8 10.7 35.1 6.2 0.13

Note: The number of reporting countries and areas varies across different years. In particular, the data were not available in many countries and areas in the early years. Population data presented here are the total population of countries and areas for which any data were available in the WHO regional leprosy database. The data for China were not available in 1983 and 1984, which largely affected the regional data and calculation of monitoring indicators. A list of countries and areas with non-available leprosy data is provided in Annex 3.

5


Table 3. Leprosy cases and monitoring indicators in countries and areas in the Western Pacific Region, 2018

Country/area

Popu

latio

n (‘0

00)

Regi

ster

ed

case

s

Prev

alen

ce p

er

10 0

00

New

case

s

Dete

ctio

n pe

r 10

0 00

0

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y per

m

illio

n

American Samoa 55 8 1.44 3 5.41 100.0 33.3 33.3 0.0 0.00Australia 24 898 11 0 6 0.02 100.0 0.0 50.0 0.0 0.00Brunei Darussalam 429 1 0.02 1 0.23 100.0 0.0 0.0 0.0 0.00Cambodia 16 250 70 0.04 151 0.93 56.3 9.3 39.7 14.6 1.35China 1 427 648 970 0.01 521 0.04 89.4 1.3 36.9 19.0 0.07China, Hong Kong SAR 7 372 9 0.01 5 0.07 80.0 0.0 100.0 0.0 0.00China, Macao SAR 632 1 0.02 0 0 NA NA NA NA 0.00Cook Islands 18 0 0 0 0 NA NA NA NA 0.00Fiji 883 9 0.1 9 1.02 77.8 11.1 11.1 22.2 2.26French Polynesia 278 0 0 0 0 NA NA NA NA 0.00Guam 166 6 0.36 8 4.83 100.0 12.5 12.5 0.0 0.00Japan 127 202 2 0 2 0 100.0 0.0 50.0 0.0 0.00Kiribati 116 215 18.56 173 149.33 41.0 27.8 51.5 2.9 43.16Lao People’s Democratic Republic

7 062 77 0.11 71 1.01 88.7 12.7 21.1 25.4 2.55

Malaysia 31 528 288 0.09 182 0.58 72.0 5.5 23.6 5.5 0.32Marshall Islands 58 64 10.96 59 101 54.2 30.5 44.1 0.0 0.00Micronesia (Federated States of)

113 121 10.74 127 112.75 54.3 30.7 35.4 2.4 26.63

Mongolia 3 170 0 0 0 0 NA NA NA NA 0.00Nauru 11 8 7.5 8 74.98 87.5 0.0 0.0 0.0 0.00New Caledonia 280 14 0.5 8 2.86 12.5 50.0 62.5 0.0 0.00New Zealand 4 743 3 0.01 3 0.06 100.0 0.0 0.0 0.0 0.00Niue 17 0 0 0 0 NA NA NA NA 0.00Northern Mariana Islands (Commonwealth of the)

57 3 0.58 3 5.77 100.0 0.0 33.3 0.0 0.00

Palau 18 1 0.56 1 5.58 100.0 0.0 0.0 0.0 0.00Papua New Guinea 8 606 626 0.73 502 5.83 82.1 27.3 39.2 5.2 3.02Philippines 106 651 4 970 0.47 2 176 2.04 89.9 6.8 33.6 2.3 0.48Pitcairn Island NA NA NA NA NA NA NA NA NA NARepublic of Korea 51 172 129 0.03 6 0.01 100.0 0.0 16.7 16.7 0.02Samoa 196 6 0.31 5 2.55 60.0 0.0 0.0 0.0 0.00Singapore 5 757 6 0.01 6 0.1 66.7 0.0 33.3 0.0 0.00Solomon Islands 653 41 0.63 47 7.2 61.7 21.3 42.6 6.4 4.60Tokelau 1 0 0 0 0 NA NA NA NA 0.00Tonga 103 1 0.1 1 0.97 100.0 0.0 0.0 0.0 0.00Tuvalu 12 9 7.82 8 69.52 50.0 50.0 37.5 0.0 0.00Vanuatu 293 4 0.14 5 1.71 80.0 0.0 80.0 0.0 0.00Viet Nam 95 546 203 0.02 96 0.1 92.7 0.0 25.0 18.8 0.19Wallis and Futuna 12 0 0 0 0 NA NA NA NA 0.00Western Pacific Region 1 921 989 7 876 0.04 4 193 0.22 82.8 10.7 35.1 6.2 0.13

6


3.3 Prevalence

Fig. 2 shows the trend of the prevalence rate in the Western Pacific Region from 1983 to 2018. It declined sharply in the late 1980s and early 1990s. This remarkable reduction was mainly driven by increased MDT implementation during the period. After the late 1990s, the rate of the decline became slower. From 2000 to 2018, the decline continued but it was less pronounced than during the previous decade. After the adoption of the World Health Assembly resolution that aimed for global elimination of leprosy, the number of registered cases decreased by 89.3% – from 68 313 cases in 1991 to 7876 cases in 2018. In 2018, the prevalence rate in the Region was 0.04 per 10 000 population, six times lower than the global average of 0.24 per 10 000 population.10

In the Western Pacific Region, in 2018, the highest prevalence rate was found in Kiribati with 18.6 per 10 000 population, followed by the Marshall Islands with 11.0 per 10 000 population and the Federated States of Micronesia with 10.7 per 10 000 population (Table 3). The highest number of registered cases was reported in the Philippines with 4970 cases, followed by China with 970 cases and Papua New Guinea with 626 cases. Countries in which the prevalence rate was above elimination level included the following six: American Samoa, Kiribati, the Marshall Islands, the Federated States of Micronesia, Nauru and Tuvalu.

Fig. 2. Prevalence rate of leprosy in the Western Pacific Region, 1983–2018

1983 1988 1993 1998 2003 2008 2013 2018

0

1

2

3

4

5

6

7

Target

Case

s reg

istere

d per

10 00

0

3.4 New case detection

The new case detection rate for the Region fluctuated at a level above 0.7 per 100 000 population from 1986 to 1997, and dropped in 1993 to 2000 (Fig. 3). After 2000, the rate continued its downward movement, with an annual reduction rate of 4.8% for the last 18 years. After the adoption of the World Health Assembly resolution, the number of new cases detected decreased by 72.0%, from 14 991 cases in 1991 to 4193 cases in 2018.

10 Weekly epidemiological record. No. 35/36 Geneva: World Health Organization; 2019; 94: 389-412.

7


Fig. 3. New case detection rate in the Western Pacific Region, 1983–2018

1983 1988 1993 1998 2003 2008 2013 2018

0

1

2

3

4

New

case

s per

100 0

00

Exponential fit: Recent annual change: −4.8 %

Fig. 4 shows the geographical distribution of the new case detection rate in the Western Pacific Region in 2018. Countries with the highest case detection rate of more than 5 cases per 100 000 population were found in the Pacific, where there are many island countries and areas with a small population. Countries with a relatively high case detection rate of between 1 and 4.99 cases per 100 000 population were found in the Pacific islands as well as in Asia. In the Pacific islands, there appears to be a clear difference in distribution of new case detection rates by subregion: higher rates were found in Micronesia and Melanesia, whereas lower rates were found in Polynesia (countries with no data are usually those with no new cases).

Fig. 4. Map showing new case detection rate in the Western Pacific Region, 2018

8


Fig. 5 shows the new case detection rate in countries and areas that reported at least one new case in 2018. The countries with the three highest new case detection rates were Kiribati with 149 per 100 000 population, the Federated States of Micronesia with 113 per 100 000 population and the Marshall Islands with 101 per 100 000 population. These three countries were followed by other Pacific island countries and areas: American Samoa, Nauru, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, Solomon Islands and Tuvalu. Of the 37 countries and areas in the Region, seven countries and areas (18.9%) did not report new leprosy cases in 2018.

Fig. 5. New case detection rate for countries that reported at least one case in 2018

0.0020.010.020.040.060.070.10.10.230.580.930.971.011.021.712.042.552.86

4.835.415.585.775.837.2

69.5274.98

101112.75

149.33

0 20 40 60 80 100 120 140 160Detection per 100 000

JapanRepublic of Korea

AustraliaChina

New ZealandChina, Hong Kong SAR

SingaporeViet Nam

Brunei DarussalamMalaysia

CambodiaTonga

Lao People's Democratic RepublicFiji

VanuatuPhilippines

SamoaNew Caledonia

GuamAmerican Samoa

PalauNorthern Mariana Islands (Commonwealth of the)

Papua New GuineaSolomon Islands

TuvaluNauru

Marshall IslandsMicronesia (Federated States of)

Kiribati

Fig. 6 shows the new case detection data for the 10 countries with the most new cases in 2018. The highest number of new cases was reported in the Philippines with 2176 cases, followed by China with 521 cases and Papua New Guinea with 502 cases. These three are followed by Malaysia (182 cases), Kiribati (173 cases), Cambodia (151 cases), the Federated States of Micronesia (127 cases), Viet Nam (96 cases), the Lao People’s Democratic Republic (71 cases) and the Marshall Islands (59 cases). A comparison between the number and rate demonstrated that countries with a high number of new cases are not necessarily those with the highest rate. The countries with the three highest new case detection rates (Kiribati, the Marshall Islands and the Federated States of Micronesia) ranked relatively lower in the numbers.

9


Fig. 6. New case detection rate and number for top 10 countries in the Western Pacific Region, 2018

1011.010.1

1130.93

1490.58

5.830.042.04

0 50 100 150 200

New case detection rate (per 100 000)

597196127151173182

502521

2176

0 500 1000 1500 2000 2500

Marshall IslandsLao People's Democratic Republic

Viet NamMicronesia (Federated States of)

CambodiaKiribati

MalaysiaPapua New Guinea

ChinaPhilippines

Total number of new cases

Fig. 7 shows the scatter plot of the new case detection rate and numbers in 2018. The graph shows a difference in the epidemiological profile among different countries and areas. These fall into three groups: Pacific island countries and areas (PICs), low- and middle-income countries, and high-income countries. Low- and middle-income countries tend to appear in the figure with high numbers and intermediate rates, whereas high-income countries appear with low values for both number and rate. In the PICs, the number of new cases detected ranged from low to intermediate, while the rate ranged from intermediate to high. This suggested that the leprosy epidemiological profile in the Region may be influenced by geographical and economic factors. Addressing the leprosy burden in such a diverse epidemiological situation calls for country-specific strategies and approaches.

Fig. 7. New case detection rate vs number, 2018

BRN

TON

PLW MNP

HKG

VUTWSM

SGP

NCLGUM

TUVNRU

FIJI

SLB

MHL

LAO

VNM

FSM

KHM

　KIR

MYS

PNG

PHL

High income PICsLow & middle income

0.1

1

10

100

New

case

detec

tion p

er 10

0 000

1 10 100 1000

Number of new cases

Note: A log scale is used for both x and y axes. Country abbreviations can be found on page xii.

10


The scatter plot of the level of incidence (new case detection rate) and annual change in the new case detection rate showed a clear positive correlation (Fig. 8). In general, the rate of annual reduction tends to be higher in lower endemic countries, while the number of new cases detected in highly endemic countries is still increasing. This analysis points to several important conclusions. First, strategies and programmatic priorities are diverse in the countries of the Region with clear distinctions between countries that have already entered into a steady declining stage of leprosy epidemiology and countries yet to reach that stage. Second, countries with increasing case detection trends, such as Kiribati, the Marshall Islands and the Federated States of Micronesia are probably the ones that are still expanding service coverage and require further investment in their programmatic response. Third, careful assessments are necessary for countries that are assumed to have lower- and middle-incidence status. For example, migration probably plays an important role in the epidemiology in Australia, Guam, New Caledonia and Singapore, and possibly Malaysia, where newly detected cases are on the rise. For countries with decreasing incidence, careful analyses, using subnational-level data, are needed to confirm whether the reduction in new case detection is associated with a true reduction of the disease burden.

Fig. 8. Level of leprosy incidence and annual change

CHNHKG

SGP

VNM

FIJI MYS

LAOKHM

PHL

NCL

SLB

PNG

GUMKIR

FSM

MHL

-20

-15

-10

-5

0

5

10

Annu

al re

ducti

on /

incre

ase (

%)

0.1 1 10 100

New case detection per 100 000 (average)


Note: New case detection rates (x-axis) were average rates calculated using data from 2009 to 2018. Annual changes (y-axis) were calculated using the historical data of new case detection rates from 2000 to 2018. A log scale is used for x-axes. Any incalculable or missing data for y-axis is deleted from the analysis. Country abbreviations can be found on page xii.

Trends for new case detection were compared among selected countries (Fig. 9 and Fig. 10). In numerical terms, the Philippines has maintained the highest leprosy caseload in terms of numbers for more than 20 years, and the number of new cases detected every year has fluctuated widely. The fluctuation may reflect the varying intensity of programme activities. China has seen a gradual decline in the number of new cases without notable fluctuation for the last 30 years. In Cambodia, the number peaked only in the 1990s and then have shown a steady decline since 2000. In contrast to these three countries, Malaysia, the Lao People’s Democratic Republic and Papua New Guinea have had a relatively stable caseload for the past 30 years.

In terms of the rate, Papua New Guinea experienced the most rapid reduction during the 1980s. However, while the rate decreased compared to during the 1990s, it has been fluctuating in recent years, making it difficult to discern a trend. In Malaysia, the rate declined during the 1980s and 1990s, but it has increased

11


in recent years. China and Malaysia have seen a slow but steady reduction over the years (see country profiles). In Cambodia and the Philippines, the rate has steadily declined, in keeping with the change in case numbers.

Fig. 9. Trend in number of new cases in top 6 countries in numbers, 1983–2018

PhilippinesChinaPapua New GuineaMalaysiaLao People's Democratic RepublicCambodia

Num

ber o

f new

case

s det

ecte

d

0

1000

2000

3000

4000

5000

6000

7000

8000

1980 1985 1990 1995 2000 2005 2010 2015 2020

Fig. 10. Trend in new case detection rate in top 6 countries in numbers, 1983–2018

PhilippinesChinaPapua New GuineaMalaysiaLao People's Democratic RepublicCambodia

New

case

s det

ecte

d per

100 0

00 po

pulat

ion

0

5

10

15

20

25

1980 1985 1990 1995 2000 2005 2010 2015 2020

12


3.5 Other key monitoring indicators

Disease typeFig. 11 shows the distribution of MB and PB cases among total new cases detected in the Region from 1983 to 2018. Cases where the disease type was unknown were classified alongside PB cases. As data disaggregated by disease type were not available in some countries in the early years, changes in the MB rate in the early years mainly indicate changes in the reporting coverage. For example, in the Region, regular reporting on MB cases started in the Lao People’s Democratic Republic and the Philippines in 1983, China in 1986, Kiribati in 1988, Cambodia in 1990, the Marshall Islands in 1993, Viet Nam in 1992, and Malaysia, the Federated States of Micronesia and Papua New Guinea in 1994. It is important to note that a drop in the MB rate between 1990 and 1994 is due to missing MB data for the Philippines. Given that these countries carry most of the leprosy cases in the Region, the MB rate after 1995 could be considered as faithfully reflecting the distribution of MB and PB cases.

The overall new case detection rate has steadily declined since 1997. The MB rate has followed, but more slowly when compared to the overall rate. During this period, the proportion of MB cases among total new cases increased from 69.0% to 82.8%.

Different factors account for the increase in the proportion of MB cases. These include:

• declining stage of endemicity (more of the incidence cases will tend to be MB due to the longer incubation for MB);11, 12

• demographics: an ageing population (MB is more likely to occur in the older age group, and is less frequently seen among children);

• start or expansion of the leprosy programme (undetected MB cases might have accumulated over the years);

• a shift from active to passive case detection; and • wide definition of MB cases.13

The regional trend probably reflects the first and second factors, though others might also apply in some settings. Hence there is a need to assess individual country data according to country context and epidemiological profile.

Fig. 11. New case detection rate by disease type in the Western Pacific Region, 1983–2018

0

1

2

3

1983 1988 1993 1998 2003 2008 2013 2018

New

case

s per

100 0

00

Total Only MB PB + Unknown MB

11 Lee J, Kim JP, Nishikiori N, Fine PE. The decline of leprosy in the Republic of Korea; patterns and trends 1977-2013. Lepr Rev. 2015;86(4):316-27.12 Ishii N, Onoda M, Sugita Y, Tomoda M, Ozaki M. Survey of newly diagnosed leprosy patients in native and foreign residents of Japan. Int J Lepr Other Mycobact Dis.

2000;68(2):172-6. 13 All factors were taken from the guidelines of the National Leprosy Eradication Programme (NLEP) in India, “Disability, MB and Child proportion – epidemiological

significance and interpretation”.

13


Fig. 12 shows the proportion of MB cases among total new cases detected in countries and areas in the Region from 2014 to 2018. The regional average of the MB proportion was 80.7% during the five years. This was largely influenced by the data from the Philippines and China, which had the largest caseloads. Three high-burden countries in the Pacific – Kiribati, the Marshall Islands and the Federated States of Micronesia – had the lowest proportion of MB cases; median being 34.1% (interquartile range [IQR] 27.2–40.8]), 45.7% (IQR 42.1–51.6]) and 58.9% (IQR 50.6–65.9]), respectively. Countries that have active case finding activities tend to have more PB than MB cases.13 Besides the three PICs, Cambodia and Solomon Islands undertook active case finding activities during the last five years when funds were available, which may have resulted in the lower MB proportion. In contrast, countries and areas in the declining stage of endemicity, such as Brunei Darussalam, China and Hong Kong SAR (China) tend to have a higher MB proportion. In high-income countries where leprosy patients are predominantly of foreign origin, such as Australia, Japan and New Zealand, the MB proportion can vary as both MB and PB cases are detected among migrants from endemic countries.

Fig. 12. Proportion of MB leprosy cases by country and area, 2014–2018

100

80

60

40

20

0

MB %

ASM

MNP

PLW

TOM

GUM VUT

WSM FJI NC

LNR

USL

BMH

LTU

VFS

M KIR PYF

PHL

CHN

VNM

PNG

LAO

MYS

KHM

BRN

HKG

NZL

KOR

AUS

MAC

JON

SGP

WPR


Note: Data shown in median and 25th and 75th percentile. Country abbreviations can be found on page xii.

Leprosy among childrenA high rate and proportion of child leprosy cases may be a sign of active and recent transmission of the disease.13 Although data on child leprosy cases have been available in the Region since 1983, reports from all endemic countries have only been available since the late 1990s. In the Region, the number of child leprosy cases decreased by 60.2%, from 1240 cases in 1997 to 450 cases in 2018. Child cases represented 10.7% of total new cases in 2018. Fig. 13 shows the trend of a new case detection rate among children in the Region from 1983 to 2018. As compared to the overall new case detection rate (Fig. 3), no decline has been observed in the child rate for more than a decade.

14


Fig. 13. New case detection rate among children in the Western Pacific Region, 1983–2018Nu

mbe

r of n

ew ca

ses d

etec

ted

0.30

0.25

0.20

0.15

0.10

0.05

0.001980 1985 1990 1995 2000 2005 2010 2015 2020

Fig. 14 shows the percentage of child leprosy cases by country and area in the Region from 2014 to 2018. The regional average of the child percentage was 10.8% during the five years. A higher percentage was observed in many PICs, with more than 20% in American Samoa, Kiribati, the Marshall Islands, the Federated States of Micronesia, New Caledonia, Solomon Islands and Tuvalu. In contrast, a lower percentage was found in low- and middle-income countries besides Papua New Guinea. Countries and areas that reported new cases from 2014 to 2018 but did not detect child cases were Australia, Brunei Darussalam, French Polynesia, Hong Kong SAR (China), Japan, Macao SAR (China), Nauru, the Commonwealth of Northern Mariana Islands, Palau, the Republic of Korea and Tonga.

Fig. 14. Proportion of child cases by country and area, 2014–2018


70

60

50

40

30

20

10

0

China

%

NCL

TUV

FSM

MHL KIR AS

M SLB

GUM

WSM VU

T FJI PYF

NRU

MNP

PLW TON

PNG

KHM PHL

LAO

MYS

VNM

CHN

NZL

SGP

AUS

BRN

HKG

MAC

JPN

KOR

WPR


15


Fig. 15 (left) shows a scatter plot of the number of total new cases and new cases among children in countries and areas that reported at least one child case in 2018. In general, a tendency was observed whereby the more total new cases were detected, the more child cases were found. A difference in this distribution was seen between the PICs and other low- and middle-income countries, with the group of PICs showing a higher proportion of children. The new case detection rate among children was also higher in PICs (Fig. 15, right).

Fig. 15. Number of new cases, child vs all cases (left) and new case detection rate among children (right), 2018

FIJIGUMASM

TUV

SLB

MHL

FSMKIR

KHMLAO MYS

PNGPHL

CHN

NCL

Num

ber o

f tot

al ne

w ca

ses i

n ch

ildre

n


0.1

1

10

100

1 10 100 1000Number of total new cases

KIRTUVFSMMHLNCL

ASMPNGSLB

GUMPHLLAOFIJI

KHMMYSCHN

1251007550250New cases per 100 000 child population

117116

109103

6.286.02

4.443.81

2.470.450.390.380.280.130.003

Note: A log scale is used for both x and y axes (left). Country abbreviations can be found on page xii.

Leprosy among womenFig. 16 shows the proportion of females among new cases detected in the Region from 2014 to 2018. The regional average was 1.96, being skewed toward males (nearly 70% of new cases were male), which was higher than the global average of 1.51. In all countries and areas in the Region, except Hong Kong SAR (China) and Kiribati, there were more males than females among their new cases, that is the male–female ratio was greater than one. Hong Kong SAR (China) reported a majority of cases among immigrants from endemic countries who are also predominantly female. The median for the three endemic countries in the Pacific were 51.4% (IQR 46.4–52.9]) for Kiribati, 35.5% for the Federated States of Micronesia (IQR 31.4–36.9) and 34.6% (IQR 32.2–45.2) for the Marshall Islands. The latter two had relatively fewer female cases.

16


Fig. 16. Proportion of female cases by country and area, 2014–2018

100

80

60

50%

40

20

0

Fem

ale %

KIR MNP

PLW PY

FVU

TAS

M NCL

SLB

FSM

MHL

TUV

GUM FJI

WSM LA

OPN

GCH

NVN

MKH

MMY

SHK

GMA

CJP

NAU

SSG

PKO

RNZ

LW

PR



Grade 2 disabilityFig. 17 shows the trend of new cases with Grade 2 disability in the Region from 1983 to 2018. Since 1997, the rate has decreased steadily over the years, which follows the reduction of the overall new case detection rate. In 1998, the Region achieved the global target of reducing the occurrence of new cases with Grade 2 disability to less than one case per million population. In 2018, the number of new cases with Grade 2 disability was 258, and the rate was 0.18 per million in the Region.

Fig. 17. New case detection rate for cases with Grade 2 disability

Target

1983 1988 1993 1998 2003 2008 2013 2018

0

1

2

3

4

5

6

7

New

case

s per

millio

n

17


In the Region, the proportion of cases with Grade 2 disability among total new cases has declined gradually with some fluctuations (Fig. 18). It fell from 15.4% in 1995 to 6.2% in 2018. The reduced percentage of cases with Grade 2 disability may indicate that cases have been detected earlier than previous years. However, careful assessment is required as the reduction in Grade 2 disability can also be attributable to a failure to assess all new cases for disability.

Fig. 18. Proportion of cases with Grade 2 disability

1983 1988 1993 1998 2003 2008 2013 2018

0

5

10

15

20

Perce

ntag

e (%

)

Global targetsFollowing are the targets envisaged by the Global Leprosy Strategy 2016–2020:14

• zero Grade 2 disability among paediatric leprosy patients; and • reduction of new leprosy cases with Grade 2 disabilities to less than one case per million

population.

Table 4 showed the progress against Grade 2 disability among paediatric leprosy patients by 2018 compared to the 2016 level. However, as there was no active reporting on Grade 2 disability among paediatric patients before 2016, no valid comparison between 2016 and 2018 could be made. Only four countries (China, Kiribati, Papua New Guinea and Solomon Islands) completed reports in 2016. In 2018, 12 countries reported on Grade 2 disability in children, and it was found in nine cases among the total 4193 new cases detected in the Region (0.21%). These nine cases were from three countries: China, Kiribati and Papua New Guinea. Progress has been seen in the Region with nine countries achieving zero Grade 2 disability in child cases and 17 countries with no child case by 2018. It is of note that Viet Nam reported 96 new cases, among which they did not find any child case. While the situation seems close to achieving the global target in the Region, data on Grade 2 disability in children is still missing for the Philippines, which reports the highest number of new cases in the Region.

14 Global Leprosy Strategy 2016-2020: Accelerating towards a leprosy-free world. New Delhi: WHO Regional Office for South-East Asia; 2016 (https://apps.who.int/iris/handle/10665/208824).

18


Table 4. Progress against the global target of a zero Grade 2 disability among paediatric leprosy patients by 2020 compared to 2016 level (mid-term assessment)

Country/area Total 2016 (number)

Total 2018 (number)

Disability in children 2016

(number)

Disability in children 2018

(number)China 672 521 1 1

Kiribati 218 173 2 1

Papua New Guinea 356 502 4 7

Solomon Islands 43 47 1 0

Cambodia 154 151 NR 0

Fiji 3 9 NR 0

Guam 16 8 NR 0

Malaysia 206 182 NR 0

Marshall Islands 80 59 NR 0

Micronesia (Federated States of) 169 127 NR 0

New Caledonia 3 8 NR 0

Tuvalu 7 8 NR 0

French Polynesia 2 0 NR NR

Lao People’s Democratic Republic 64 71 NR NR

New Zealand 0 3 NR NR

Niue 0 0 NR NR

Philippines 1 721 2 176 NR NR

Wallis and Futuna 0 0 NR NR

Australia 19 6 NR NA

Brunei Darussalam 0 1 NR NA

China, Hong Kong SAR 3 5 NR NA

China, Macao SAR 2 0 NR NA

Cook Islands 0 0 NR NA

Japan 3 2 NR NA

Mongolia 0 0 NR NA

Nauru 0 8 NR NA

Northern Mariana Islands (Commonwealth of the) 2 3 NR NA

Palau 2 1 NR NA

Republic of Korea 4 6 NR NA

Samoa 11 5 NR NA

Singapore 7 6 NR NA

Tokelau 0 0 NR NA

Tonga 0 1 NR NA

Vanuatu 2 5 NR NA

Viet Nam 138 96 NR NA

Western Pacific Region 3 914 4193 8 9

NR: No report available, NA: Not applicable

19


Table 5 and Fig. 19 show the rates of new leprosy cases with Grade 2 disabilities per million population among the selected countries. In the Region, the rate decreased from 0.19 in 2016 to 0.13 in 2018. The rate increased in the Fiji, Malaysia, the Federated States of Micronesia and Solomon Islands, but otherwise a reduction was observed. A significant reduction was especially observed for Kiribati, where intensified case findings are taking place. Among these selected countries, Cambodia, Fiji, Kiribati, the Lao People’s Democratic Republic, the Federated States of Micronesia, Papua New Guinea and Solomon Islands have yet to achieve the global target of reducing the occurrence of new cases with Grade 2 disability to less than one case per million population.

Table 5. Progress against the global target of reduction in new cases with Grade 2 disability to less than one case per million population by 2020 compared to 2016 level (mid-term assessment)

Country/area

Disability 2016

(rate per million)

Disability 2018

(rate per million)

Kiribati 85.91 43.16

Micronesia (Federated States of) 0 26.63

Solomon Islands 3.27 4.6

Papua New Guinea 4.48 3.02

Lao People’s Democratic Republic 2.62 2.55

Fiji 1.1 2.26

Cambodia 1.87 1.35

Philippines 0.65 0.48

Malaysia 0.22 0.32

Viet Nam 0.35 0.19

China 0.11 0.07

Republic of Korea 0.02 0.02

American Samoa 0 0

Australia 0.16 0

Brunei Darussalam 0 0

China, Hong Kong SAR 0 0

China, Macao SAR 0 0

Cook Islands 0 0

Westem Pacific Region 0.191 0.131

Country/area

Disability 2016

(rate per million)

Disability 2018

(rate per million)

French Polynesia 3.53 0

Guam 0 0

Japan 0 0

Marshall Islands 0 0

Mongolia 0 0

Nauru 0 0

New Caledonia 0 0

New Zealand 0 0

Niue 0 0

Northern Mariana Islands (Commonwealth of the)

0 0

Palau 0 0

Samoa 10.18 0

Singapore 0 0

Tokelau 0 0

Tonga 0 0

Tuvalu 0 0

Vanuatu 0 0

Wallis and Futuna 0 0

20


Fig. 19. Change in Grade 2 disability rate from 2016 to 2018

Target

KIR FSM SLB PNG LAO FJI KHM PHL MYS VNM CHN KOR AUS PYF WSM WPR

Disability 2016 (Rate per million) Disability 2018 (Rate per million)

10

1

0.1

0.01

Disab

ility (

Rate

per m

illion

popu

lation

)

Note: A log scale is used for y axes. Country abbreviations can be found on page xii.

4. Legislation related to discrimination

4.1 Background

In the past, leprosy was once feared as a highly contagious and debilitating disease.15 People affected by leprosy were forcibly quarantined under the law in isolated hospitals, sanatoria or leprosy colonies.16 In 1897, the First International Leprosy Congress held in Berlin recommended control by segregation of people with leprosy.17 This recommendation was reaffirmed during the Second International Leprosy Congress in Bergen in 1909, which further recommended the separation of children from parents who had leprosy.18

Following the international recommendations, governments enacted laws to legalize segregation of people affected by leprosy. India passed the Lepers Act in 1898, and Pakistan brought in the Lepers Act in the same year.17 South Africa enacted the Leprosy Repression Act in 1891.17 All these laws sanctioned the compulsory segregation of people affected by leprosy.17 The Bahamas, Egypt and Myanmar also had policies of compulsory segregation that were enforced by law.17

In addition to the enactment of these segregation laws and policies, provisions that discriminated against people affected by leprosy were introduced into other existing laws. For example, in India, under several personal laws, leprosy in either spouse constitutes a ground for divorce.19 The state-level beggary prevention laws allow for beggars and their dependents affected by leprosy to be detained or confined to leprosy asylums indefinitely.19 People with leprosy are liable to be disqualified from holding civic positions because they have leprosy.19 Furthermore, the right to travel on railways and the right to obtain a driving licence may be denied to peoples similarly affected.19 In Myanmar, prior to 1992,17 under the Inland Waterways Act, people with leprosy were required to report their condition to the captain of a vessel and request special

15 Hansen’s Disease (Leprosy) [website]. Atlanta: Centers for Disease Control and Prevention; 2016 (http://www.cdc.gov/leprosy/, accessed on 13 January 2016).16 International Federation of Anti-Leprosy Associations (ILEP). Press release for world leprosy day, 25th January 2015, London.17 Shigeki Sakamoto, “Requests Addressed To The Advisory Committee Stemming From Human Rights Council Resolutions: Elimination Of Discrimination Against Persons

Affected By Leprosy And Their Family Members”, UN Human Rights Council, Doc. No. A/HRC/AC/3/CRP.2 (31 July, 2009)18 Skinsnes, supra note 11, p.226.19 Report No. 256, Eliminating discrimination against persons affected by leprosy. April 2015. Law Commission of India, Government of India.

21


accommodation. They were not permitted to handle food, machinery or clothing, or to use public wells and ponds.17 In Angola, people with leprosy were denied national identity cards.17

Even today, in some countries, people with leprosy and their families may be directly or indirectly discriminated against with respect to marriage, employment or the use of public places such as hotels, restaurants and means of transport.16 Furthermore, in many countries, having the disease can be cause to withhold entry visas and work permits, or even result in deportation under immigration laws. Despite the fact that leprosy was found not to be particularly contagious and is now curable with multidrug therapy, such laws continue to cause needless discrimination against people affected by leprosy and their family members, and in some settings, may be violations of fundamental human rights.

4.2 Rationale

In December 2010, the United Nations General Assembly adopted a resolution that called for the elimination of discrimination against people affected by leprosy and their family members. The resolution reaffirmed that:

Persons affected by leprosy and their family members should be treated as individuals with dignity and are entitled to all human rights and fundamental freedoms under customary international law, relevant conventions and national constitutions and laws.20

The resolution introduced a set of principles and guidelines for governments and other organizations. One of the guidelines included:

(States should) take all appropriate legislative and administrative measures to modify, repeal or abolish existing laws, rules, policies, regulations, customs and practices that discriminate directly or indirectly against persons affected by leprosy and their family members, or that forcefully or compulsorily segregate and isolate persons on the grounds of leprosy in the context of such discrimination.21

In response to these international guidelines, in 2015, the Law Commission of India conducted a comprehensive review of domestic laws that could either be repealed or that needed amending, and submitted its report and recommendations to the Minister for Law and Justice for further action.19 The International Federation of Anti-Leprosy Associations has also been conducting a review of legislation in 63 countries.

As part of the preparation for this epidemiological report, the WHO Regional Office for the Western Pacific conducted a regional review of policy and legislation related to discrimination against people affected by leprosy. A structured questionnaire was sent to the leprosy focal points in 36 countries and areas of the Region, the aim being to ascertain whether the country had, at present or in the past, laws that might directly or indirectly discriminate against people affected by leprosy.22 The respondents to the questionnaire included 19 countries (53%): Australia, Brunei Darussalam, Cambodia, China, Hong Kong SAR (China), Japan, the Lao People’s Democratic Republic, Macao SAR (China), Malaysia, the Federated States of Micronesia, Mongolia, New Zealand, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, Singapore, Solomon Islands, Tuvalu and Viet Nam. The Regional Office also reviewed an unpublished report concerning the Philippines,23 and literature and law databases for some countries that were available online.

20 UN resolution A/RES/65/215, Elimination of discrimination against persons affected by leprosy and their family members.21 UN Human Rights Council, Advisory Committee, A/HRC/AC/5/2, Revised principles and guidelines for the elimination of discrimination against persons affected by

leprosy and their family members.22 Pitcairn Islands was not included due to its small population size.23 Belen Dofitas, “An overview of Philippine laws and bills on leprosy - A report submitted to the World Health Organization Western Pacific Regional Office”, December

2015.

22


Zero countries with legislation on leprosy allowing discrimination is one of the targets to be achieved under the Global Leprosy Strategy 2016–2020,14 and this review will help establish a basis for evaluating the achievement of this target in the Region.

4.3 Segregation law and policy

In the Western Pacific Region, countries and areas that had leprosy segregation laws or policies in the past include Australia, China, Hong Kong SAR (China), Japan, Macao SAR (China), Malaysia, New Zealand, the Philippines, the Republic of Korea, Singapore and Solomon Islands. All of these countries abolished their segregation law or policy at some date ranging from the 1940s in New Zealand to 1996 in Japan. In Australia, Queensland’s Leprosy Act of 1892 promoted the detention and isolation of people with leprosy. An uninhabited offshore island was selected as a leper colony that was exclusively for indigenous people.24 In Singapore, compulsory segregation of people affected by leprosy was enforced in 1897. In Japan, the Leprosy Prevention laws permitted the segregation of patients in sanatoria, where forced abortions and sterilization were common.25 In the Republic of Korea, the compulsory segregation law for people affected by leprosy was abolished in 1961.17 In Malaysia, the Leprosy Act was enacted by the former British colonial government. In Hong Kong SAR (China), the Lepers Ordinance was enacted to sanction segregation of people affected by leprosy in 1910.26

4.4 Immigration laws and policies

In the Western Pacific Region, the issuance of an entry visa for people who have leprosy may be affected under immigration laws and policies in Brunei Darussalam, Cambodia, Malaysia, the Philippines, Solomon Islands and Tuvalu, and possibly other countries. Of them, Malaysia, the Philippines, Solomon Islands and Tuvalu may refuse a visa to a person with the untreated active disease, while Brunei Darussalam and Cambodia may do so for a person with the disease under treatment. However, the scope and rigidity of such regulations seem to vary widely depending on the types of visa, purpose of entry and duration of the intended stay. In Brunei Darussalam, a foreign-born person found to have leprosy within the country is subject to deportation to their home county. A similar deportation policy also exists in Malaysia. In Australia, a “health undertaking” can be requested from a visa applicant who has leprosy, who must then agree to be placed under the supervision of a local health authority for treatment or investigation. In the Federated States of Micronesia, a foreign-born person found to have leprosy within the country is not permitted to work until he or she completes the first two weeks of treatment with a treatment partner. In all responding countries and areas, entry visas and work permits were not withheld for people who had leprosy but had completed MDT.

4.5 Other laws

In Singapore, people affected by leprosy were banned from using public transport under the Railway Act of 1906.17 A breach of this regulation was punishable by a fine not exceeding 500 Singapore dollars and an order to pay for the disinfection of the carriage.27 In Malaysia, a woman married in accordance with hukum syarak (the traditional Islamic law) can obtain the dissolution of marriage with her husband on the basis of leprosy under the Islamic Family Law of 1984.28 In the Philippines, under the Revised Rules of Courts that are currently in force, a hospitalized person who has leprosy is included in a list of legally “incompetent” people for whom the guardianship is to be appointed by a court.23 This may infringe on their rights to determine their own medical care or even the right to administer their own properties.

24 Genever, Geoffrey. Queensland’s Black Leper Colony. Queensland Review, Vol. 15, No. 2, 2008: 59-68.25 Jensen, M. and Jolly, M (eds.). We Shall Bear Witness: Life Narratives and Human Rights (Wisconsin Studies in Autobiography). Madison: University of Wisconsin Press;

2014. 26 LEPERS ORDINANCE, 1910. Hong Kong: The Historical Laws of Hong Kong Online; 2016 (http://oelawhk.lib.hku.hk/items/show/1246, accessed on 19 February 2016).27 Railway Act (Chapter 263). Singapore: Singapore Statutes Online; 2020 (https://sso.agc.gov.sg/Act/RA1905, accessed on 17 January 2020).28 Laws of Malaysia Act 303 Islamic Family Law (Federal Territories) Act 1984. Kuala Lumpur: The Commissioner of Law Revision; 2006 (http://www.somalilandlaw.com/

Malaysian_Islamic_Family_Law_1984.pdf, accessed on 11 December 2016).

23


4.6 Limitations and way forward

This regional review has several limitations. First, some of the relevant laws and rules could have been omitted due to limitations in the methodology. All respondents of our survey are leprosy focal persons in the health ministries who provided information, with or without consultation with other ministries. Laws and legal rules under the purview of other ministries may have been insufficiently examined. Second, a structured questionnaire with multiple-choice questions could have restricted the flexibility of the response, and therefore some legal domains may not have been captured in the questionnaire. Third, the relevant legal documents and information might not be available or accessible as they tend to date back a long time. Despite these limitations, the review demonstrated that laws that directly or indirectly discriminated against people with leprosy and their family members were in force in the past in some countries and areas of the Western Pacific Region, and some seem to be applicable even today, regardless of whether they are enforced.

To repeal or amend discriminatory laws requires a more rigorous review at the country level. Although parliamentary procedures to repeal or amend legislation may vary from one country to another, a situation assessment, with a review of domestic laws by local jurists and leprosy experts, would be a necessary foundation for initiating a wider policy discussion. Learning from successful experiences reported in many parts of the world, all countries and areas in the Region are encouraged to work towards eliminating legal discrimination against people affected by leprosy and their family members.

25

Part II. Country profiles

AMERICAN SAMOA

Population

55 465 (2018)

Background

• Leprosy has been endemic for many years. • Staff at health centres refer suspected cases to the Department of Health. • MDT has been administered since 1984. • Case finding is mainly passive. • Contacts of active cases are listed for systematic examination, but compliance with examination

is partial.

Elimination target

• Reached in 1996 (less than 10 prevalent cases, which WHO considers as elimination for countries with a small population). However, the elimination level has not been sustained as more than 10 prevalent cases were reported in 2009 and 2012.

Epidemiology

• The prevalence rate has fluctuated between 0.7 and 2.8 per 10 000 population since 1995. • The new case detection rate declined between 1983 and 1996, whereas over the last two

decades the rate has fluctuated between 0 and 17.6 per 100 000 population. • The number of new cases with Grade 2 disability is reported as less than two each year since

1983.

Post-elimination activities

• The disease is being closely monitored, and efforts are being made to sustain leprosy awareness in the community and among health staff.

26


Leprosy profile in American Samoa

Others With Grade 2 disability Adult Child


0

5

10

15

1020304050

01020304050

20406080

100120

0

5

10

15

10

15

0102030405060

102030405060

020406080

100120

102030405060

0

0

0

5

0

0

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target

Prevalence rate New case detection rate

New case detection rate by disease type Proportion of MB cases

Number of cases with Grade 2 disability Number of child cases

New cases with Grade 2 disability (Rate) Proportion of child cases

Proportion of cases with Grade 2 disability Proportion of female cases

Leprosy profile in American Samoa

27

Part II. Country ProfIles : amerICan samoa

Leprosy indicators in American Samoa

YearPo

pula

tion

(‘000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 36 NA NA 15 41.48 60.0 20.0 NA 0.0 0.00

1984 0

1985 39 NA NA 9 22.93 55.6 11.1 NA 22.2 50.96

1986 41 NA NA 11 26.94 45.5 27.3 NA 0.0 0.00

1987 42 NA NA 13 30.62 30.8 23.1 NA 7.7 23.56

1988 44 NA NA 7 15.89 NA NA NA NA NA

1989 46 NA NA 6 13.16 83.3 0.0 NA 33.3 43.87

1990 47 62 13.18 9 19.13 88.9 11.1 NA 0.0 0.00

1991 48 49 10.13 9 18.60 88.9 0.0 NA 0.0 0.00

1992 50 NA NA 7 14.10 28.6 14.3 NA 0.0 0.00

1993 51 21 4.13 4 7.88 100.0 0.0 NA 0.0 0.00

1994

1995 53 13 2.46 4 7.56 50.0 0.0 NA 0.0 0.00

1996 54 7 1.30 3 5.57 66.7 0.0 NA 0.0 0.00

1997 55 8 1.46 6 10.94 83.3 33.3 NA 0.0 0.00

1998 56 8 1.44 6 10.76 83.3 0.0 NA 0.0 0.00

1999 57 9 1.59 10 17.65 50.0 20.0 NA 0.0 0.00

2000 58 10 1.74 2 3.47 100.0 50.0 NA 0.0 0.00

2001 59 8 1.36 5 8.53 100.0 0.0 NA 0.0 0.00

2002 60 6 1.01 0 0.00 NA NA NA NA 0.00

2003 61 8 1.32 2 3.29 50.0 50.0 NA 0.0 0.00

2004 62 4 0.65 3 4.85 66.7 0.0 NA 0.0 0.00

2005 0

2006 64 6 0.94 6 9.37 NA NA NA NA NA

2007

2008

2009 67 16 2.38 3 4.46 100.0 0.0 33.3 0.0 0.00

2010 68 6 0.88 0 0.00 NA Inf Inf NA 0.00

2011 70 8 1.15 4 5.75 100.0 0.0 25.0 0.0 0.00

2012 71 14 1.98 8 11.32 100.0 0.0 12.5 0.0 0.00

2013 72 5 0.70 1 1.39 0.0 0.0 0.0 100.0 13.92

2014 73 6 0.82 4 5.48 100.0 25.0 50.0 0.0 0.00

2015

2016 56 7 1.26 7 12.58 100.0 14.3 42.9 0.0 0.00

2017 56 0 0.00 0 0.00 NA NA NA NA 0.00

2018 55 8 1.44 3 5.41 100.0 33.3 33.3 0.0 0.00

28


AUSTRALIA

Population

24 898 152 (2018)

Background

• Cases have been treated with MDT since 1982. • Locally acquired infections are uncommon and have mostly affected the indigenous population. • The majority of Australia’s leprosy notifications are acquired overseas in leprosy-endemic regions. • There is no national control policy and no national register. However, leprosy is a notifiable

disease in Australia, and the Australian Government holds a national register of all new cases for surveillance purposes only.

• Case finding is mainly passive, with occasional community surveys in endemic pockets and contract surveys.

Elimination target

• Australia has already achieved the elimination targets but continues to record a small number of cases each year, mostly in migrants who initially acquired their infection overseas in a leprosy-endemic region.

Epidemiology

• The number of new cases reported annually has slightly increased from 2010 to 2018 as compared to 2000 to 2009, although the reporting is incomplete.

• The new case detection rate has been stable, being lower than 0.1 per 100 000 population since 1990.


• Not applicable.

29

Part II. Country ProfIles : australIa

Leprosy profile in Australia

Exponential fit: Recent annual change: 1.6 %

Adult Child


Others With Grade 2 disability

0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

0

10

20

30

40

0

10

20

30

40

0.00

0.05

0.10

0.15

0.20

05

1015202530

05

1015202530

020406080

100

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)



Number of child cases

Proportion of child cases

Proportion of female cases

Number of cases with Grade 2 disability

New cases with Grade 2 disability (Rate)

Proportion of cases with Grade 2 disability

Leprosy profile in Australia

30


Leprosy indicators in Australia

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1984 15 549 NA NA 28 0.18 NA NA NA NA NA

1985 15 791 NA NA 38 0.24 NA NA NA NA NA

1986 16 047 NA NA 27 0.17 NA NA NA NA NA

1987 16 315 NA NA 30 0.18 NA NA NA NA NA

1988 16 586 NA NA 20 0.12 NA NA NA NA NA

1989

1990 17 096 62 0.04 16 0.09 NA NA NA NA NA

1991

1992

1993

1994 17 922 10 0.01 0 0.00 NA NA NA NA NA

1995 18 118 9 0.00 7 0.04 NA NA 14.3 NA NA

1996 18 320 NA NA 11 0.06 NA NA 18.2 NA NA

1997 18 525 NA NA 15 0.08 NA 20.0 26.7 NA NA

1998 18 735 11 0.01 2 0.01 NA NA NA NA NA

1999 18 948 5 0.00 6 0.03 NA NA 16.7 NA NA

2000 19 164 0 0.00 5 0.03 60.0 NA 80.0 NA NA

2001 19 382 NA NA 4 0.02 NA 25.0 NA NA NA

2002 19 604 0 0.00 8 0.04 12.5 0.0 37.5 0.0 0.00

2003 19 840 0 0.00 9 0.05 22.2 0.0 66.7 11.1 0.05

2004 20 104 0 0.00 6 0.03 66.7 0.0 66.7 16.7 0.05

2005 20 404 NA NA 10 0.05 NA NA 60.0 NA NA

2006 20 744 NA NA 9 0.04 NA 11.1 77.8 NA NA

2007 21 120 NA NA 13 0.06 53.8 0.0 23.1 15.4 0.09

2008 21 514 0 0.00 11 0.05 9.1 0.0 27.3 9.1 0.05

2009 21 902 NA NA 5 0.02 80.0 20.0 60.0 20.0 0.05

2010 22 268 NA NA 10 0.04 80.0 10.0 20.0 20.0 0.09

2011 22 606 NA NA 9 0.04 77.8 0.0 33.3 22.2 0.09

2012 22 919 NA NA 8 0.03 50.0 0.0 25.0 25.0 0.09

2013 23 214 NA NA 14 0.06 71.4 0.0 42.9 7.1 0.04

2014 23 503 NA NA 9 0.04 77.8 0.0 44.4 11.1 0.04

2015 23 793 0 0.00 13 0.05 30.8 0.0 38.5 15.4 0.08

2016 24 263 19 0.01 19 0.08 79.0 0.0 15.8 21.1 0.16

2017 24 585 20 0.01 10 0.04 70.0 0.0 10.0 20.0 0.08

2018 24 898 11 0.00 6 0.02 100.0 0.0 50.0 0.0 0.00

31

Part II. Country ProfIles : BruneI darussalam

BRUNEI DARUSSALAM

Population

428 963 (2018)

Background

• Leprosy is not a public health problem. However, since 1985, a few cases have been reported almost every year.

• The case finding strategy is passive. • Clinical management has been provided by the Dermatology Department, and public health

management has been provided by the Disease Control Division.

Elimination target

• Not applicable

Epidemiology

• The prevalence rate has been less than 0.21 per 10 000 population since 1986. • The number of new cases has been reported as less than four since 1986. • No child cases or cases with Grade 2 disability have ever been reported.


• Not applicable.

32


Leprosy profile in Brunei Darussalam

Adult Child



0.00.20.40.60.81.0

0.0

0.5

1.0

1.5

0.0

0.5

1.0

1.5

050

100150200250

0

1

2

3

4

0

1

2

3

4

0.000.020.040.060.080.10

02468

10

02468

10

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)









33

Part II. Country ProfIles : BruneI darussalam

Leprosy indicators in Brunei Darussalam

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1986 229 3 0.13 1 0.44 NA NA NA NA NA

1987

1988

1989

1990 252 3 0.12 0 0.00 NA NA NA NA NA

1991

1992

1993 274 3 0.11 4 1.46 50.0 NA NA NA NA

1994 282 6 0.21 4 1.42 100.0 0.0 NA 0.0 0.00

1995 290 6 0.21 1 0.35 100.0 NA 100.0 NA NA

1996 297 3 0.10 1 0.34 0.0 0.0 NA 0.0 0.00

1997 305 6 0.20 1 0.33 200.0 0.0 NA 0.0 0.00

1998

1999 320 1 0.03 1 0.31 100.0 0.0 NA 0.0 0.00

2000 327 0 0.00 0 0.00 NA NA NA NA 0.00

2001 334 5 0.15 4 1.20 125.0 0.0 25.0 0.0 0.00

2002 342 1 0.03 1 0.29 NA 0.0 0.0 0.0 0.00

2003 349 2 0.06 2 0.57 0.0 0.0 50.0 0.0 0.00

2004

2005 363 1 0.03 3 0.83 NA NA 33.3 NA NA

2006

2007

2008 385 0 0.00 2 0.52 100.0 0.0 50.0 0.0 0.00

2009 392 2 0.05 2 0.51 100.0 0.0 0.0 0.0 0.00

2010 399 3 0.08 3 0.75 100.0 0.0 33.3 0.0 0.00

2011 406 2 0.05 0 0.00 NA NA NA NA 0.00

2012 413 1 0.02 2 0.48 100.0 0.0 0.0 0.0 0.00

2013 420 1 0.02 0 0.00 NA NA NA NA 0.00

2014 427 0 0.00 1 0.23 100.0 0.0 0.0 0.0 0.00

2015 433 0 0.00 0 0.00 NA NA NA NA 0.00

2016 420 0 0.00 0 0.00 NA NA NA NA 0.00

2017 424 0 0.00 2 0.46 100.0 0.0 0.0 0.0 0.00

2018 429 1 0.02 1 0.23 100.0 0.0 0.0 0.0 0.00

34


CAMBODIA

Population

16 249 792 (2018)

Background

• Leprosy has been endemic for many decades. There was an estimated backlog of 10 000 cases in 1995. However, most of the backlog and new cases that were detected were treated by 1998.

• MDT treatment has been used since 1984. • Case detection activities were intensified from 1995 through special projects such as leprosy

elimination campaigns (LECs) and special action projects for elimination of leprosy (SAPELs) covering the whole country.

• Leprosy control activities were integrated with the National Tuberculosis Control Programme in 1996.

• Contact tracing, along with an information, education and communication (IEC) campaign was conducted during from 2011 to 2018.

Elimination target

• Achieved by the end of 1998 with a prevalence rate of 0.86 per 10 000 population at the national level.

• Subnational elimination was achieved in all the provinces except two by the end of 2001. • District-level elimination is within grasp.

Epidemiology

• Prevalence and new case detection rates increased steeply from 1993 to 1997 corresponding to the intensified case finding activities.

• After the period of intensified activities, prevalence and new case detection rates sharply dropped over a few years and now show a gradual declining trend without any notable increase.

• The proportion of child cases among total cases has been stable at around 10% since 1993. • The proportion of cases with Grade 2 disability was highest in 1993 at 24.6%, and they have been

declining.


• A pilot post-elimination surveillance system based on the protocol developed by the WHO Regional Office for the Western Pacific has been operating in selected provinces since 2000.

• IEC activities are being carried out, including refresher training, intensified case detection activities in high-endemic pockets, prevention and management of disabilities, and the use of geographic information systems.

35

Part II. Country ProfIles : CamBodIa

Leprosy profile in Cambodia


Adult Child



0.00.51.01.52.02.53.0

05

10152025

05

10152025

020406080

100

0500

1000150020002500

0500

1000150020002500

01020304050

0

5

10

15

20

05

1015202530

01020304050

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target



Number of cases with Grade 2 disability Number of child cases

New cases with Grade 2 disability (Rate) Proportion of child cases

Proportion of cases with Grade 2 disability Proportion of female cases

36


Leprosy indicators in Cambodia

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1985 7 743 649 0.84 704 9.09 NA NA NA NA NA

1986 7 990 742 0.93 549 6.87 NA NA NA NA NA

1987 8 228 1 145 1.39 545 6.62 78.2 9.0 NA 17.1 11.30

1988 8 467 1 334 1.58 706 8.34 NA NA NA NA NA

1989 8 724 1 170 1.34 789 9.04 NA NA NA NA NA

1990 9 532 1 728 1.81 581 6.10 74.5 9.3 NA 14.5 8.81

1991 9 868 1 669 1.69 415 4.21 63.6 7.2 NA 13.5 5.67

1992 10 206 1 627 1.59 617 6.05 62.1 17.7 NA 10.5 6.37

1993 10 539 2 038 1.93 945 8.97 64.6 NA NA 24.6 22.01

1994 10 862 2 461 2.27 1 644 15.14 55.4 9.0 NA 20.7 31.30

1995 11 169 2 886 2.58 2 219 19.87 54.3 9.6 NA 20.9 41.54

1996 11 459 2 960 2.58 2 404 20.98 50.1 10.8 NA 16.4 34.47

1997 11 731 1 921 1.64 2 438 20.78 51.8 11.0 NA 17.0 35.38

1998 11 986 984 0.82 1 609 13.42 49.0 9.5 NA 9.1 12.18

1999 12 224 584 0.48 790 6.46 53.5 13.3 NA 9.7 6.30

2000 12 447 582 0.47 747 6.00 66.7 10.4 NA 8.2 4.90

2001 12 654 526 0.42 634 5.01 62.8 11.2 29.7 8.2 4.11

2002 12 845 588 0.46 740 5.76 66.1 8.5 25.0 8.2 4.75

2003 13 024 409 0.31 509 3.91 68.4 9.2 26.5 14.5 5.68

2004 13 194 370 0.28 460 3.49 68.3 11.1 30.7 14.8 5.15

2005 13 358 348 0.26 429 3.21 69.7 9.1 28.2 14.5 4.64

2006 13 516 305 0.23 376 2.78 74.2 9.8 27.9 16.0 4.44

2007 13 670 257 0.19 315 2.30 67.3 7.9 28.3 11.4 2.63

2008 13 823 242 0.18 306 2.21 71.6 6.9 27.8 13.1 2.89

2009 13 978 283 0.20 351 2.51 69.5 7.7 29.9 10.3 2.58

2010 14 138 236 0.17 262 1.85 70.6 8.4 21.4 9.9 1.84

2011 14 305 255 0.18 314 2.20 59.6 8.3 30.3 6.1 1.33

2012 14 478 353 0.24 475 3.28 54.5 9.7 39.8 9.7 3.18

2013 14 656 284 0.19 373 2.55 52.3 8.6 30.8 4.6 1.16

2014 14 836 284 0.19 310 2.09 38.7 6.1 25.8 2.3 0.47

2015 0

2016 15 766 0 0.00 154 0.96 69.5 7.8 22.7 19.5 1.87

2017 16 009 120 0.07 137 0.84 56.9 4.4 30.7 13.1 1.11

2018 16 250 70 0.04 151 0.93 56.3 9.3 39.7 14.6 1.35

37

Part II. Country ProfIles : ChIna

CHINA

Population

1 427 647 786 (2018)

Background

• Leprosy has long been endemic – in 1950 there were an estimated 500 000 cases. • Leprosy services have been delivered under various models, including ones combined with

dermatology, integrated with the general health system or combined with tuberculosis (TB), sexually transmitted infections and HIV services.

• MDT was introduced in 1982 in Yangzhou Prefecture in Jiangsu Province and in Sichuan and Yunnan provinces. MDT was introduced in 1985, and nationwide implementation began in 1987.

• Tremendous progress has been made in bringing the disease under control, and the problem is now limited to a few pockets in several provinces of south-west China.

• Case finding is passive in eastern China at general hospital skin clinics or dermatology departments, but in some counties in south-west China where leprosy is more prevalent, active case finding has been performed in rural areas.

Elimination target

• Leprosy has been eliminated as a public health problem. The national-level elimination target was met in 1982. Subnational elimination was accomplished at the provincial, municipal and autonomous region level by 1992.

• At the end of 2000, the prevalence rate exceeded 1 per 10 000 population in 48 counties (out of some 2500 counties) in Hunan, Sichuan, Tibet and Yunnan provinces. By the end of 2014, only nine counties in Sichuan and Yunnan had a prevalence rate of more than 1 per 10 000 population.

Epidemiology

• The prevalence rate has decreased considerably in the late 1980s and early 1990s, and it has been less than 0.1 per 10 000 population since 1992.

• The number of new cases has declined over the last three decades, falling from nearly 5 000 cases in 1986 to less than 1 000 cases since 2013. Accordingly, the new case detection rate decreased from 0.5 to less than 0.1 per 100 000 population in the same period.

• The proportion of MB cases among total cases has increased over the years, while the proportion of cases with Grade 2 disability has remained stable at around 20%.


• Efforts are being made to eliminate remaining pockets of infection located mostly in hard-to-access areas and communities, through special campaigns.

• There are an estimated 120 000 individuals disabled due to leprosy and efforts are being made to rehabilitate them.

• The programme has emphasized the maintenance of leprosy expertise both at the national and subnational levels.

38


Leprosy profile in China


Adult Child



0.00.20.40.60.81.01.2

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

010002000300040005000

010002000300040005000

0.0

0.2

0.4

0.6

02468

10

0

10

20

30

010203040

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









39

Part II. Country ProfIles : ChIna

Leprosy indicators in China

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1985 1 052 622 100 000 0.95 NA NA

1986 1 071 835 NA NA 4 945 0.46 NA NA NA NA NA

1987 1 092 647 70 000 0.64 4 042 0.37 57.0 NA NA NA NA

1988 1 114 162 55 240 0.50 3 837 0.34 60.0 NA NA NA NA

1989 1 135 128 40 000 0.35 3 303 0.29 74.0 3.0 NA NA NA

1990 1 145 195 30 000 0.26 3 345 0.29 63.0 NA NA NA NA

1991 1 160 800 20 003 0.17 3 400 0.29 53.0 3.0 NA NA NA

1992 1 175 230 8 460 0.07 2 728 0.23 57.0 3.0 NA NA NA

1993 1 188 688 6 055 0.05 2 191 0.18 66.0 3.0 NA 24.0 0.56

1994 1 201 523 5 655 0.05 2 109 0.18 66.0 3.0 NA 24.0 0.44

1995 1 213 987 4 833 0.04 1 895 0.16 69.0 3.0 NA 21.0 0.37

1996 1 226 134 4 474 0.04 1 845 0.15 68.0 3.0 NA 23.4 0.36

1997 1 237 850 4 045 0.03 1 854 0.15 69.2 3.4 NA 10.4 0.16

1998 1 249 020 4 087 0.03 2 051 0.16 81.3 4.3 NA 21.3 0.32

1999 1 259 477 4 029 0.03 1 692 0.13 77.8 5.4 NA 20.5 0.34

2000 1 269 117 3 646 0.03 1 603 0.13 79.6 3.4 NA 22.0 0.30

2001 1 277 904 3 510 0.03 1 726 0.14 82.3 3.6 NA 21.1 0.27

2002 1 285 934 3 263 0.03 1 646 0.13 87.5 2.7 NA 23.4 0.30

2003 1 293 397 3 261 0.03 1 404 0.11 86.5 3.1 NA 21.2 0.23

2004 1 300 552 3 203 0.02 1 499 0.12 87.9 3.1 32.4 23.5 0.27

2005 1 307 593 3 171 0.02 1 658 0.13 89.1 2.1 30.8 21.3 0.27

2006 1 314 581 3 264 0.02 1 516 0.12 87.9 2.8 33.4 22.8 0.26

2007 1 321 482 3 196 0.02 1 526 0.12 84.9 2.2 32.2 22.7 0.26

2008 1 328 276 3 388 0.03 1 614 0.12 86.9 2.5 30.2 22.1 0.27

2009 1 334 909 3 332 0.02 1 597 0.12 84.3 2.4 32.0 22.8 0.27

2010 1 341 335 2 886 0.02 1 324 0.10 84.9 2.9 31.6 22.5 0.22

2011 1 347 565 2 468 0.02 1 144 0.08 82.3 2.5 31.9 27.0 0.23

2012 1 353 601 2 331 0.02 1 206 0.09 80.8 2.4 29.8 28.7 0.26

2013 1 359 368 1 908 0.01 924 0.07 86.6 1.5 33.3 20.3 0.14

2014 1 364 773 1 601 0.01 823 0.06 88.5 1.7 32.0 20.0 0.12

2015 1 369 743 1 353 0.01 678 0.05 88.2 2.9 30.1 18.6 0.09

2016 1 414 049 0 0.00 672 0.05 89.0 2.8 32.0 22.0 0.11

2017 1 421 022 1 177 0.01 634 0.04 91.8 1.4 34.2 20.0 0.09

2018 1 427 648 970 0.01 521 0.04 89.4 1.3 36.9 19.0 0.07

40


CHINA, HONG KONG SAR

Population

7 371 730 (2018)

Background

• The programme is part of the Social Hygiene Service of the Department of Health. • Leprosy cases are mainly managed as outpatients with MDT. No other treatment regimens are

used currently. • Contacts of new cases are screened after voluntary referral by the index case. • Treatment is free of charge and cases include active as well as treated cases. • New cases of leprosy detected by other units are also referred to the unit. • There is a call-back system for leprosy patients who fall outside the follow-up.

Elimination target

• Leprosy is no longer a public health problem.

Epidemiology

• Both the prevalence and new case detection rate have been low since 1991. • The number of new cases has gradually decreased over time. However, three to seven new cases

have been reported every year since 2002. • New cases are mainly foreign-origin cases from Asian countries such as China, Indonesia, Nepal

and the Philippines.


• Nothing specific.

41

Part II. Country ProfIles : ChIna, hong Kong sar

Leprosy profile in China, Hong Kong SAR


Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

0

10

20

30

40

0

10

20

30

40

0.00.20.40.60.81.0

02468

1012

01020304050

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)









42


Leprosy indicators in China, Hong Kong SAR

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 5 291 NA NA 38 0.72 71.1 NA NA NA NA

1984 5 350 NA NA 32 0.60 40.6 NA NA NA NA

1985 5 415 NA NA 32 0.59 59.4 NA NA NA NA

1986 5 487 NA NA 29 0.53 51.7 NA NA NA NA

1987 5 565 NA NA 21 0.38 52.4 NA NA NA NA

1988 5 645 NA NA 22 0.39 63.6 NA NA NA NA

1989 5 722 NA NA 26 0.45 84.6 NA NA NA NA

1990 5 794 NA NA 31 0.54 54.8 NA NA NA NA

1991 5 857 65 0.11 26 0.44 69.2 NA NA NA NA

1992 5 914 47 0.08 20 0.34 65.0 NA NA 20.0 0.68

1993 5 974 NA NA 31 0.52 74.2 0.0 45.2 NA NA

1994 6 048 NA NA 21 0.35 61.9 4.8 38.1 NA NA

1995 6 144 NA NA 15 0.24 80.0 6.7 40.0 33.3 0.81

1996 6 268 44 0.07 8 0.13 50.0 0.0 50.0 12.5 0.16

1997 6 414 54 0.08 11 0.17 27.3 0.0 36.4 0.0 0.00

1998 6 564 56 0.09 11 0.17 81.8 0.0 72.7 9.1 0.15

1999 6 693 33 0.05 14 0.21 42.9 0.0 21.4 0.0 0.00

2000 6 783 36 0.05 11 0.16 54.5 0.0 36.4 0.0 0.00

2001 6 829 37 0.05 10 0.15 40.0 10.0 20.0 30.0 0.44

2002 6 837 39 0.06 6 0.09 66.7 0.0 66.7 16.7 0.15

2003 6 822 38 0.06 7 0.10 42.9 0.0 71.4 14.3 0.15

2004 6 808 36 0.05 6 0.09 83.3 0.0 33.3 16.7 0.15

2005 6 810 32 0.05 4 0.06 100.0 0.0 75.0 0.0 0.00

2006 6 833 30 0.04 6 0.09 100.0 0.0 50.0 16.7 0.15

2007 6 873 28 0.04 2 0.03 0.0 0.0 50.0 0.0 0.00

2008 6 926 24 0.03 5 0.07 40.0 0.0 20.0 0.0 0.00

2009 6 988 19 0.03 4 0.06 40.0 0.0 20.0 0.0 0.00

2010 7 053 20 0.03 3 0.04 100.0 0.0 100.0 0.0 0.00

2011 7 122 20 0.03 6 0.08 100.0 0.0 50.0 33.3 0.28

2012 7 196 15 0.02 4 0.06 100.0 0.0 100.0 0.0 0.00

2013 7 274 17 0.02 5 0.07 100.0 0.0 60.0 40.0 0.27

2014 7 353 16 0.02 7 0.10 100.0 0.0 42.9 14.3 0.14

2015 7 431 12 0.02 2 0.03 100.0 0.0 100.0 0.0 0.00

2016 7 244 14 0.02 3 0.04 100.0 0.0 100.0 0.0 0.00

2017 7 306 10 0.01 3 0.04 100.0 0.0 33.3 0.0 0.00

2018 7 372 9 0.01 5 0.07 80.0 0.0 100.0 0.0 0.00

43

Part II. Country ProfIles : ChIna, maCao sar

CHINA, MACAO SAR

Population

631 636 (2018)

Background

• Very few cases are still reported. • The case finding strategy is passive. • Leprosy has been a disease notifiable to the Health Bureau under the law since 1987. • The Government is responsible for providing treatment of leprosy.

Elimination target

• Leprosy is not a public health problem.

Epidemiology

• The prevalence rate below the elimination level (1 per 10 000 population) has been maintained for all reporting years, but new cases are still reported sporadically.


• Not applicable.

44


Leprosy profile in China, Macao SAR

Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

0.0

0.5

1.0

1.5

2.0

0.0

0.5

1.0

1.5

2.0

0.00.51.01.52.02.5

02468

10

020406080

100120

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









45

Part II. Country ProfIles : ChIna, maCao sar

Leprosy indicators in China, Macao SAR

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1991 369 18 0.49 2 0.54 NA NA NA NA NA

1992 378 25 0.66 2 0.53 50.0 NA NA NA NA

1993 385 13 0.34 1 0.26 NA NA NA NA NA

1994

1995 398 7 0.18 0 0.00 NA NA NA NA NA

1996

1997

1998 417 0 0.00 0 0.00 NA NA NA NA NA

1999 424 2 0.05 2 0.47 50.0 0.0 50.0 0.0 0.00

2000 432 1 0.02 1 0.23 0.0 0.0 0.0 0.0 0.00

2001 440 0 0.00 0 0.00 NA NA NA NA 0.00

2002 449 0 0.00 0 0.00 NA NA NA NA 0.00

2003 459 1 0.02 1 0.22 100.0 0.0 100.0 100.0 2.18

2004 470 2 0.04 2 0.43 0.0 0.0 100.0 0.0 0.00

2005 481 0 0.00 0 0.00 NA NA NA NA 0.00

2006 493 0 0.00 0 0.00 NA NA NA NA 0.00

2007 506 0 0.00 0 0.00 NA NA NA NA 0.00

2008 518 1 0.02 1 0.19 100.0 0.0 100.0 0.0 0.00

2009 531 0 0.00 0 0.00 NA NA NA NA 0.00

2010 544 0 0.00 0 0.00 NA NA NA NA 0.00

2011 556 0 0.00 0 0.00 NA NA NA NA 0.00

2012 567 0 0.00 0 0.00 NA NA NA NA 0.00

2013 579 1 0.02 1 0.17 100.0 0.0 0.0 0.0 0.00

2014 590 0 0.00 0 0.00 NA NA NA NA 0.00

2015 601 1 0.02 1 0.17 100.0 0.0 100.0 0.0 0.00

2016 613 4 0.06 2 0.32 50.0 0.0 0.0 0.0 0.00

2017 623 3 0.05 0 0.00 NA NA NA NA 0.00

2018 632 1 0.02 0 0.00 NA NA NA NA 0.00

46


COOK ISLANDS

Population

17 518 (2018)

Background

• There were few new cases from 1988 to 1995. • MDT has been used since 1986. • Leprosy services are fully integrated with general health services. • Case finding is mainly passive and through school surveys.

Elimination target

• Leprosy is not a public health problem.

Epidemiology

• New cases had been reported sporadically until 1995. • Since 1997, no new cases have been reported.


• Not applicable.

47

Part II. Country ProfIles : CooK Islands

Leprosy profile in Cook Islands

Adult Child



02468

1012

0

10

20

30

40

0

10

20

30

40

0102030405060

0123456

0123456

0.000.020.040.060.080.10

02468

10

02468

10

02468

10

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









48


Leprosy indicators in Cook Islands

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1986 18 15 8.46 NA NA NA NA NA NA NA

1987 18 16 9.05 NA NA NA NA NA NA NA

1988 18 NA NA 6 34.07 NA NA NA NA NA

1989

1990 18 0 0.00 0 0.00 NA NA NA NA NA

1991 18 2 1.13 2 11.28 0.0 0.0 NA 0.0 0.00

1992 18 0 0.00 0 0.00 NA NA NA NA NA

1993 18 0 0.00 0 0.00 NA NA NA NA NA

1994 18 0 0.00 0 0.00 NA NA NA NA NA

1995 18 1 0.55 2 10.93 50.0 0.0 NA 0.0 0.00

1996

1997 18 0 0.00 0 0.00 NA NA NA NA NA

1998 18 1 0.56 0 0.00 NA NA NA NA NA

1999 18 0 0.00 0 0.00 NA NA NA NA NA

2000 18 0 0.00 0 0.00 NA NA NA NA NA

2001 18 0 0.00 0 0.00 NA NA NA NA NA

2002 18 0 0.00 0 0.00 NA NA NA NA 0.00

2003 19 0 0.00 0 0.00 NA NA NA NA 0.00

2004 19 0 0.00 0 0.00 NA NA NA NA 0.00

2005 19 0 0.00 0 0.00 NA NA NA NA 0.00

2006 20 0 0.00 0 0.00 NA NA NA NA NA

2007 20 0 0.00 0 0.00 NA NA NA NA NA

2008 20 0 0.00 0 0.00 NA NA NA NA 0.00

2009 20 0 0.00 0 0.00 NA NA NA NA 0.00

2010 20 0 0.00 0 0.00 NA NA NA NA 0.00

2011 20 0 0.00 0 0.00 NA NA NA NA 0.00

2012 21 0 0.00 0 0.00 NA NA NA NA 0.00

2013 21 0 0.00 0 0.00 NA NA NA NA 0.00

2014 21 0 0.00 0 0.00 NA NA NA NA 0.00

2015

2016 18 0 0.00 0 0.00 NA NA NA NA 0.00

2017 18 0 0.00 0 0.00 NA NA NA NA 0.00

2018 18 0 0.00 0 0.00 NA NA NA NA 0.00

49

Part II. Country ProfIles : fIjI

FIJI

Population

883 483 (2018)

Background

• Leprosy has been prevalent for many years. • Control programmes were integrated within a central unit, including a clinic for leprosy cases at

Twomey Memorial Hospital that also served as regional training centre for leprosy for the South Pacific region.

• MDT has been used since 1983. • School surveys are carried out on a regular basis for case finding.

Elimination target

• Reached in 1992 and sustained for more than 20 years.

Epidemiology

• Both prevalence and new case detection rates fell sharply in the 1980s. • The prevalence rate has been below elimination level since 1992. • Between 2004 and 2018, a total of 24 new cases were reported. Of them, 18 (75%) were MB cases.


• Known pockets of endemicity are being monitored. • IEC activities are carried out to sustain leprosy awareness in the community and among health

staff.

50


Leprosy profile in Fiji


Adult Child



0

2

4

6

8

01234567

0123456

020406080

100120

0

10

20

30

0

10

20

30

02468

1012

0102030405060

020406080

100

0102030405060

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









51

Part II. Country ProfIles : fIjI

Leprosy indicators in Fiji

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 685 455 6.64 36 5.25 47.2 16.7 NA NA NA

1984 700 444 6.34 25 3.57 52.0 8.0 NA NA NA

1985 712 367 5.16 22 3.09 54.5 13.6 NA NA NA

1986 719 283 3.94 20 2.78 20.0 20.0 NA NA NA

1987 722 243 3.37 19 2.63 68.4 15.8 NA NA NA

1988 723 204 2.82 17 2.35 70.6 23.5 NA NA NA

1989 725 147 2.03 16 2.21 81.3 NA NA NA NA

1990

1991 735 86 1.17 6 0.82 50.0 NA NA NA NA

1992 744 49 0.66 11 1.48 54.5 NA NA NA NA

1993 755 39 0.52 7 0.93 57.1 NA NA NA NA

1994 766 39 0.51 9 1.18 55.6 11.1 NA 77.8 9.14

1995 776 24 0.31 6 0.77 33.3 NA NA NA NA

1996 785 17 0.22 6 0.76 50.0 0.0 NA 0.0 0.00

1997 793 13 0.16 8 1.01 100.0 NA NA 12.5 1.26

1998 801 12 0.15 7 0.87 71.4 0.0 NA 0.0 0.00

1999 807 7 0.09 7 0.87 100.0 0.0 NA 14.3 1.24

2000 812 7 0.09 9 1.11 66.7 11.1 NA NA NA

2001 815 6 0.07 6 0.74 83.3 0.0 NA 0.0 0.00

2002 816 2 0.02 4 0.49 0.0 25.0 NA 0.0 0.00

2003 817 2 0.02 2 0.24 50.0 50.0 NA 0.0 0.00

2004 819 4 0.05 3 0.37 33.3 0.0 NA 0.0 0.00

2005 823 5 0.06 4 0.49 75.0 25.0 NA 0.0 0.00

2006 828 3 0.04 4 0.48 NA NA NA NA NA

2007 835 9 0.11 6 0.72 NA NA NA NA NA

2008 844 7 0.08 4 0.47 0.0 0.0 50.0 0.0 0.00

2009 852 2 0.02 2 0.23 100.0 0.0 0.0 0.0 0.00

2010 861 6 0.07 2 0.23 100.0 0.0 0.0 0.0 0.00

2011 868 NA NA 4 0.46 100.0 25.0 NA NA NA

2012 876 3 0.03 3 0.34 100.0 0.0 33.3 0.0 0.00

2013 883 8 0.09 6 0.68 100.0 0.0 33.3 0.0 0.00

2014 890 7 0.08 5 0.56 60.0 0.0 40.0 20.0 1.12

2015 896 3 0.03 3 0.33 66.7 0.0 33.3 66.7 2.23

2016 872 3 0.03 3 0.33 100.0 0.0 0.0 33.3 1.10

2017 877 4 0.04 4 0.44 75.0 25.0 0.0 75.0 3.29

2018 883 9 0.10 9 1.02 77.8 11.1 11.1 22.2 2.26

52


FRENCH POLYNESIA

Population

277 679 (2018)

Background

• In the 1940s, the disease was highly endemic with prevalence rates of about 24 per 10 000 population.

• The programme was mainly vertical, with a central leprosy unit. • Modified MDT has been used since 1982, with daily rifampicin doses both for PB and MB with a

fixed duration regimen. • Case finding is mainly passive, while active case finding is systematically performed in contacts of

known cases.

Elimination target

• Data on prevalent cases have been available since 1991 when leprosy was already eliminated as a public health problem. This has been sustained for more than 20 years.

Epidemiology

• The number and rate of new cases detected have declined over the last three decades, with some fluctuations.

• The prevalence rate has been below elimination level for more than two decades.


• Nothing specific was implemented, except close monitoring of the situation and management of the few new cases.

53

Part II. Country ProfIles : frenCh PolynesIa

Leprosy profile in French Polynesia

Adult Child



0.00.20.40.60.81.0

0

5

10

15

0

5

10

15

020406080

100120

05

10152025

05

10152025

05

101520

01020304050

020406080

100120

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









54


Leprosy indicators in French Polynesia

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 166 NA NA 24 14.49 37.5 12.5 NA 12.5 18.11

1984 170 NA NA 12 7.04 33.3 16.7 NA 8.3 5.87

1985 175 NA NA 11 6.28 0.0 27.3 NA 0.0 0.00

1986 180 NA NA 14 7.77 42.9 21.4 NA 7.1 5.55

1987 185 NA NA 19 10.27 26.3 42.1 NA 10.5 10.81

1988 190 NA NA 10 5.27 60.0 20.0 NA 10.0 5.27

1989 194 NA NA 3 1.54 0.0 0.0 NA 33.3 5.15

1990 195 NA NA 8 4.09 37.5 12.5 NA 25.0 10.24

1991 199 9 0.45 5 2.51 60.0 0.0 NA 60.0 15.04

1992 203 18 0.88 12 5.90 33.3 33.3 NA 8.3 4.91

1993 207 18 0.87 7 3.37 42.9 14.3 NA 28.6 9.64

1994 212 11 0.52 9 4.25 55.6 22.2 NA 0.0 0.00

1995 216 12 0.56 6 2.78 83.3 33.3 NA 0.0 0.00

1996 220 14 0.64 6 2.73 100.0 33.3 NA 0.0 0.00

1997 225 13 0.58 5 2.23 20.0 0.0 NA 0.0 0.00

1998 229 11 0.48 7 3.05 85.7 0.0 NA 28.6 8.73

1999 234 10 0.43 3 1.28 66.7 0.0 NA 33.3 4.28

2000 238 16 0.67 5 2.10 20.0 20.0 NA 0.0 0.00

2001 241 6 0.25 4 1.66 75.0 0.0 NA 100.0 16.57

2002 245 17 0.69 11 4.49 90.9 0.0 NA 0.0 0.00

2003 248 17 0.68 11 4.43 NA NA NA NA NA

2004 252 17 0.68 11 4.37 NA NA NA NA NA

2005 255 16 0.63 10 3.92 50.0 0.0 NA 0.0 0.00

2006 258 15 0.58 8 3.10 NA NA NA NA NA

2007

2008 265 6 0.23 5 1.89 40.0 20.0 60.0 20.0 3.78

2009 268 10 0.37 9 3.36 77.8 11.1 22.2 0.0 0.00

2010 271 18 0.66 6 2.22 50.0 0.0 100.0 0.0 0.00

2011

2012 277 14 0.51 3 1.08 0.0 33.3 0.0 33.3 3.61

2013

2014

2015

2016 275 8 0.28 2 0.71 0.0 0.0 50.0 50.0 3.53

2017 276 0 0.00 0 0.00 NA NA NA NA 0.00

2018 278 0 0.00 0 0.00 NA NA NA NA 0.00

55

Part II. Country ProfIles : guam

GUAM

Population

165 768 (2018)

Background

• New cases have been continuously reported since 1983. • MDT was introduced in 1988. • New leprosy cases are found mostly among migrants. There is an increasing proportion of cases

from the Federated States of Micronesia. • Case finding is mainly passive, but contacts of known cases are screened systematically.

Elimination target

• The elimination target was reached in 1994. However, prevalence rates of more than 1 per 10 000 population have been sporadically reported.

Epidemiology

• The prevalence rate has fluctuated widely, reverting to the pre-elimination levels in 1997–1998 and again in 2008 and in 2013–2016.

• The number of new cases has increased in recent years, and the majority of them are MB cases, indicating the presence of infectious cases.


• Contacts of known leprosy cases have been screened systematically. • The areas where large migrant populations generally live have been surveyed and monitored. • IEC activities have been carried out to sustain leprosy awareness in the community. • Health staff have received refresher training.

56


Leprosy profile in Guam


Adult Child



0.0

0.5

1.0

1.5

2.0

0

5

10

15

0

5

10

15

020406080

100120

05

10152025

05

10152025

05

10152025

020406080

100120

0

10

20

30

40

0102030405060

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









57

Part II. Country ProfIles : guam

Leprosy indicators in Guam

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 111 NA NA 3 2.69 33.3 0.0 NA 33.3 8.98

1984

1985

1986 119 NA NA 4 3.35 50.0 0.0 NA 0.0 0.00

1987 122 NA NA 3 2.46 66.7 0.0 NA 0.0 0.00

1988 125 NA NA 4 3.21 75.0 0.0 NA 0.0 0.00

1989

1990 134 NA NA 2 1.49 100.0 0.0 NA 0.0 0.00

1991 137 20 1.47 5 3.66 80.0 0.0 NA 0.0 0.00

1992 139 23 1.65 7 5.04 71.4 14.3 NA 0.0 0.00

1993 141 24 1.70 4 2.83 100.0 25.0 NA 25.0 7.08

1994 143 10 0.70 6 4.18 83.3 NA NA NA NA

1995 146 8 0.55 6 4.12 50.0 NA NA NA NA

1996

1997 149 20 1.34 6 4.02 66.7 16.7 NA 0.0 0.00

1998 151 27 1.79 16 10.59 93.8 6.3 NA 0.0 0.00

1999 153 5 0.33 5 3.27 100.0 20.0 NA 0.0 0.00

2000 155 5 0.32 5 3.22 80.0 20.0 NA NA NA

2001 158 1 0.06 1 0.63 100.0 100.0 NA NA NA

2002

2003 163 1 0.06 1 0.61 NA NA NA NA NA

2004 166 1 0.06 1 0.60 100.0 0.0 NA 0.0 0.00

2005 169 9 0.53 6 3.56 100.0 16.7 NA 0.0 0.00

2006 171 3 0.18 3 1.75 NA NA NA NA NA

2007 173 8 0.46 6 3.46 NA NA NA NA NA

2008 176 16 0.91 13 7.41 92.3 23.1 38.5 7.7 5.70

2009 178 10 0.56 6 3.38 83.3 33.3 16.7 0.0 0.00

2010 180 14 0.78 10 5.56 100.0 20.0 20.0 0.0 0.00

2011 182 9 0.49 8 4.39 100.0 0.0 0.0 0.0 0.00

2012 184 11 0.60 10 5.42 100.0 20.0 50.0 10.0 5.42

2013 187 21 1.13 17 9.11 94.1 5.9 17.6 23.5 21.44

2014 189 30 1.59 19 10.06 94.7 15.8 15.8 10.5 10.59

2015 191 23 1.20 23 12.04 100.0 21.7 21.7 4.3 5.24

2016 163 16 0.97 16 9.74 100.0 6.3 50.0 0.0 0.00

2017 164 11 0.66 14 8.45 92.9 0.0 28.6 7.1 6.03

2018 166 6 0.36 8 4.83 100.0 12.5 12.5 0.0 0.00

58


JAPAN

Population

127 202 192 (2018)

Background

• Almost all leprosy patients were in sanatoria in the past. If physicians (mainly dermatologists) detected a case, they referred the person to a sanatorium.

• MDT was not implemented in the country as a public health measure because most of the patients were treated before the MDT period (dapsone single treatment).

• Presently, MDT is used for new leprosy patients (both from abroad and domestic). • At present there is no active survey, and all cases, both of foreign origin and domestic, are

passively detected. • School-based surveys were conducted in Okinawa (the southern islands of Japan) from 1967 to

1990.

Elimination target

• Leprosy has not been a public health problem. • Almost all leprosy patients were in the sanatoria under the Leprosy Prevention Law.

Epidemiology

• Both prevalence and new case detection rates have been kept low from the 1980s to date. • The number of new cases has decreased over time, although new cases have been still reported

(less than 10 cases since 2005). • Only a few new Japanese cases are registered. Most are residents of Okinawa, which was the last

pocket of leprosy in Japan, while others are imported cases from foreign countries. • No child cases have been reported for the last three decades, with the exception of 1 case in

1999.


• Nothing specific for case detections. • Training on leprosy is held annually, targeting dermatologists. • There have been support initiatives for former leprosy patients.

59

Part II. Country ProfIles : jaPan

Leprosy profile in Japan

Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

0

10

20

30

40

0

10

20

30

40

0.000.020.040.060.080.10

02468

10

0102030405060

0

20

40

60

80

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)









60


Leprosy indicators in Japan

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1984 119 319 NA NA 30 0.03 NA NA NA NA NA

1985 119 989 NA NA 42 0.04 NA NA NA NA NA

1986 120 551 NA NA 42 0.03 NA NA NA NA NA

1987 121 022 NA NA 15 0.01 NA NA NA NA NA

1988 121 433 NA NA 33 0.03 NA NA NA NA NA

1989 121 831 NA NA 26 0.02 NA NA NA NA NA

1990 122 251 NA NA 14 0.01 NA NA NA NA NA

1991 122 703 NA NA 17 0.01 NA NA NA NA NA

1992 123 178 NA NA 15 0.01 NA NA NA NA NA

1993 123 653 NA NA 18 0.01 50.0 0.0 11.1 NA NA

1994

1995

1996 124 815 NA NA 24 0.02 45.8 0.0 25.0 NA NA

1997

1998

1999 125 532 NA NA 19 0.02 63.2 5.3 31.6 21.1 0.03

2000 125 720 NA NA 14 0.01 57.1 0.0 50.0 0.0 0.00

2001 125 894 NA NA 13 0.01 53.8 0.0 38.5 15.4 0.02

2002

2003 126 184 5 0.00 8 0.01 75.0 0.0 12.5 12.5 0.01

2004 126 299 8 0.00 12 0.01 91.7 0.0 25.0 8.3 0.01

2005 126 393 3 0.00 6 0.00 83.3 0.0 16.7 0.0 0.00

2006 126 465 6 0.00 7 0.01 100.0 0.0 0.0 14.3 0.01

2007 126 515 14 0.00 12 0.01 83.3 0.0 8.3 0.0 0.00

2008 126 545 3 0.00 7 0.01 71.4 0.0 57.1 28.6 0.02

2009 126 552 5 0.00 2 0.00 50.0 0.0 50.0 50.0 0.01

2010 126 536 8 0.00 4 0.00 75.0 0.0 0.0 25.0 0.01

2011 126 497 6 0.00 5 0.00 80.0 0.0 40.0 0.0 0.00

2012 126 435 0 0.00 3 0.00 33.3 0.0 0.0 0.0 0.00

2013 126 345 2 0.00 3 0.00 66.7 0.0 33.3 0.0 0.00

2014 126 225 3 0.00 5 0.00 60.0 0.0 60.0 40.0 0.02

2015 126 072 5 0.00 7 0.01 85.7 0.0 28.6 14.3 0.01

2016 127 763 5 0.00 3 0.00 33.3 0.0 0.0 0.0 0.00

2017 127 503 3 0.00 2 0.00 50.0 0.0 50.0 0.0 0.00

2018 127 202 2 0.00 2 0.00 100.0 0.0 50.0 0.0 0.00

61

Part II. Country ProfIles : KIrIBatI

KIRIBATI

Population

115 847 (2018)

Background

• Leprosy was endemic for many years in Kiribati. However, it has been confirmed that only few islands have been considered as endemic islands such as Abemama, Kuria, Marakei, Onotoa South Tarawa and Tamana.

• MDT was launched in 1988. • The leprosy programme was vertical before 2006, when it was first implemented into other

public health programmes. • Besides screening of selected groups since 1995, the entire healthy population was given

preventive therapy in the form of a single dose of rifampicin, ofloxacin and minocycline (ROM) in Tarawa and in some known endemic islands in 1996–1997.

Elimination target

• The elimination target of a prevalence rate below 1 per 10 000 population was met only in 2000, 2003 and 2011, and it has not been sustained.

Epidemiology

• Both prevalence and new case detection rates have fluctuated with sharp increases in 1996–1997, 2008–2010 and 2018, reflecting the intensified case detection activities conducted during the time.

• The number of new cases has increased in recent years due to the strengthened programme activities including screening and an awareness campaign, and since 2010 more than 100 cases continue to be detected every year.


• Population screening in highly endemic villages in South Tarawa has still continued as a pioneering activity initiated by the Pacific Leprosy Foundation. Some islands will be also visited depending on the availability of funds.

• Almost all health staff in South Tarawa have been given refresher training while some other outer island staff were given updated training only during outer island tours.

62


Leprosy profile in Kiribati


Adult Child



05

10152025

050

100150200250

0

50

100

150

200

0

20

40

60

80

0

50

100

150

200

0

50

100

150

200

0

50

100

150

020406080

0

5

10

15

010203040506070

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









63

Part II. Country ProfIles : KIrIBatI

Leprosy indicators in Kiribati

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1988 69 NA NA 28 40.52 NA 39.3 NA NA NA

1989 71 NA NA 63 88.90 41.3 28.6 NA NA NA

1990 72 NA NA 33 45.94 48.5 12.1 NA NA NA

1991 73 NA NA 59 80.65 20.3 37.3 NA NA NA

1992 74 NA NA 44 59.25 22.7 27.3 NA NA NA

1993 75 NA NA 41 54.51 39.0 26.8 NA NA NA

1994 76 46 6.04 17 22.32 64.7 29.4 NA 11.8 26.25

1995 77 13 1.68 16 20.71 25.0 37.5 NA NA NA

1996 78 42 5.36 78 99.46 21.8 32.1 NA 0.0 0.00

1997 80 78 9.79 128 160.59 13.3 32.0 NA NA NA

1998 81 13 1.60 26 32.07 26.9 61.5 NA 0.0 0.00

1999 83 21 2.54 37 44.84 21.6 73.0 NA 0.0 0.00

2000 84 8 0.95 19 22.62 36.8 26.3 NA 5.3 11.90

2001 86 9 1.05 18 21.04 55.6 27.8 NA 0.0 0.00

2002 87 20 2.30 25 28.69 68.0 40.0 NA 4.0 11.48

2003 89 8 0.90 21 23.66 38.1 38.1 NA 0.0 0.00

2004 90 29 3.21 64 70.80 25.0 45.3 37.5 0.0 0.00

2005 92 19 2.07 34 36.96 32.4 32.4 52.9 0.0 0.00

2006 94 26 2.78 41 43.84 43.9 48.8 48.8 0.0 0.00

2007 95 27 2.84 63 66.29 49.2 38.1 34.9 0.0 0.00

2008 97 88 9.12 42 43.51 66.7 42.9 42.9 0.0 0.00

2009 98 112 11.43 97 98.96 48.5 35.1 53.6 2.1 20.40

2010 100 20 2.01 182 182.84 36.3 24.7 45.1 1.1 20.09

2011 101 10 0.99 111 109.81 36.9 26.1 43.2 0.0 0.00

2012 103 16 1.56 114 111.05 32.5 20.2 44.7 0.9 9.74

2013 104 24 2.30 137 131.42 24.1 29.2 52.6 5.1 67.15

2014 106 84 7.94 123 116.20 34.1 34.1 46.3 1.6 18.89

2015 107 103 9.58 180 167.48 27.8 26.7 54.4 6.7 111.65

2016 113 115 9.88 218 187.29 26.6 36.2 51.4 4.6 85.91

2017 114 110 9.29 187 157.92 40.6 24.1 46.5 4.3 67.56

2018 116 215 18.56 173 149.33 41.0 27.8 51.5 2.9 43.16

64


LAO PEOPLE’S DEMOCRATIC REPUBLIC

Population

7 061 507 (2018)

Background

• Leprosy was endemic for many decades. • MDT has been administered since 1984. • The leprosy programme is vertical at the central and provincial levels and integrated at the

district and lower levels; it is supervised by the National Dermatology Centre. • Case finding is mainly passive. Active case finding is limited to areas with a known high number

of cases. • Leprosy elimination campaigns (LECs) were conducted in 1997–1998 in selected provinces. • The Netherlands Leprosy Relief Association and the Leprosy Mission International support the

programme to a considerable extent.

Elimination target

• Reached in 1998 and sustained since. • Subnational elimination was achieved in most provinces, and two provinces out of 18 still have a

prevalence rate of more than 1 per 10 000 population.

Epidemiology

• The prevalence has declined continuously since the 1980s and after elimination, apart from a sharp rise in 1990 when all patients treated with monotherapy (dapsone) started MDT treatment. The rate has been kept below elimination level since 1998.

• The number and rate of new cases detected have steadily decreased over the years. • The rate of new cases with Grade 2 disability has gradually decreased for the last two decades;

however, it has not yet fallen below 1 per 1 000 000 population. • The proportion of MB among new cases has risen over the years.


• Special projects are being undertaken to detect cases in areas and populations that are difficult to access.

• A pilot post-elimination surveillance system is being developed in a few selected provinces. • Besides strengthening of monitoring and supervision, efforts are being made to intensify IEC

activities to increase leprosy awareness in the community.

65

Part II. Country ProfIles : lao PeoPle’s demoCratIC rePuBlIC

Leprosy profile in the Lao People’s Democratic Republic


Adult Child



02468

1012

05

101520

0

5

10

15

20

020406080

100

0100200300400500600700

0100200300400500600700

05

1015202530

0

5

10

15

01020304050

0102030405060

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









66


Leprosy indicators in the Lao People’s Democratic Republic

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1985 3 680 3 152 8.56 307 8.34 33.9 NA NA NA NA

1986 3 785 3 381 8.93 426 11.25 64.1 NA NA NA NA

1987 3 895 2 353 6.04 702 18.02 30.1 NA NA NA NA

1988 4 009 1 955 4.88 168 4.19 45.8 NA NA NA NA

1989 4 127 1 376 3.33 264 6.40 40.9 NA NA NA NA

1990 4 192 2 529 6.03 371 8.85 43.1 NA NA NA NA

1991 4 312 1 393 3.23 340 7.88 47.1 NA NA NA NA

1992 4 435 1 361 3.07 317 7.15 47.0 NA NA 34.1 24.35

1993 4 557 1 085 2.38 234 5.13 41.9 NA NA 38.0 19.53

1994 4 678 967 2.07 304 6.50 75.0 NA NA 28.9 18.81

1995 4 795 694 1.45 298 6.21 67.1 3.4 NA 25.2 15.64

1996 4 908 574 1.17 270 5.50 67.8 4.1 NA 29.3 16.10

1997 5 017 533 1.06 256 5.10 66.0 3.5 NA 26.2 13.36

1998 5 121 373 0.73 236 4.61 66.1 2.1 NA 19.1 8.79

1999 5 221 282 0.54 177 3.39 74.0 4.0 NA 24.9 8.43

2000 5 317 286 0.54 304 5.72 70.1 6.6 NA 15.8 9.03

2001 5 409 200 0.37 183 3.38 77.0 6.6 NA 15.3 5.18

2002 5 497 162 0.29 155 2.82 76.8 3.9 NA 17.4 4.91

2003 5 582 144 0.26 156 2.79 75.0 7.1 NA 16.0 4.48

2004 5 667 210 0.37 215 3.79 78.6 6.0 45.1 19.5 7.41

2005 5 753 140 0.24 143 2.49 76.2 5.6 35.0 14.0 3.48

2006 5 842 163 0.28 150 2.57 66.0 2.7 26.7 17.3 4.45

2007 5 931 112 0.19 125 2.11 84.0 4.0 30.4 11.2 2.36

2008 6 022 172 0.29 93 1.54 72.0 4.3 22.6 20.4 3.16

2009 6 112 188 0.31 101 1.65 72.3 2.0 17.8 13.9 2.29

2010 6 201 91 0.15 86 1.39 75.6 1.2 23.3 15.1 2.10

2011 6 288 93 0.15 93 1.48 82.8 3.2 29.0 16.1 2.39

2012 6 374 70 0.11 88 1.38 69.3 4.5 42.0 18.2 2.51

2013 6 459 67 0.10 84 1.30 82.1 3.6 41.7 33.3 4.34

2014 6 543 94 0.14 104 1.59 76.0 12.5 41.3 31.7 5.04

2015 6 628 93 0.14 88 1.33 67.0 5.7 43.2 22.7 3.02

2016 6 846 54 0.08 64 0.93 78.1 4.7 42.2 28.1 2.62

2017 6 953 95 0.14 90 1.29 70.0 6.7 32.2 20.0 2.59

2018 7 062 77 0.11 71 1.01 88.7 12.7 21.1 25.4 2.55

67

Part II. Country ProfIles : malaysIa

MALAYSIA

Population

31 528 033 (2018)

Background

• The National Leprosy Control Programme was integrated into the General Public Health Care System in 1995 and is coordinated by the Disease Control Division.

• MDT was launched in 1985, and the regimen was fully implemented as the first-line treatment in 2012.

• People can be screened for leprosy at primary health clinics and treated when diagnosis is established after a laboratory test. Any complicated leprosy case or doubtful diagnosis will be referred to a state dermatology clinic.

• Case detection is mainly passive, but since 2012 active case finding has been increasingly implemented as a Ministry of Health effort towards eradication of the disease.

• While most patients successfully complete treatment, a few cases, especially among illegal migrants, are lost to follow-up.

Elimination target

• Malaysia achieved the status of leprosy elimination as defined by WHO in 1994.

Epidemiology

• The prevalence rate declined sharply from 3.8 to 0.9 per 10 000 population between 1987 and 1994.

• After reaching elimination level in 1994, prevalence gradually fell to below 0.1 per 10 000 population by 2016.

• The new case detection rate decreased from 2.1 to 0.7 per 100 000 population between 1987 and 1998. Since then, it has been stable within a range of between 0.7 and 1.1 per 100 000 population.

• The rate of new cases with Grade 2 disabilities sharply decreased in the early 1990s, following the trend of the prevalence rate.


• In October 2014, the second edition of the Guidelines of Leprosy Management was released, followed by the establishment of 44 primary health clinics as treatment centres for leprosy in Peninsular Malaysia to provide easy access to services.

• Training for health staff has been continuously provided to improve the skills and knowledge in diagnosis and patient management.

• A mobile health team has conducted a screening programme for high-risk groups in selected districts to facilitate early case detection.

68


Leprosy profile in Malaysia


Adult Child



012345

0.00.51.01.52.02.5

0.00.51.01.52.02.5

020406080

100

050

100150200250300350

050

100150200250300350

01234567

0

5

10

15

0

10

20

30

0

10

20

30

40

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









69

Part II. Country ProfIles : malaysIa

Leprosy indicators in Malaysia

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1987 16 704 6 373 3.82 348 2.08 NA 8.0 NA NA NA

1988 17 202 5 723 3.33 311 1.81 NA 9.0 NA 19.9 3.60

1989 17 707 5 031 2.84 329 1.86 NA 9.1 NA 28.0 5.20

1990 18 209 4 149 2.28 296 1.63 NA 11.1 NA 23.0 3.73

1991 18 708 3 439 1.84 315 1.68 NA 5.1 NA 19.0 3.21

1992 19 204 2 989 1.56 220 1.15 55.0 NA NA 19.1 2.19

1993 19 701 3 439 1.75 315 1.60 NA NA NA NA NA

1994 20 205 1 823 0.90 330 1.63 73.9 7.0 NA 9.1 1.48

1995 20 721 1 561 0.75 293 1.41 73.0 4.8 NA 5.5 0.77

1996 21 247 1 314 0.62 273 1.28 69.6 9.9 NA 3.3 0.42

1997 21 781 1 073 0.49 277 1.27 67.9 5.4 NA 3.2 0.41

1998 22 322 1 125 0.50 148 0.66 52.0 4.1 NA 16.2 1.08

1999 22 868 1 022 0.45 224 0.98 73.2 7.6 NA 4.0 0.39

2000 23 415 631 0.27 207 0.88 62.3 10.6 NA 5.3 0.47

2001 23 965 931 0.39 195 0.81 76.9 4.1 NA 5.1 0.42

2002 24 515 955 0.39 168 0.69 73.2 11.9 NA 1.8 0.12

2003 25 060 972 0.39 219 0.87 52.5 11.9 NA 4.6 0.40

2004 25 590 810 0.32 244 0.95 54.5 7.0 30.7 2.0 0.20

2005 26 100 759 0.29 263 1.01 67.3 6.1 31.2 3.0 0.31

2006 26 586 725 0.27 237 0.89 72.2 7.6 28.3 5.1 0.45

2007 27 051 681 0.25 190 0.70 70.5 5.3 31.1 1.1 0.07

2008 27 502 696 0.25 218 0.79 74.3 2.8 33.5 4.1 0.33

2009 27 949 690 0.25 187 0.67 73.8 6.4 28.9 4.3 0.29

2010 28 401 566 0.20 194 0.68 87.6 7.7 30.9 4.1 0.28

2011 28 859 219 0.08 216 0.75 80.1 6.9 28.2 3.7 0.28

2012 29 322 496 0.17 325 1.11 62.2 7.7 33.8 2.8 0.31

2013 29 787 353 0.12 307 1.03 74.6 8.5 28.3 2.6 0.27

2014 30 252 360 0.12 308 1.02 71.4 7.1 27.9 1.6 0.17

2015 30 714 341 0.11 210 0.68 73.8 5.2 35.7 3.8 0.26

2016 30 685 221 0.07 206 0.65 70.4 2.9 25.2 3.4 0.22

2017 31 105 279 0.09 196 0.61 71.4 9.2 30.6 3.6 0.22

2018 31 528 288 0.09 182 0.58 72.0 5.5 23.6 5.5 0.32

70


MARSHALL ISLANDS

Population

58 413 (2018)

Background

• Leprosy has been endemic for many years. • The leprosy programme is integrated with the TB control programme. • MDT was launched in 1986. • In 1998–2002, screening was undertaken, and a number of new cases were detected. A single-

dose prophylactic treatment with ROM was administered to the family contacts of all known cases.

Elimination target

• Not yet reached.Epidemiology

• The prevalence rate increased in 1995–1998, and then it declined until 2002. After several years of stagnation, the rate again rose sharply in 2009 and 2011. It has never fallen below the elimination level.

• The increases in the new case detection rate corresponded to intensified case detection activities conducted in 1996 and 1998–2000.

• The percentage of children among new cases remains high, with 25–45% in recent years. • New cases with Grade 2 disability have been reported sporadically.


• Not applicable

71

Part II. Country ProfIles : marshall Islands

Leprosy profile in the Marshall Islands


Adult Child



01020304050

050

100150200250300

050

100150200250300

020406080

100

020406080

100120140

020406080

100120140

0

20

40

60

0102030405060

05

10152025

0102030405060

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









72


Leprosy indicators in the Marshall Islands

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 35 NA NA 2 5.73 NA NA NA NA NA

1984 37 NA NA 5 13.67 NA NA NA 20.0 27.35

1985 38 NA NA 7 18.26 NA NA NA NA NA

1986 40 NA NA 13 32.33 NA NA NA NA NA

1987 42 NA NA 10 23.73 NA NA NA NA NA

1988 44 NA NA 19 43.12 NA NA NA NA NA

1989 46 NA NA 24 52.39 NA NA NA NA NA

1990 47 NA NA 26 54.99 NA NA NA NA NA

1991 48 50 10.32 32 66.03 NA NA NA NA NA

1992 49 NA NA 21 42.54 NA NA NA NA NA

1993 50 20 4.00 20 39.97 65.0 0.0 NA 0.0 0.00

1994 51 8 1.58 8 15.82 62.5 12.5 NA 0.0 0.00

1995 51 46 9.02 18 35.29 77.8 50.0 NA NA NA

1996 51 85 16.54 112 217.98 38.4 32.1 NA 0.0 0.00

1997 52 116 22.44 70 135.42 41.4 35.7 NA 0.0 0.00

1998 52 130 25.04 126 242.66 38.1 30.2 NA 2.4 57.78

1999 52 91 17.48 116 222.77 19.0 37.1 NA 0.0 0.00

2000 52 64 12.28 97 186.04 32.0 33.0 NA 1.0 19.18

2001 52 52 9.98 63 120.87 46.0 30.2 NA 0.0 0.00

2002 52 48 9.22 52 99.89 63.5 28.8 NA 0.0 0.00

2003 52 50 9.62 76 146.20 48.7 26.3 NA 0.0 0.00

2004 52 55 10.59 62 119.32 59.7 19.4 41.9 0.0 0.00

2005 52 37 7.11 44 84.57 50.0 25.0 NA 0.0 0.00

2006 52 54 10.34 42 80.46 NA NA NA NA NA

2007 52 63 12.00 76 144.82 56.6 18.4 47.4 NA NA

2008 53 57 10.78 54 102.13 55.6 20.4 37.0 0.0 0.00

2009 53 130 24.35 44 82.41 61.4 25.0 36.4 0.0 0.00

2010 54 103 19.06 110 203.58 39.1 44.5 13.6 0.9 18.51

2011 55 226 41.23 120 218.94 50.0 39.2 30.8 0.0 0.00

2012 56 140 25.13 137 245.93 43.1 38.7 25.5 0.0 0.00

2013 57 73 12.88 93 164.08 59.1 31.2 22.6 0.0 0.00

2014 58 91 15.79 81 140.51 46.9 28.4 34.6 0.0 0.00

2015 59 55 9.39 56 95.63 58.9 41.1 30.4 0.0 0.00

2016 58 64 12.05 80 150.58 71.3 18.8 46.3 0.0 0.00

2017 58 61 11.47 53 99.69 60.4 43.4 34.0 0.0 0.00

2018 58 64 10.96 59 101.00 54.2 30.5 44.1 0.0 0.00

73

Part II. Country ProfIles : mICronesIa (federated states of)

MICRONESIA (FEDERATED STATES OF)

Population

112 640 (2018)

Background

• Leprosy is highly endemic but unevenly distributed among the states (islands). For example, few cases were reported from Kosrae and Yap states.

• The leprosy programme is integrated with the TB control programme and has a national programme manager and a coordinator in each state.

• Rifampicin was introduced in the treatment regimen in 1980, and MDT began in 1984. • A special project was carried out in 1996 and 1997 to address the problem of continuing high

endemicity. The project consisted of total population screening for detection of leprosy cases and mass preventive therapy with a single dose of ROM to healthy patients. Coverage with prophylactic treatment was up to 87%, with the population screened each year for two years. Screening of people in high-endemic pockets, the family contacts of cases and schoolchildren is being continued with intensified IEC activities.

Elimination target

• Not yet reached. The prevalence rate has stayed above 10 per 10 000 population in recent years.

Epidemiology

• The prevalence rate declined notably from 94.5 to less than 10 per 10 000 population between 1987 and 1998. Since then, the rate has remained relatively low, but the elimination level has not yet been achieved.

• The new case detection rate increased in the 2000s and 2010s. • Several sharp rises in the new case detection rate were not accompanied by an increase in MB

cases, showing that many were detected at the early stage of the disease through intensified case finding activities.


• Not applicable.

74


Leprosy profile in the Federated States of Micronesia


Adult Child



020406080

100120

050

100150200250300350

050

100150200250300

0

20

40

60

80

050

100150200250300

050

100150200250300

020406080

0102030405060

02468

10

01020304050

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









75

Part II. Country ProfIles : mICronesIa (federated states of)

Leprosy indicators in the Federated States of Micronesia

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1987 90 851 94.53 177 196.61 NA NA NA NA NA

1988 92 782 84.98 87 94.54 NA NA NA NA NA

1989 94 658 69.93 96 102.03 NA NA NA NA NA

1990 96 628 65.20 80 83.06 NA NA NA NA NA

1991 99 501 50.73 84 85.06 NA NA NA NA NA

1992 101 349 34.45 90 88.83 NA NA NA NA NA

1993 104 362 34.88 220 211.99 NA NA NA NA NA

1994 106 290 27.40 95 89.77 42.1 22.1 NA NA NA

1995 107 368 34.32 206 192.11 29.6 NA NA NA NA

1996 108 448 41.52 288 266.90 23.3 NA NA 0.0 0.00

1997 108 169 15.66 123 113.94 28.5 43.9 NA 0.0 0.00

1998 108 65 6.04 39 36.24 38.5 43.6 NA 0.0 0.00

1999 107 61 5.69 66 61.55 60.6 37.9 NA 3.0 18.65

2000 107 57 5.32 90 84.03 52.2 28.9 NA 0.0 0.00

2001 107 58 5.41 88 82.02 48.9 50.0 NA 0.0 0.00

2002 108 79 7.33 108 100.25 52.8 40.7 NA 0.9 9.28

2003 108 70 6.46 89 82.16 47.2 41.6 NA 0.0 0.00

2004 109 85 7.80 153 140.46 41.2 45.1 41.2 0.7 9.18

2005 109 158 14.44 260 237.62 30.0 32.3 36.2 0.8 18.28

2006 110 107 9.75 151 137.54 45.7 25.8 31.1 0.7 9.11

2007 110 87 7.90 141 128.07 46.1 27.0 20.6 NA NA

2008 110 190 17.22 124 112.35 58.1 39.5 43.5 0.0 0.00

2009 111 143 12.92 122 110.23 41.0 29.5 37.7 6.6 72.28

2010 111 137 12.34 117 105.34 53.0 18.8 35.0 3.4 36.02

2011 112 175 15.69 196 175.72 40.3 37.8 43.9 1.0 17.93

2012 112 224 19.98 252 224.80 34.1 41.3 36.9 0.8 17.84

2013 113 188 16.68 195 172.99 41.0 39.5 38.5 0.5 8.87

2014 113 126 11.11 178 156.95 40.4 39.9 36.5 2.2 35.27

2015 114 148 12.96 164 143.66 45.7 12.2 27.4 1.8 26.28

2016 110 139 13.17 169 160.12 43.8 23.7 37.3 0.0 0.00

2017 111 0 0.00 141 132.73 48.9 37.6 35.5 2.1 28.24

2018 113 121 10.74 127 112.75 54.3 30.7 35.4 2.4 26.63

76


MONGOLIA

Population

3 170 216 (2018)

Background

• No cases of leprosy are reported in the country.

Elimination target

• Not a public health problem, therefore no targets or programme in the country.

Epidemiology

• No new and prevalent cases have been reported for all reporting years. • Data are not available before 2002.


• Not applicable.

77

Part II. Country ProfIles : mongolIa

Leprosy profile in Mongolia

Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

02468

10

−1.0

−0.5

0.0

0.5

1.0

−1.0

−0.5

0.0

0.5

1.0

0.000.020.040.060.080.10

02468

10

02468

10

02468

10

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)


New case detection rate Proportion of MB cases







78


Leprosy indicators in Mongolia

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

2002 2 459 0 0 0 0 NA NA NA NA 0

2003 2 485 0 0 0 0 NA NA NA NA 0

2004

2005 2 547 0 0 0 0 NA NA NA NA 0

2006

2007

2008 2 667 0 0 0 0 NA NA NA NA 0

2009 2 712 0 0 0 0 NA NA NA NA 0

2010 2 756 0 0 0 0 NA NA NA NA 0

2011 2 800 0 0 0 0 NA NA NA NA 0

2012 2 844 0 0 0 0 NA NA NA NA 0

2013 2 888 0 0 0 0 NA NA NA NA 0

2014 2 932 0 0 0 0 NA NA NA NA 0

2015

2016 3 056 0 0 0 0 NA NA NA NA 0

2017 3 114 0 0 0 0 NA NA NA NA 0

2018 3 170 0 0 0 0 NA NA NA NA 0

79

Part II. Country ProfIles : nauru

NAURU

Population

10 670 (2018)

Background

• Leprosy has been prevalent for decades in Nauru, with the first cases detected in migrants in 1912. The disease became epidemic and affected nearly 30% of the population by 1925.

• Control takes place at the Community Health Clinic of the Division of Public Health. • MDT was launched in 1993. • School screenings are performed occasionally.

Elimination target

• The target was reached in 1994, when the number of prevalent cases dropped below 10.

Epidemiology

• The number of new cases has been less than six every year for the last three decades. • In 2018, there were eight new cases after two years of no cases.


• Besides monitoring and treatment of the few cases, leprosy awareness among health staff is being maintained through on-the-job training.

80


Leprosy profile in Nauru

Adult Child



0

5

10

15

020406080

100

0

20

40

60

80

020406080

100120

0

2

4

6

8

0

2

4

6

8

020406080

100120

020406080

100120

0

10

20

30

40

0102030405060

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00Ne

w ca

ses p

er 10

0 000

Num

ber

New

case

s per

milli

onPe

rcent

age (

%)

New

case

s per

100 0

00Pe

rcent

age (

%)

Num

ber

Perce

ntag

e (%

)Pe

rcent

age (

%)

Target

Target









81

Part II. Country ProfIles : nauru

Leprosy indicators in Nauru

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 8 NA NA 1 12.73 0.0 NA NA NA NA

1984 8 NA NA 1 12.49 100.0 100.0 NA NA NA

1985 8 NA NA 3 36.71 33.3 33.3 NA NA NA


1987 9 NA NA 3 35.09 NA 0.0 NA NA NA

1988 9 NA NA 3 34.28 66.7 0.0 NA NA NA

1989 9 NA NA 2 22.33 100.0 50.0 NA NA NA

1990 9 NA NA 1 10.93 100.0 100.0 NA NA NA

1991 9 NA NA 2 21.40 100.0 0.0 NA 0.0 0.00

1992 10 14 14.68 2 20.97 100.0 0.0 NA NA NA

1993 10 NA NA 3 30.89 66.7 0.0 NA NA NA

1994 10 8 8.12 2 20.29 100.0 0.0 NA 0.0 0.00

1995

1996 10 4 3.99 2 19.95 NA 100.0 NA NA NA

1997 10 5 4.98 2 19.90 100.0 50.0 NA NA NA

1998

1999 10 9 8.96 3 29.88 100.0 0.0 NA NA NA

2000 10 7 6.98 5 49.83 40.0 40.0 NA 0.0 0.00

2001 10 3 2.99 3 29.88 66.7 66.7 NA 33.3 99.61

2002 10 5 4.98 3 29.85 66.7 33.3 NA 0.0 0.00

2003 10 5 4.97 3 29.80 NA NA NA NA NA

2004 10 5 4.96 3 29.73 NA NA NA NA NA

2005 10 0 0.00 1 9.89 100.0 0.0 NA 0.0 0.00

2006 10 5 4.94 1 9.88 NA NA NA NA NA

2007 10 3 2.96 3 29.57 NA NA NA NA NA

2008 10 3 2.95 2 19.66 50.0 100.0 0.0 0.0 0.00

2009 10 3 2.94 3 29.40 0.0 33.3 33.3 0.0 0.00

2010 10 4 3.90 2 19.52 100.0 0.0 0.0 0.0 0.00

2011 10 NA NA 6 58.25 100.0 NA NA NA NA

2012 10 8 7.72 3 28.95 66.7 0.0 33.3 0.0 0.00

2013 10 2 1.92 2 19.18 100.0 0.0 50.0 0.0 0.00

2014 10 0 0.00 0 0.00 NA NA NA NA 0.00

2015 11 2 1.89 2 18.94 50.0 0.0 50.0 0.0 0.00

2016 10 0 0.00 0 0.00 NA NA NA NA 0.00

2017 11 0 0.00 0 0.00 NA NA NA NA 0.00

2018 11 8 7.50 8 74.98 87.5 0.0 0.0 0.0 0.00

82


NEW CALEDONIA

Population

279 993 (2018)

Background

• The programme is run from the dermatology service of the central hospital in Nouméa (Centre Hospitalier Territorial).

• Modified MDT with a fixed duration was launched in 1983. Rifampicin is given on a daily basis to all cases.

• Case finding is mainly passive.

Elimination target

• Reached in 1995 and maintained.

Epidemiology

• The prevalence rate decreased in the 1980s and early 1990s, with a sharp drop in 1989. Since 1995, the rate has been below the elimination level.

• The new case detection rate has also declined over time especially in the 1980s and 1990s, but the rate has appeared to stabilize in the 2000s.

• The number of new cases detected has ranged from two to 10 every year for the last two decades.

• New cases with Grade 2 disability have not been reported since 2002.


• Nothing specific, except monitoring of the situation and management of cases.

83

Part II. Country ProfIles : neW CaledonIa

Leprosy profile in New Caledonia


Adult Child



05

1015202530

05

10152025

05

10152025

020406080

100120

05

101520253035

05

101520253035

0

5

10

15

20

0

20

40

60

80

0

20

40

60

80

0

20

40

60

80

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









84


Leprosy indicators in New Caledonia

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 149 363 24.36 23 15.44 26.1 47.8 NA NA NA

1984 151 334 22.06 20 13.21 35.0 45.0 NA NA NA

1985 154 315 20.46 20 12.99 40.0 25.0 NA NA NA

1986 157 326 20.83 32 20.45 34.4 21.9 NA NA NA

1987 159 339 21.30 22 13.82 40.9 18.2 NA NA NA

1988 162 352 21.72 14 8.64 35.7 21.4 NA NA NA

1989 165 70 4.24 15 9.08 53.3 26.7 NA NA NA

1990 170 90 5.30 16 9.43 37.5 6.3 NA NA NA

1991 174 48 2.77 13 7.49 30.8 23.1 NA NA NA

1992 178 64 3.60 10 5.63 50.0 10.0 NA NA NA

1993 182 22 1.21 10 5.50 60.0 20.0 NA NA NA

1994 186 27 1.45 9 4.83 33.3 0.0 NA NA NA

1995 191 13 0.68 7 3.67 71.4 14.3 NA 28.6 10.48

1996

1997 199 13 0.65 9 4.51 55.6 0.0 NA 33.3 15.04

1998 204 17 0.83 5 2.45 60.0 0.0 NA 60.0 14.73

1999 208 10 0.48 7 3.37 57.1 NA NA 14.3 4.81

2000 212 9 0.42 7 3.30 57.1 0.0 NA 28.6 9.44

2001 216 17 0.79 7 3.24 71.4 14.3 NA 14.3 4.63

2002 220 7 0.32 2 0.91 50.0 0.0 NA 0.0 0.00

2003 223 0 0.00 4 1.79 0.0 25.0 NA 0.0 0.00

2004 227 0 0.00 4 1.76 NA NA NA NA NA

2005

2006 235 16 0.68 7 2.98 NA NA NA NA NA

2007 239 4 0.17 2 0.84 NA NA NA NA NA

2008

2009 247 10 0.41 7 2.84 57.1 28.6 28.6 0.0 0.00

2010 251 9 0.36 8 3.19 50.0 37.5 37.5 NA NA

2011 255 12 0.47 10 3.92 70.0 10.0 20.0 NA NA

2012 259 10 0.39 5 1.93 40.0 0.0 20.0 NA NA

2013

2014

2015

2016 274 7 0.25 3 1.09 100.0 66.7 33.3 0.0 0.00

2017 277 14 0.50 7 2.50 71.4 57.1 42.9 0.0 0.00

2018 280 14 0.50 8 2.86 12.5 50.0 62.5 0.0 0.00

85

Part II. Country ProfIles : neW Zealand

NEW ZEALAND

Population

4 743 131 (2018)

Background

• Data were not available prior to 1990. • Nearly all cases of leprosy in New Zealand have occurred in individuals who have contracted the

disease overseas. • All cases are passively detected. Cases are managed in close collaboration among dermatologists,

infectious disease physicians, public health services, general practitioners and laboratories.

Elimination target

• Leprosy has not been a public health problem.

Epidemiology

• Both prevalence and new case detection rates have been kept low for more than two decades. • New cases are still being reported, ranging from one to four cases every year. • Past data on new cases with Grade 2 disability are not available. For 2017–2018, no Grade 2

disability was diagnosed in six new cases reported. (Detailed epidemiological data between 2004 and 2013 are available in an article published in 2015.29)


• Not applicable.

29 Richard Yu, Paul Jarrett, David Holland, Jill Sherwood, Catherine Pikholz. (2015) Leprosy in New Zealand: an epidemiological update. The New Zealand Medical Journal, Volume 128, Number 1414. https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1414-15-may-2015/6531 [accessed on 4 January 2020]

https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1414-15-may-2015/6531

86


Leprosy profile in New Zealand

Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

02468

10

02468

10

0.000.020.040.060.080.10

0102030405060

02468

10

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)









87

Part II. Country ProfIles : neW Zealand

Leprosy indicators in New Zealand

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1990 3 398 3 0.01 1 0.03 100.0 NA NA NA NA

1991 3 446 0 0.00 4 0.12 NA NA NA NA NA

1992 0

1993 0

1994 3 623 1 0.00 1 0.03 NA NA NA NA NA

1995 3 675 1 0.00 1 0.03 0.0 NA NA NA NA

1996 3 717 10 0.03 10 0.27 70.0 NA 40.0 NA NA

1997 0

1998 0

1999 3 817 6 0.02 10 0.26 80.0 0.0 20.0 NA NA

2000 3 858 0 0.00 4 0.10 50.0 0.0 25.0 NA NA

2001 3 907 5 0.01 3 0.08 0.0 0.0 33.3 NA NA

2002 3 962 0 0.00 4 0.10 50.0 0.0 75.0 NA NA

2003 4 021 0 0.00 4 0.10 50.0 25.0 50.0 NA NA

2004 4 079 0 0.00 3 0.07 100.0 33.3 33.3 NA NA

2005 4 134 0 0.00 2 0.05 50.0 50.0 0.0 NA NA

2006 0

2007 0

2008 0

2009 4 323 3 0.01 3 0.07 66.7 0.0 66.7 NA NA

2010 4 368 3 0.01 3 0.07 100.0 0.0 33.3 NA NA

2011 4 415 1 0.00 1 0.02 0.0 0.0 100.0 NA NA

2012 4 461 1 0.00 2 0.04 50.0 0.0 0.0 NA NA

2013 4 508 3 0.01 7 0.16 42.9 28.6 14.3 NA NA

2014 4 555 NA NA 4 0.09 100.0 0.0 0.0 NA NA

2015 4 601 NA NA 3 0.07 66.7 33.3 0.0 NA NA

2016 4 659 0 0.00 0 0.00 NA NA NA NA 0.00

2017 4 702 0 0.00 3 0.06 100.0 0.0 66.7 0.0 0.00

2018 4 743 3 0.01 3 0.06 100.0 0.0 0.0 0.0 0.00

88


NIUE

Population

1620 (2018)

Background

• No cases of leprosy were reported.

Elimination target

• Not applicable.

Epidemiology

• No cases have been reported.


• Not applicable.

89

Part II. Country ProfIles : nIue

Leprosy profile in Niue

Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

02468

10

−1.0

−0.5

0.0

0.5

1.0

−1.0

−0.5

0.0

0.5

1.0

0.000.020.040.060.080.10

02468

10

02468

10

02468

10

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)


New case detection rate Proportion of MB cases







90


Leprosy indicators in Niue

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

2002 2 0 0 0 0 NA NA NA NA 0

2003 2 0 0 0 0 NA NA NA NA 0

2004 2 0 0 0 0 NA NA NA NA 0

2005 2 0 0 0 0 NA NA NA NA 0

2006 2 NA NA 0 0 NA NA NA NA NA

2007 2 0 0 0 0 NA NA NA NA NA

2008 2 0 0 0 0 NA NA NA NA 0

2009 2 0 0 0 0 NA NA NA NA 0

2010 1 0 0 0 0 NA NA NA NA 0

2011

2012

2013 1 0 0 0 0 NA NA NA NA 0

2014 0

2015

2016 2 0 0 0 0 NA NA NA NA 0

2017 2 0 0 0 0 NA NA NA NA 0

2018 2 0 0 0 0 NA NA NA NA 0

91

Part II. Country ProfIles : northern marIana Islands (CommonWealth of the)

NORTHERN MARIANA ISLANDS (COMMONWEALTH OF THE)

Population

56 882 (2018)

Background

• The programme is integrated with the TB control programme and supervised at public health clinics.

• Rifampicin was introduced in the treatment regimen in 1980, and MDT was introduced in 1986. • Case finding is mainly passive.

Elimination target

• First reached in 1992, fluctuated widely between 1994 and 2007, and again since 2008.

Epidemiology

• Although the prevalence and new case detection rates have fluctuated widely due to the small population, lower rates have been observed in recent years.

• The number of new cases has been less than 10 per year for the last three decades. A few cases were reported since 2013 after six years without new case detection.


• Areas with large numbers of migrants are being closely monitored. • There is continuous education of community doctors and the general public about leprosy in

order to facilitate case detection.

92


Leprosy profile in Northern Mariana Islands (Commonwealth of the)

Adult Child



0.00.51.01.52.02.5

0

5

10

15

20

0

5

10

15

20

020406080

100120

0

2

4

6

8

0

2

4

6

8

020406080

100

020406080

100120

020406080

100120

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









93

Part II. Country ProfIles : northern marIana Islands (CommonWealth of the)

Leprosy indicators in Northern Mariana Islands (Commonwealth of the)

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 24 NA NA 3 12.34 NA NA NA NA NA

1984 27 NA NA 2 7.31 0.0 NA NA 50.0 36.54

1985 30 NA NA 3 9.89 66.7 NA NA 33.3 32.96


1987 36 NA NA 4 11.14 75.0 25.0 NA NA NA




1991 47 NA NA 8 17.12 NA NA NA NA NA

1992 49 4 0.81 4 8.09 100.0 25.0 NA 100.0 80.89


1994 55 9 1.64 1 1.82 0.0 100.0 NA 0.0 0.00

1995 58 7 1.22 6 10.43 66.7 0.0 NA 0.0 0.00

1996 60 11 1.83 6 9.97 66.7 16.7 NA 0.0 0.00

1997 63 4 0.64 5 7.97 60.0 0.0 NA 20.0 15.93

1998 65 6 0.92 7 10.75 71.4 14.3 NA 0.0 0.00

1999 67 7 1.04 7 10.44 100.0 0.0 NA 0.0 0.00

2000 68 10 1.46 3 4.38 100.0 0.0 NA 0.0 0.00

2001 69 6 0.87 5 7.23 100.0 20.0 NA 20.0 14.46

2002

2003 69 8 1.16 4 5.79 75.0 0.0 NA 0.0 0.00

2004 68 8 1.17 4 5.85 NA NA NA NA NA

2005

2006 66 14 2.12 7 10.61 NA NA NA NA NA

2007 64 7 1.09 0 0.00 NA NA NA NA NA

2008 63 2 0.32 0 0.00 NA NA NA NA 0.00

2009 61 2 0.33 0 0.00 NA NA NA NA 0.00

2010 61 4 0.66 0 0.00 NA NA NA NA 0.00

2011 61 3 0.49 0 0.00 NA NA NA NA 0.00

2012 62 0 0.00 0 0.00 NA NA NA NA 0.00

2013 64 3 0.47 2 3.15 50.0 0.0 0.0 0.0 0.00

2014 65 2 0.31 1 1.54 100.0 0.0 0.0 0.0 0.00

2015 66 2 0.30 2 3.01 100.0 0.0 50.0 0.0 0.00

2016 56 2 0.36 2 3.63 100.0 0.0 100.0 0.0 0.00

2017 57 2 0.36 2 3.62 100.0 0.0 50.0 0.0 0.00

2018 57 3 0.58 3 5.77 100.0 0.0 33.3 0.0 0.00

94


PALAU

Population

17 907 (2018)

Background

• The programme is managed and coordinated by the Hansen’s Disease Programme of the Communicable Disease Unit under the Bureau of Public Health Services at Palau Ministry of Health.

• Case finding is mainly passive. • MDT launched in 1982 and is still in place.

Elimination target

• Reached in 1995 when the number of prevalent cases fell below 10. This has been sustained for 20 years.

Epidemiology

• The prevalence rate declined in the 1990s. Since 2000, it has been fluctuating between 0.5 and 4.6 per 10 000 population.

• No more than 10 new cases have been detected per year for the last three decades. • Cases with Grade 2 disability have not been reported since 1996. • No child case has been reported since 2014.


• The situation and detected cases are closely monitored.

95

Part II. Country ProfIles : Palau

Leprosy profile in Palau

Adult Child



02468

1012

010203040506070

0102030405060

020406080

100120

0

2

4

6

8

0

2

4

6

8

0

20

40

60

80

0

20

40

60

80

0

5

10

15

20

020406080

100120

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









96


Leprosy indicators in Palau

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 13 NA NA 7 53.78 71.4 0.0 NA 0.0 0.00

1984 13 NA NA 2 14.96 50.0 0.0 NA 0.0 0.00

1985 14 NA NA 2 14.60 100.0 0.0 NA 0.0 0.00

1986 14 NA NA 1 7.15 100.0 0.0 NA 0.0 0.00

1987 14 NA NA 3 21.07 66.7 33.3 NA 0.0 0.00

1988 14 NA NA 3 20.71 0.0 33.3 NA 0.0 0.00

1989 15 NA NA 1 6.77 0.0 0.0 NA 0.0 0.00

1990 15 NA NA 5 33.15 100.0 20.0 NA 0.0 0.00

1991 15 16 10.35 6 38.80 50.0 50.0 NA 16.7 64.67

1992 16 NA NA 2 12.59 100.0 0.0 NA 0.0 0.00

1993 16 NA NA 4 24.48 75.0 NA NA 0.0 0.00

1994 17 12 7.14 6 35.72 33.3 0.0 NA 0.0 0.00

1995 17 8 4.64 9 52.18 33.3 22.2 NA 11.1 57.98

1996 18 7 3.96 4 22.62 25.0 25.0 NA 0.0 0.00

1997 18 2 1.10 1 5.52 0.0 0.0 NA 0.0 0.00

1998 19 3 1.62 3 16.20 66.7 NA NA 0.0 0.00

1999

2000 19 6 3.13 6 31.31 83.3 0.0 NA 0.0 0.00

2001

2002 20 3 1.53 4 20.44 75.0 0.0 NA 0.0 0.00

2003 20 9 4.57 7 35.55 42.9 14.3 NA 0.0 0.00

2004 20 6 3.03 6 30.31 33.3 0.0 NA 0.0 0.00

2005 20 2 1.01 2 10.05 100.0 0.0 NA 0.0 0.00

2006 20 1 0.50 6 29.99 NA NA NA NA NA

2007 20 7 3.48 4 19.89 NA NA NA NA NA

2008 20 5 2.47 5 24.73 100.0 0.0 0.0 0.0 0.00

2009 20 8 3.93 4 19.67 100.0 0.0 50.0 0.0 0.00

2010 20 6 2.93 3 14.66 100.0 0.0 0.0 0.0 0.00

2011 21 3 1.46 3 14.56 100.0 33.3 33.3 NA NA

2012 21 6 2.89 2 9.64 50.0 50.0 50.0 0.0 0.00

2013 21 5 2.39 3 14.34 0.0 66.7 33.3 0.0 0.00

2014 21 4 1.90 2 9.48 100.0 0.0 100.0 0.0 0.00

2015 21 3 1.41 2 9.40 100.0 0.0 50.0 0.0 0.00

2016 18 3 1.38 2 9.20 100.0 0.0 50.0 0.0 0.00

2017 18 0 0.00 0 0.00 NA NA NA NA 0.00

2018 18 1 0.56 1 5.58 100.0 0.0 0.0 0.0 0.00

97

Part II. Country ProfIles : PaPua neW guInea

PAPUA NEW GUINEA

Population

8 606 323 (2018)

Background

• Leprosy has been prevalent for many years in Papua New Guinea. The disease has been in decline since 1977.

• The programme is integrated, and programme activities are supervised by a national programme manager.

• MDT was launched in 1987 and eventually covered all provinces by 1994. Fixed duration treatment began in 1995.

• Case finding is mainly passive. • Special projects such as LECs and SAPELs were conducted in areas of high prevalence and among

hard-to-reach populations. • The Sasakawa Memorial Health Foundation (Japan), the Leprosy Mission International and WHO

provided support to the programme.

Elimination target

• The elimination target was reached at the national level by the end of 2000. • At the provincial level, 14 provinces out of 22 had achieved the elimination target by the end of

2000. Additionally, one province reached the target in 2004, while the remaining five provinces are yet to reach the target as of 2014.

Epidemiology

• The prevalence rate decreased from 27.9 to 0.7 per 10 000 population between 1983 and 2000, and has been stable in the range between 0.5 and 1.1 per 10 000 for the last 18 years.

• The new case detection rate declined in the 1980s and early 1990s. Since 2000 it has been stable at less than 10 per 100 000 population.

• The proportion of MB cases has increased in recent years. • The rate of new cases with Grade 2 disability has been declining over the years with some

fluctuations.


• A brainstorming workshop was held in 2001 to formulate post-elimination strategies. • Efforts are focused on the five provinces that have not yet reached the elimination target, as well

as on the retrieval of patients who were lost to follow-up. • IEC activities are being intensified to promote leprosy awareness in the community and among

general health staff. • In the post-elimination transition period, the leprosy programme has been receiving less funding

support and is affected by complacency.

98


Leprosy profile in Papua New Guinea


Adult Child



0

10

20

30

05

101520253035

05

1015202530

020406080

100

0

200

400

600

800

1000

0

200

400

600

800

1000

05

10152025

0

10

20

30

40

05

1015202530

01020304050

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









99

Part II. Country ProfIles : PaPua neW guInea

Leprosy indicators in Papua New Guinea

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 3 489 9 752 27.95 912 26.14 NA NA NA NA NA

1984 3 584 8 715 24.32 683 19.06 NA NA NA NA NA

1985 3 678 8 203 22.30 773 21.02 NA NA NA NA NA

1986 3 772 7 543 20.00 568 15.06 NA NA NA NA NA

1987 3 865 7 465 19.31 579 14.98 NA NA NA NA NA

1988 3 960 8 163 20.61 650 16.41 NA NA NA NA NA

1989 4 057 5 188 12.79 544 13.41 NA NA NA NA NA

1990 4 158 4 330 10.41 512 12.31 NA NA NA NA NA

1991 4 262 3 799 8.91 519 12.18 NA NA NA NA NA

1992 4 369 2 297 5.26 304 6.96 NA NA NA NA NA

1993 4 480 2 353 5.25 514 11.47 NA NA NA NA NA

1994 4 595 2 196 4.78 413 8.99 41.9 15.0 NA 23.5 21.11

1995 4 716 1 318 2.79 231 4.90 52.4 19.5 NA 20.3 9.97

1996 4 841 1 105 2.28 701 14.48 51.6 20.8 NA 6.0 8.68

1997 4 970 1 004 2.02 547 11.00 56.5 32.5 NA 11.9 13.08

1998 5 104 1 033 2.02 572 11.21 54.0 18.4 NA 7.9 8.82

1999 5 241 504 0.96 713 13.61 44.6 25.5 NA 3.8 5.15

2000 5 379 370 0.69 338 6.28 49.1 26.3 NA 3.8 2.42

2001 5 519 394 0.71 369 6.69 59.6 17.9 NA 6.0 3.99

2002 5 660 628 1.11 552 9.75 43.8 21.2 NA 10.3 10.07

2003 5 803 338 0.58 263 4.53 51.7 22.1 NA 5.3 2.41

2004 5 948 440 0.74 274 4.61 54.4 29.6 NA 10.6 4.88

2005 6 095 538 0.88 381 6.25 53.5 28.6 NA 14.4 9.02

2006 6 245 305 0.49 223 3.57 65.0 27.8 NA 7.2 2.56

2007 6 396 452 0.71 270 4.22 61.9 20.0 37.8 7.4 3.13

2008 6 549 614 0.94 432 6.60 64.1 28.7 36.6 7.4 4.89

2009 6 703 622 0.93 435 6.49 60.7 30.3 40.7 7.8 5.07

2010 6 858 580 0.85 281 4.10 68.0 28.1 33.8 5.0 2.04

2011 7 014 548 0.78 302 4.31 76.8 28.5 33.8 2.0 0.86

2012 7 170 592 0.83 276 3.85 79.7 20.3 33.3 4.0 1.53

2013 7 327 650 0.89 381 5.20 78.2 21.3 33.6 2.4 1.23

2014 7 486 519 0.69 540 7.21 80.7 25.6 35.0 4.4 3.21

2015 7 645 658 0.86 388 5.08 85.6 30.4 43.3 10.8 5.49

2016 8 272 439 0.53 356 4.31 75.6 25.0 39.3 10.4 4.48

2017 8 438 632 0.75 583 6.93 78.4 33.1 37.4 7.7 5.35

2018 8 606 626 0.73 502 5.83 82.1 27.3 39.2 5.2 3.02

100


PHILIPPINES

Population

106 651 394 (2018)

Background

• The disease has been present for many decades. • Since 1982 there has been a steady decline in prevalence. • The leprosy programme is integrated. • MDT was launched in 1983 in two provinces (Cebu and Ilocos Norte) and expanded nationwide

from 1986 to 1989. • Case finding is mainly passive. • Special projects such as LECs, mini-LECs and SAPELs have been conducted in high- prevalence

provinces and hard-to-reach populations and areas. • The American Leprosy Mission, the Sasakawa Memorial Health Foundation (Japan) and the

Philippine Leprosy Mission have provided support to the programme.

Elimination target

• Reached in 1998 and sustained since. • Subnational elimination at regional level was reached by 2001. • Fifteen provinces and two cities are yet to achieve elimination as of 2001.

Epidemiology

• The prevalence rate considerably decreased in the 1980s and 1990s, and it has been kept below the elimination level since 1998.

• The new case detection rate increased in the late 1980s. After reaching the peak in 1991, the rate has steadily declined from 11.3 to 2.0 per 100 000 population for the last two decades.

• The proportion of MB cases has gradually increased over the years. Around 90% of new cases are MB cases in recent years.


• Efforts are being made to achieve elimination at the subnational level. • Intensified IEC activities, as well as on-the-job and refresher training, are being carried out to

sustain leprosy awareness in the community and among general health staff. • Plans are underway to start a post-elimination surveillance system in selected provinces.

101

Part II. Country ProfIles : PhIlIPPInes

Leprosy profile in the Philippines


Adult Child



02468

0

5

10

15

02468

101214

020406080

100120

0

2000

4000

6000

0

2000

4000

6000

0

1

2

3

4

0

5

10

15

02468

10

010203040

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00Ne

w ca

ses p

er 10

0 000

Num

ber

New

case

s per

milli

onPe

rcent

age (

%)

New

case

s per

100 0

00Pe

rcent

age (

%)

Num

ber

Perce

ntag

e (%

)Pe

rcent

age (

%)

Target

Target









102


Leprosy indicators in the Philippines

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 51 455 37 323 7.25 1 730 3.36 49.0 14.6 NA NA NA

1984 52 874 37 377 7.07 1 726 3.26 49.0 14.5 NA NA NA

1985 54 324 38 814 7.14 1 139 2.10 49.0 14.3 NA NA NA

1986 55 804 38 570 6.91 2 185 3.92 52.0 14.5 NA NA NA

1987 57 313 35 281 6.16 2 748 4.79 55.0 14.5 NA NA NA

1988 58 844 36 972 6.28 2 442 4.15 63.0 NA NA NA NA

1989 60 391 31 947 5.29 4 163 6.89 65.0 NA NA NA NA

1990 61 629 20 280 3.29 5 725 9.29 NA NA NA NA NA

1991 63 147 17 347 2.75 7 169 11.35 NA NA NA NA NA

1992 64 659 15 317 2.37 5 896 9.12 NA NA NA NA NA

1993 66 174 15 441 2.33 3 442 5.20 NA NA NA NA NA

1994 67 703 16 486 2.44 4 450 6.57 NA NA NA NA NA

1995 69 255 11 674 1.69 3 988 5.76 78.8 NA NA NA NA

1996 70 831 8 659 1.22 4 081 5.76 83.7 8.3 NA 0.0 0.00

1997 72 427 8 749 1.21 4 942 6.82 80.6 8.0 NA 5.1 3.48

1998 74 041 7 005 0.95 3 490 4.71 82.4 7.6 NA 5.5 2.59

1999 75 670 4 786 0.63 3 736 4.94 82.8 7.7 NA 4.8 2.37

2000 77 310 4 320 0.56 3 379 4.37 86.6 6.3 NA 7.2 3.14

2001 78 964 3 816 0.48 2 669 3.38 89.2 5.1 NA 2.3 0.77

2002 80 630 3 334 0.41 2 479 3.07 90.5 4.3 NA 1.9 0.58

2003 82 294 3 334 0.41 2 397 2.91 91.0 5.3 NA 3.7 1.07

2004 83 937 3 287 0.39 2 254 2.69 89.8 6.1 NA 4.6 1.23

2005 85 546 3 096 0.36 3 130 3.66 94.3 5.1 NA 1.5 0.55

2006 87 116 3 787 0.43 2 517 2.89 90.5 7.9 NA 2.9 0.85

2007 88 653 2 279 0.26 2 514 2.84 61.3 3.8 20.0 2.7 0.78

2008 90 173 3 338 0.37 2 373 2.63 90.3 4.6 12.0 1.9 0.50

2009 91 703 7 102 0.77 1 880 2.05 93.4 7.6 31.5 5.4 1.10

2010 93 261 2 873 0.31 2 041 2.19 93.9 4.6 20.0 4.2 0.92

2011 94 852 2 701 0.28 1 818 1.92 91.2 7.3 36.6 5.9 1.13

2012 96 471 2 485 0.26 2 150 2.23 91.6 6.9 32.7 4.0 0.89

2013 98 113 2 963 0.30 1 729 1.76 92.7 6.8 30.2 4.2 0.73

2014 99 765 3 655 0.37 1 655 1.66 91.7 7.6 30.7 3.4 0.56

2015 101 421 2 559 0.25 1 617 1.59 92.2 8.1 28.2 3.7 0.59

2016 103 664 4 316 0.41 1 721 1.64 88.3 5.2 34.2 4.0 0.65

2017 105 173 4 126 0.39 1 908 1.79 87.0 6.7 33.3 1.9 0.34

2018 106 651 4 970 0.47 2 176 2.04 89.9 6.8 33.6 2.3 0.48

103

Part II. Country ProfIles : rePuBlIC of Korea

REPUBLIC OF KOREA

Population

51 171 706 (2018)

Background

• The Korean Leprosy Control Association coordinates the programme. • Modified MDT was launched in 1982 (intensive phase with daily rifampicin and continuation until

skin smears are negative).

Elimination target

• Leprosy has not been a public health problem.Epidemiology

• The new case detection rate decreased dramatically in the early 1980s. After several years of stagnation in the late 1980s and early 1990s, it again dropped in 1995. The rate has been lower than 0.1 per 100 000 population since 2005, but five to seven new cases are still being reported every year.

• The prevalence rate has gradually decreased over the years. Despite the small number of new cases, in relative terms a large number of cases have been registered in recent years.

• New cases were rarely reported in children.


• Besides treatment of the few newly detected cases, patients requiring care for disabilities are maintained on a register and followed up in settlement villages.

104


Leprosy profile in the Republic of Korea


Adult Child



0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.00.20.40.60.81.0

020406080

100120

050

100150200250300350

050

100150200250300350

0.00.20.40.60.81.0

02468

10

0

20

40

60

80

020406080

100

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)









105

Part II. Country ProfIles : rePuBlIC of Korea

Leprosy indicators in the Republic of Korea

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 39 295 NA NA 345 0.88 NA NA NA NA NA

1984 39 913 NA NA 293 0.73 NA NA NA NA NA

1985 40 502 NA NA 195 0.48 NA NA NA NA NA

1986 41 059 NA NA 142 0.35 NA NA NA NA NA

1987 41 588 NA NA 131 0.31 NA NA NA NA NA

1988 42 085 NA NA 157 0.37 59.2 1.3 NA 22.9 0.86

1989

1990 42 980 1 637 0.38 157 0.37 61.8 NA NA NA NA

1991

1992 43 729 1 469 0.34 136 0.31 75.0 NA NA 11.8 0.37

1993 44 057 1 309 0.30 130 0.30 63.8 NA NA 5.4 0.16

1994 44 366 1 209 0.27 113 0.25 62.8 0.9 NA 12.4 0.32

1995 44 662 1 126 0.25 39 0.09 66.7 0.0 NA 15.4 0.13

1996 44 950 1 072 0.24 39 0.09 59.0 0.0 NA 5.1 0.04

1997 45 228 707 0.16 34 0.08 79.4 0.0 50.0 2.9 0.02

1998 45 495 595 0.13 39 0.09 64.1 0.0 51.3 5.1 0.04

1999 45 749 551 0.12 21 0.05 61.9 0.0 42.9 23.8 0.11

2000 45 988 535 0.12 35 0.08 65.7 0.0 45.7 28.6 0.22

2001 46 211 581 0.13 36 0.08 83.3 0.0 47.2 16.7 0.13

2002 46 421 543 0.12 22 0.05 90.9 0.0 50.0 31.8 0.15

2003 46 625 518 0.11 17 0.04 94.1 0.0 52.9 17.6 0.06

2004 46 831 493 0.11 17 0.04 88.2 0.0 76.5 35.3 0.13

2005 47 044 420 0.09 15 0.03 100.0 6.7 60.0 26.7 0.09

2006 47 268 388 0.08 15 0.03 93.3 0.0 40.0 46.7 0.15

2007 47 499 363 0.08 12 0.03 83.3 0.0 41.7 50.0 0.13

2008 47 734 332 0.07 7 0.01 85.7 0.0 85.7 42.9 0.06

2009 47 964 312 0.07 5 0.01 100.0 0.0 80.0 60.0 0.06

2010 48 184 283 0.06 6 0.01 100.0 0.0 33.3 33.3 0.04

2011 48 391 265 0.05 7 0.01 57.1 0.0 28.6 14.3 0.02

2012 48 588 255 0.05 5 0.01 60.0 0.0 20.0 20.0 0.02

2013 48 775 210 0.04 7 0.01 85.7 0.0 28.6 42.9 0.06

2014 48 952 199 0.04 6 0.01 83.3 0.0 33.3 33.3 0.04

2015 49 120 190 0.04 2 0.00 50.0 NA 50.0 50.0 0.02

2016 50 983 166 0.03 4 0.01 75.0 0.0 50.0 25.0 0.02

2017 51 096 125 0.02 3 0.01 100.0 0.0 33.3 0.0 0.00

2018 51 172 129 0.03 6 0.01 100.0 0.0 16.7 16.7 0.02

106


SAMOA

Population

196 129 (2018)

Background

• The leprosy programme is partially integrated and supervised by the TB and leprosy section of the Public Health Division of the Ministry of Health.

• MDT was launched in 1985. • Case finding is mainly passive.

Elimination target

• The elimination target was first reached in 1993 but has fluctuated for several years since then. However, the prevalence rate has been kept below the elimination level since 2000.

Epidemiology

• The prevalence rate decreased in the 1990s and it has been lower than 1 per 10 000 population since 2000.

• The new case detection rate has been fluctuating in the range between 2.6 and 12.0 per 100 000 population due to the small population.

• The number and rate of new cases with Grade 2 disability have decreased in recent years compared with the late 1990s and early 2000s.

• The proportion of MB cases remains high, indicating delays in diagnosis.


• Besides closely monitoring the leprosy situation and treating newly detected patients, efforts are being made to sustain leprosy awareness in the community and among health staff through intensified IEC activities and refresher training.

107

Part II. Country ProfIles : samoa

Leprosy profile in Samoa

Adult Child



0.00.51.01.52.02.53.0

0

5

10

15

02468

101214

020406080

100120

0

5

10

15

20

0

5

10

15

20

0

20

40

60

01020304050

020406080

100120

020406080

100

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









108


Leprosy indicators in Samoa

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1985 160 NA NA 15 9.37 53.3 20.0 NA NA NA

1986 161 NA NA 16 9.96 62.5 6.3 NA NA NA

1987 161 NA NA 19 11.80 57.9 5.3 NA NA NA

1988 161 NA NA 11 6.81 27.3 9.1 NA NA NA

1989 162 NA NA 18 11.11 27.8 16.7 NA NA NA

1990 161 36 2.23 13 8.06 15.4 38.5 NA NA NA

1991 163 34 2.09 10 6.15 40.0 20.0 NA NA NA

1992 164 25 1.53 9 5.49 77.8 0.0 NA NA NA

1993 165 14 0.85 5 3.03 60.0 0.0 NA NA NA

1994 167 20 1.20 10 6.00 70.0 0.0 NA NA NA

1995 168 21 1.25 13 7.73 76.9 15.4 NA NA NA

1996 170 19 1.12 13 7.65 92.3 7.7 NA 23.1 17.65

1997 172 16 0.93 13 7.57 53.8 7.7 NA 0.0 0.00

1998 174 16 0.92 19 10.95 57.9 21.1 NA 31.6 34.57

1999 175 20 1.14 21 11.99 76.2 9.5 NA 38.1 45.67

2000 177 4 0.23 5 2.83 100.0 0.0 NA 100.0 28.32

2001 178 17 0.96 13 7.32 76.9 7.7 NA 76.9 56.29

2002 178 8 0.45 12 6.72 66.7 8.3 NA 16.7 11.21

2003 179 13 0.73 11 6.14 90.9 9.1 NA 72.7 44.66

2004 180 8 0.45 10 5.56 50.0 10.0 NA 20.0 11.13

2005 180 5 0.28 7 3.88 100.0 28.6 NA 28.6 11.10

2006 181 4 0.22 5 2.77 NA NA NA NA NA

2007 181 4 0.22 5 2.76 NA NA NA NA NA

2008 182 5 0.28 6 3.30 83.3 33.3 33.3 0.0 0.00

2009 182 4 0.22 5 2.74 100.0 0.0 20.0 0.0 0.00

2010 183 13 0.71 12 6.55 91.7 16.7 25.0 25.0 16.39

2011 184 12 0.65 8 4.35 87.5 12.5 50.0 0.0 0.00

2012 185 12 0.65 8 4.33 100.0 12.5 25.0 NA NA

2013 186 3 0.16 12 6.46 50.0 16.7 50.0 16.7 10.77

2014 187 12 0.64 8 4.29 100.0 12.5 12.5 12.5 5.36

2015 188 7 0.37 6 3.20 100.0 33.3 83.3 0.0 0.00

2016 195 14 0.71 11 5.60 90.9 0.0 0.0 18.2 10.18

2017 195 0 0.00 0 0.00 NA NA NA NA 0.00

2018 196 6 0.31 5 2.55 60.0 0.0 0.0 0.0 0.00

109

Part II. Country ProfIles : sIngaPore

SINGAPORE

Population

5 757 499 (2018)

Background

• MDT was launched in 1982.

Elimination target

• Reached in 1997 and sustained since.

Epidemiology

• The prevalence rate largely decreased in the early 1990s. Since 1997, the rate has been kept below the elimination level.

• The new case detection rate also decreased in the early 1990s. New cases are nonetheless being reported every year, ranging from five to 20 cases per year for more than a decade.

• No child cases have been reported since 2003, except for one case in 2014. • No new cases with Grade 2 disability have been reported since 1995.


• With effective chemotherapy, leprosy is curable today and patients are now treated in the general health services alongside other diseases.

• Currently, the Cutaneous Infections Unit of the National Skin Centre undertakes the treatment of leprosy based on WHO therapeutic guidelines.

110


Leprosy profile in Singapore


Adult Child



0123456

0

1

2

3

4

5

0

1

2

3

4

020406080

100120

020406080

100120

020406080

100120

0.0

0.2

0.4

0.6

0.8

0

5

10

15

20

0

2

4

6

8

10

0

20

40

60

80

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









111

Part II. Country ProfIles : sIngaPore

Leprosy indicators in Singapore

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1990 3 017 NA NA 32 1.06 68.8 0.0 34.4 6.3 0.66

1991 3 099 1 406 4.54 24 0.77 NA 8.3 33.3 NA NA

1992 3 191 1 171 3.67 119 3.73 16.0 1.7 26.9 NA NA

1993 3 287 1 063 3.23 30 0.91 33.3 6.7 16.7 3.3 0.30

1994 3 385 NA NA 22 0.65 NA 0.0 45.5 NA NA

1995 3 482 747 2.15 42 1.21 38.1 0.0 26.2 0.0 0.00

1996 3 577 NA NA 30 0.84 NA 0.0 30.0 NA NA

1997 3 671 44 0.12 22 0.60 18.2 0.0 31.8 0.0 0.00

1998 3 761 45 0.12 12 0.32 41.7 0.0 50.0 0.0 0.00

1999 3 845 43 0.11 33 0.86 27.3 12.1 39.4 0.0 0.00

2000 3 919 30 0.08 13 0.33 15.4 0.0 46.2 0.0 0.00

2001 3 981 28 0.07 14 0.35 35.7 0.0 35.7 0.0 0.00

2002 4 032 25 0.06 18 0.45 5.6 5.6 27.8 0.0 0.00

2003 4 086 23 0.06 20 0.49 20.0 0.0 10.0 0.0 0.00

2004 4 160 21 0.05 18 0.43 16.7 0.0 44.4 0.0 0.00

2005 4 266 25 0.06 13 0.30 0.5 0.0 38.5 0.0 0.00

2006 4 410 NA NA 16 0.36 NA 0.0 43.8 NA NA

2007 4 585 NA NA 7 0.15 NA 0.0 14.3 NA NA

2008 4 772 18 0.04 5 0.10 100.0 0.0 20.0 0.0 0.00

2009 4 946 12 0.02 9 0.18 22.2 0.0 11.1 0.0 0.00

2010 5 086 15 0.03 13 0.26 46.2 0.0 38.5 0.0 0.00

2011 5 188 11 0.02 16 0.31 75.0 0.0 43.8 NA NA

2012 5 256 15 0.03 15 0.29 73.3 0.0 26.7 0.0 0.00

2013 5 301 8 0.02 12 0.23 66.7 0.0 41.7 0.0 0.00

2014 5 337 4 0.01 6 0.11 50.0 16.7 50.0 0.0 0.00

2015 5 375 3 0.01 3 0.06 33.3 0.0 66.7 0.0 0.00

2016 5 654 7 0.01 7 0.12 42.9 0.0 14.3 0.0 0.00

2017 5 708 11 0.02 6 0.10 66.7 0.0 16.7 0.0 0.00

2018 5 757 6 0.01 6 0.10 66.7 0.0 33.3 0.0 0.00

112


SOLOMON ISLANDS

Population

652 857 (2018)

Background

• The leprosy programme has been coordinated with the TB programme both at the national and provincial levels. Leprosy services were integrated into general health services in 1982 through the health system strengthening programme.

• MDT was introduced in 1986. • Case detection has been intensified through contact tracing, screening in hotspots and

disseminating leprosy information. Active case finding activities were implemented in 2009, 2013 and 2014.

• Stigma associated with leprosy was common in the past. However, it has been reduced in recent years due to intensified education on leprosy in communities and schools.

Elimination target

• The National Leprosy Control Programme achieved elimination status in 1994. Although the prevalence rate was slightly above the pre-elimination level in 1997, it has been sustained as of 2018.

Epidemiology

• The prevalence rate has been kept below the elimination level since 1998. • The new case detection rate has fluctuated widely between 1.1 and 7.2 per 100 000 population

since 1998. The fluctuation was the result of intensified active case finding during the high peak years. This implied that a number of cases remain undetected in post-endemic villages, communities and settlements, particularly in Honiara.

• The proportion of MB among new cases remains continuously high, ranging from 42.9% to 85.7%.


• Efforts are being undertaken to further reduce the disease burden due to leprosy and achieve elimination at the subnational level. Securing sufficient funding for the programme and building health staff capacity will be key to accomplishing these targets.

• The Pacific Leprosy Foundation and other nongovernmental organizations (NGOs) have offered continuous support to case finding and case management activities.

• Patients on treatment are subject to review every three months in order to check on their medication, compliance, reactions and clinical improvement.

• Disabled patients are managed collaboratively by the Leprosy Programme and community-based rehabilitation. Patients with disability are closely monitored from pretreatment to post-treatment periods in order to facilitate early disability management and rehabilitation.

113

Part II. Country ProfIles : solomon Islands

Leprosy profile in Solomon Islands


Adult Child



0.00.51.01.52.02.5

0

5

10

15

20

0

5

10

15

020406080

100

01020304050

01020304050

02468

10

0

20

40

60

05

1015202530

020406080

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









114


Leprosy indicators in Solomon Islands

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 255 NA NA 38 14.93 63.2 28.9 21.1 0.0 0.00

1984 263 NA NA 27 10.28 77.8 33.3 51.9 3.7 3.81

1985 271 NA NA 38 14.03 73.7 15.8 34.2 5.3 7.39

1986 279 NA NA 21 7.53 81.0 19.0 42.9 9.5 7.17

1987 287 NA NA 23 8.02 52.2 8.7 52.2 4.3 3.49

1988 295 NA NA 24 8.14 54.2 12.5 62.5 4.2 3.39

1989 303 NA NA 44 14.51 22.7 11.4 43.2 4.5 6.60

1990 310 NA NA 19 6.14 84.2 26.3 57.9 5.3 3.23

1991 318 NA NA 21 6.60 81.0 4.8 57.1 9.5 6.28

1992 328 NA NA 15 4.58 80.0 6.7 60.0 0.0 0.00

1993 337 66 1.96 8 2.37 50.0 0.0 37.5 0.0 0.00

1994 347 35 1.01 9 2.60 77.8 0.0 66.7 0.0 0.00

1995 356 24 0.67 10 2.81 80.0 10.0 60.0 0.0 0.00

1996 366 36 0.98 25 6.82 64.0 28.0 44.0 12.0 8.19

1997 377 42 1.12 21 5.58 47.6 33.3 47.6 4.8 2.66

1998 387 21 0.54 21 5.43 52.4 14.3 52.4 9.5 5.17

1999 398 8 0.20 12 3.02 50.0 41.7 16.7 8.3 2.51

2000 409 8 0.20 12 2.94 50.0 41.7 16.7 8.3 2.45

2001 420 7 0.17 7 1.67 42.9 0.0 0.0 0.0 0.00

2002 432 26 0.60 26 6.02 57.7 26.9 42.3 0.0 0.00

2003 444 5 0.11 5 1.13 60.0 20.0 60.0 0.0 0.00

2004 457 5 0.11 24 5.25 20.8 20.8 45.8 0.0 0.00

2005 470 21 0.45 25 5.32 64.0 36.0 44.0 0.0 0.00

2006 483 9 0.19 20 4.14 45.0 0.0 40.0 0.0 0.00

2007 496 12 0.24 15 3.02 53.3 13.3 73.3 0.0 0.00

2008 510 14 0.27 17 3.33 82.4 17.6 29.4 0.0 0.00

2009 524 21 0.40 30 5.72 56.7 46.7 50.0 0.0 0.00

2010 538 12 0.22 14 2.60 85.7 21.4 50.0 0.0 0.00

2011 552 3 0.05 9 1.63 77.8 11.1 33.3 0.0 0.00

2012 566 11 0.19 13 2.29 84.6 46.2 23.1 15.4 3.53

2013 581 38 0.65 30 5.17 60.0 56.7 43.3 13.3 6.89

2014 595 41 0.69 48 8.06 52.1 25.0 31.3 10.4 8.40

2015 610 32 0.52 13 2.13 46.2 30.8 38.5 23.1 4.92

2016 619 43 0.70 43 7.03 69.8 16.3 41.9 4.7 3.27

2017 636 48 0.77 41 6.58 65.9 22.0 36.6 12.2 8.02

2018 653 41 0.63 47 7.20 61.7 21.3 42.6 6.4 4.60

115

Part II. Country ProfIles : toKelau

TOKELAU

Population

1319 (2018)

Background

• The leprosy programme is integrated. • MDT was launched in 1990.

Elimination target

• Not a public health problem.

Epidemiology

• One new case was detected in 1991 and another in 1992. No prevalent and new cases have been reported for the last two decades.


• Not applicable.

116


Leprosy profile in Tokelau

Adult Child



0

2

4

6

8

0

20

40

60

80

0

20

40

60

80

02468

10

0.00.20.40.60.81.0

0.00.20.40.60.81.0

0.000.020.040.060.080.10

02468

10

02468

10

02468

10

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









117

Part II. Country ProfIles : toKelau

Leprosy indicators in Tokelau

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion


1991 2 NA NA 1 63.49 0.0 NA NA NA NA

1992 2 1 6.45 1 64.47 0.0 NA NA NA NA

1993

1994 2 0 0.00 0 0.00 NA NA NA NA NA

1995 2 0 0.00 0 0.00 NA NA NA NA NA

1996

1997 2 0 0.00 0 0.00 NA NA NA NA NA

1998 2 0 0.00 0 0.00 NA NA NA NA NA

1999 2 0 0.00 0 0.00 NA NA NA NA NA

2000 2 0 0.00 0 0.00 NA NA NA NA NA

2001 1 0 0.00 0 0.00 NA NA NA NA NA

2002 1 0 0.00 0 0.00 NA NA NA NA 0.00

2003 1 0 0.00 0 0.00 NA NA NA NA 0.00

2004 1 0 0.00 0 0.00 NA NA NA NA NA

2005 1 0 0.00 0 0.00 NA NA NA NA 0.00


2007

2008 1 0 0.00 0 0.00 NA NA NA NA 0.00

2009 1 0 0.00 0 0.00 NA NA NA NA 0.00

2010 1 0 0.00 0 0.00 NA NA NA NA 0.00

2011 1 0 0.00 0 0.00 NA NA NA NA 0.00

2012 1 0 0.00 0 0.00 NA NA NA NA 0.00

2013 1 0 0.00 0 0.00 NA NA NA NA 0.00

2014

2015

2016 1 0 0.00 0 0.00 NA NA NA NA 0.00

2017 1 0 0.00 0 0.00 NA NA NA NA 0.00

2018 1 0 0.00 0 0.00 NA NA NA NA 0.00

118


TONGA

Population

103 197 (2018)

Background

• The programme is integrated into the activities of the General Hospital. • The Medical Officer for Communicable Diseases is responsible for the leprosy control programme. • Case finding is passive. • MDT was launched in 1986.

Elimination target


Epidemiology

• A few cases have been sporadically reported. • Most recently, three new cases were detected in 2011 and one new case in 2018.


• Not applicable.

119

Part II. Country ProfIles : tonga

Leprosy profile in Tonga

Adult Child



0.00.20.40.60.81.0

0

1

2

3

0.00.51.01.52.02.53.03.5

020406080

100120

0.00.51.01.52.02.53.0

0.00.51.01.52.02.53.0

02468

1012

02468

10

0

10

20

30

40

02468

10

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









120


Leprosy indicators in Tonga

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion









1991 95 2 0.21 1 1.05 100.0 NA NA NA NA

1992 95 1 0.10 0 0.00 NA NA NA NA NA

1993 96 1 0.10 0 0.00 NA NA NA NA NA

1994

1995 96 2 0.21 0 0.00 NA NA NA NA NA

1996

1997 97 1 0.10 1 1.04 100.0 0.0 NA 0.0 0.00

1998 97 2 0.21 1 1.03 100.0 0.0 NA 0.0 0.00

1999 97 2 0.21 0 0.00 NA NA NA NA NA

2000 98 0 0.00 0 0.00 NA NA NA NA NA


2002 99 0 0.00 0 0.00 NA NA NA NA 0.00

2003 100 0 0.00 0 0.00 NA NA NA NA 0.00

2004 100 0 0.00 1 1.00 0.0 0.0 NA 0.0 0.00

2005 101 0 0.00 0 0.00 NA NA NA NA 0.00

2006 102 0 0.00 0 0.00 NA NA NA NA NA

2007 102 0 0.00 0 0.00 NA NA NA NA NA

2008 103 0 0.00 0 0.00 NA NA NA NA 0.00

2009 104 0 0.00 0 0.00 NA NA NA NA 0.00

2010 104 0 0.00 0 0.00 NA NA NA NA 0.00

2011 105 3 0.29 3 2.87 100.0 NA NA 33.3 9.57

2012 105 3 0.29 0 0.00 NA NA NA NA NA

2013

2014

2015

2016 101 0 0.00 0 0.00 NA NA NA NA 0.00

2017 102 0 0.00 0 0.00 NA NA NA NA 0.00

2018 103 1 0.10 1 0.97 100.0 0.0 0.0 0.0 0.00

121

Part II. Country ProfIles : tuvalu

TUVALU

Population

11 508 (2018)

Background

• The leprosy programme is integrated. • MDT was started in 1984. Prednisolone may be added to MDT. • Active case finding is undertaken occasionally in schools and highly endemic islands. There has

been support from the Pacific Leprosy Foundation.

Elimination target

• The elimination target for countries with small populations (less than 10 prevalent cases) has been maintained for more than 20 years.

Epidemiology

• A few new cases continue to be reported sporadically, ranging from one to eight cases annually. • Previously, the disease was detected only among the family members of a patient, but recently it

has been detected among people who have been exposed to it in public. • A new case with Grade 2 disability was first detected in 2015 by a visiting team (not detected by

local health workers), and treated with MDT and prednisolone.


• Not applicable.

122


Leprosy profile in Tuvalu

Adult Child



02468

10

020406080

100

020406080

100

020406080

100120

0

2

4

6

8

0

2

4

6

8

0.000.020.040.060.080.10

020406080

100120

02468

10

01020304050

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target









123

Part II. Country ProfIles : tuvalu

Leprosy indicators in Tuvalu

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1990 9 0 0.00 0 0.00 NA NA NA NA NA

1991

1992 9 2 2.20 0 0.00 NA NA NA NA NA

1993 9 2 2.19 2 21.88 NA NA NA NA NA

1994 9 3 3.27 3 32.67 100.0 0.0 NA 0.0 0.00

1995 9 3 3.25 0 0.00 NA NA NA NA 0.00

1996 9 1 1.08 1 10.80 100.0 0.0 NA 0.0 0.00

1997

1998

1999

2000 9 0 0.00 0 0.00 NA NA NA NA NA

2001 9 0 0.00 0 0.00 NA NA NA NA NA

2002 10 0 0.00 0 0.00 NA NA NA NA 0.00

2003 10 0 0.00 0 0.00 NA NA NA NA 0.00

2004 10 0 0.00 0 0.00 NA NA NA NA 0.00

2005 10 0 0.00 0 0.00 NA NA NA NA 0.00

2006 10 0 0.00 0 0.00 NA NA NA NA NA

2007 10 1 1.03 1 10.25 NA NA NA NA NA

2008 10 1 1.02 0 0.00 NA NA NA NA 0.00

2009 10 1 1.02 0 0.00 NA NA NA NA 0.00

2010 10 0 0.00 0 0.00 NA NA NA NA 0.00

2011 10 1 1.02 1 10.16 0.0 100.0 0.0 0.0 0.00

2012 10 3 3.04 3 30.42 100.0 0.0 0.0 0.0 0.00

2013 10 8 8.10 8 80.97 100.0 12.5 0.0 0.0 0.00

2014 10 3 3.03 0 0.00 NA NA NA NA 0.00

2015 10 5 5.03 3 30.19 66.7 0.0 0.0 0.0 0.00

2016 11 0 0.00 7 62.54 57.1 42.9 28.6 0.0 0.00

2017 11 3 2.66 3 26.58 33.3 33.3 33.3 0.0 0.00

2018 12 9 7.82 8 69.52 50.0 50.0 37.5 0.0 0.00

124


VANUATU

Population

292 680 (2018)

Background

• The leprosy programme is vertical at the national and district levels, and partially integrated at the provincial level.

• Case finding is mainly passive, with occasional community surveys. • MDT was launched in 1982. A modified MDT without dapsone was introduced due to the high

level of dapsone intolerance in Vanuatu.

Elimination target

• Reached in 1997 and sustained since.

Epidemiology

• The prevalence rate decreased considerably in the late 1990s. The rate has been kept below the elimination level since 1997.

• The new case detection rate decreased from 25 to 0.6 per 100 000 population with some fluctuations between 1983 and 1998. Since 1999, the rate has been stable at less than 4 per 100 000 population.

• The number of new cases detected has ranged from one to five for the last decade. • New cases with Grade 2 disability have not been reported since 1998. • Child cases have been reported sporadically.


• The detected cases are being treated and the situation is closely monitored. • Efforts are being made to sustain leprosy awareness in the community and among health staff

through health education and orientation training.

125

Part II. Country ProfIles : vanuatu

Leprosy profile in Vanuatu

Adult Child



0.00.51.01.52.0

05

1015202530

05

1015202530

020406080

100120

05

1015202530

05

1015202530

0

2

4

6

8

020406080

100120

0

5

10

15

20

020406080

100

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

Case

s reg

ister

ed pe

r 10 0

00

New

case

s per

100 0

00

New

case

s per

100 0

00

Perce

ntag

e (%

)

Num

ber

Num

ber

New

case

s per

milli

on

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Perce

ntag

e (%

)

Target

Target









126


Leprosy indicators in Vanuatu

Year

Popu

latio

n (0

00)

Regi

ster

ed

case

s

Prev

alen

ce

per 1

0 00

0

New

case

s

Dete

ctio

n pe

r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 124 NA NA 31 24.95 NA NA NA NA NA

1984 127 NA NA 28 22.03 NA NA NA NA NA

1985 130 NA NA 21 16.15 NA NA NA NA NA

1986 133 NA NA 15 11.27 NA NA NA NA NA

1987 136 NA NA 11 8.08 NA NA NA NA NA

1988 139 NA NA 11 7.89 NA NA NA NA NA

1989 143 NA NA 7 4.90 NA NA NA NA NA

1990 147 NA NA 10 6.82 NA NA NA NA NA

1991 151 15 0.99 7 4.64 28.6 NA NA NA NA

1992 155 23 1.48 17 10.95 52.9 5.9 NA 5.9 6.44

1993 160 29 1.81 14 8.76 14.3 7.1 NA 0.0 0.00

1994 164 16 0.97 3 1.83 66.7 33.3 NA 0.0 0.00

1995 168 20 1.19 14 8.32 35.7 14.3 NA 7.1 5.94

1996 172 20 1.16 7 4.07 28.6 0.0 NA 0.0 0.00

1997 175 8 0.46 6 3.43 66.7 16.7 NA 16.7 5.72

1998 178 4 0.22 1 0.56 100.0 0.0 NA 0.0 0.00

1999 181 2 0.11 2 1.10 50.0 50.0 NA 0.0 0.00

2000 185 5 0.27 3 1.62 66.7 0.0 NA 0.0 0.00

2001 190 2 0.11 1 0.53 100.0 0.0 NA 0.0 0.00

2002 195 8 0.41 6 3.08 83.3 16.7 NA 0.0 0.00

2003 200 11 0.55 7 3.50 42.9 28.6 NA 0.0 0.00

2004 206 11 0.54 3 1.46 66.7 66.7 NA 0.0 0.00

2005 211 2 0.09 0 0.00 NA NA NA NA 0.00

2006 217 0 0.00 3 1.38 NA NA NA NA NA

2007 222 4 0.18 3 1.35 NA NA NA NA NA

2008 228 0 0.00 0 0.00 NA NA NA NA 0.00

2009 234 5 0.21 5 2.14 60.0 40.0 40.0 0.0 0.00

2010 240 3 0.13 3 1.25 66.7 0.0 0.0 0.0 0.00

2011 246 4 0.16 2 0.81 100.0 NA NA NA NA

2012 252 3 0.12 3 1.19 66.7 0.0 NA NA NA

2013 258 NA NA 0 0.00 NA NA NA NA NA

2014 264 0 0.00 5 1.89 100.0 20.0 20.0 0.0 0.00

2015 270 1 0.04 1 0.37 100.0 100.0 0.0 0.0 0.00

2016 278 2 0.07 2 0.72 50.0 0.0 50.0 0.0 0.00

2017 286 2 0.07 2 0.71 100.0 0.0 50.0 0.0 0.00

2018 293 4 0.14 5 1.71 80.0 0.0 80.0 0.0 0.00

127

Part II. Country ProfIles : vIet nam

VIET NAM

Population

95 545 962 (2018)

Background

• The programme is vertical and the National Institute of Dermatology and Venereology in Hanoi is responsible for the programme at the central level.

• Activities are integrated into the general health system at the village level. • Special projects such as SAPELs and LECs were conducted from 1995 to detect and treat cases in

difficult-to-access areas and communities, as well as in highly endemic pockets. • The disease is unevenly distributed: 12 provinces in mountainous areas and four provinces on the

high plateau have been considered as highly endemic. • Case detection is mainly carried out through mass contact tracing and group screening. • MDT has been progressively used since 1982.

Elimination target

• Reached in 1995 and sustained since. • Subnational elimination was achieved in all provinces, except one, by the end of 2000.

Epidemiology

• The prevalence rate has gone steadily down over the last three decades, with a steep decline observed in the 1980s and early 1990s. The rate has been kept below the elimination level since 1995.

• Between 1983 and 1997, the new case detection rate fluctuated between 2.8 and 4.4 per 100 000 population. Since 1998, the rate has continuously decreased, reaching 0.1 per 100 000 population in 2018.

• The proportion of MB among new cases remains high at more than 80% in recent years. • The rate of new cases with Grade 2 disability was consistently high in the 1980s and early 1990s,

but it fell to below 1 case per million population in 2008.


• A five-year plan was developed in 2001 with the aim of further reducing prevalence and case detection rates and rehabilitating disabled leprosy patients with specific annual targets.

• Action was taken in 2001 to pilot a post-elimination surveillance system in selected provinces based on the protocol developed by WHO Regional Office for the Western Pacific.

• Efforts are being made to detect and treat all cases in endemic pockets at the sub-provincial level by intensifying IEC activities to sustain leprosy awareness in the community and among general health staff.

128


Leprosy profile in Viet Nam


Adult Child



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1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

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129

Part II. Country ProfIles : vIet nam

Leprosy indicators in Viet Nam

YearPo

pula

tion

(000

)

Regi

ster

ed

case

s

Prev

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ce

per 1

0 00

0

New

case

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Dete

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r 100

000

MB % Child

%

Fem

ale %

Disa

bilit

y %

Disa

bilit

y pe

r mill

ion

1983 58 277 36 616 6.28 2 021 3.47 NA 6.0 NA 41.0 14.23

1984 59 653 34 240 5.74 2 103 3.53 NA 4.0 NA 30.0 10.58

1985 61 049 30 750 5.04 2 062 3.38 NA 7.0 NA 32.0 10.81

1986 62 460 28 240 4.52 2 292 3.67 NA 8.0 NA 30.0 11.02

1987 63 881 26 750 4.19 2 183 3.42 NA 9.0 NA 28.0 9.56

1988 65 314 24 150 3.70 1 847 2.83 NA 8.0 NA 28.0 7.92

1989 66 757 23 463 3.51 2 073 3.11 NA 6.0 NA 28.0 8.69

1990 67 102 20 997 3.13 1 995 2.97 NA 7.0 NA 28.0 8.33

1991 68 536 18 342 2.68 2 500 3.65 NA NA NA 24.0 8.75

1992 69 988 9 449 1.35 3 142 4.49 68.0 8.0 NA 22.0 9.87

1993 71 417 7 320 1.02 3 185 4.46 55.0 7.0 NA 18.0 8.02

1994 72 769 7 419 1.02 3 173 4.36 66.0 5.0 NA 20.0 8.73

1995 74 008 5 277 0.71 2 591 3.50 65.2 8.6 35.7 30.1 10.53

1996 75 117 4 527 0.60 2 866 3.82 62.7 7.3 35.5 31.9 12.15

1997 76 111 4 665 0.61 2 807 3.69 64.1 5.7 36.4 30.5 11.23

1998 77 020 3 482 0.45 2 162 2.81 59.1 7.5 37.1 28.9 8.11

1999 77 891 2 077 0.27 1 795 2.30 59.7 6.9 37.7 25.1 5.78

2000 78 758 1 718 0.22 1 477 1.88 61.3 7.1 38.7 20.9 3.92

2001 79 630 1 532 0.19 1 336 1.68 61.5 5.8 37.2 20.0 3.35

2002 80 501 1 269 0.16 1 158 1.44 61.7 5.6 37.7 19.4 2.80

2003 81 377 1 204 0.15 949 1.17 62.2 5.5 35.7 18.9 2.20

2004 82 263 829 0.10 858 1.04 65.3 5.5 37.5 16.9 1.76

2005 83 161 656 0.08 746 0.90 60.6 6.3 36.1 16.2 1.46

2006 84 076 572 0.07 666 0.79 61.7 5.6 36.8 17.3 1.37

2007 85 007 506 0.06 552 0.65 68.3 4.5 32.2 18.5 1.20

2008 85 952 540 0.06 530 0.62 71.3 3.4 38.1 16.2 1.00

2009 86 901 350 0.04 413 0.48 71.4 2.9 27.6 18.9 0.90

2010 87 848 318 0.04 359 0.41 72.1 3.9 27.3 18.7 0.76

2011 88 792 322 0.04 374 0.42 71.9 2.9 32.4 21.4 0.90

2012 89 730 265 0.03 296 0.33 64.5 3.4 35.5 14.9 0.49

2013 90 657 225 0.02 260 0.29 69.2 5.4 31.5 17.3 0.50

2014 91 563 181 0.02 187 0.20 81.8 3.7 35.3 10.7 0.22

2015 92 443 174 0.02 178 0.19 80.3 2.8 29.8 17.4 0.34

2016 93 640 152 0.02 138 0.14 83.3 2.9 28.3 23.9 0.35

2017 94 601 248 0.03 109 0.11 83.5 1.8 34.9 23.9 0.27

2018 95 546 203 0.02 96 0.10 92.7 0.0 25.0 18.8 0.19

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WALLIS AND FUTUNA

Population

11 661 (2018)

Background

• Leprosy was not endemic in the country, although one new case was reported in 2009.

Elimination target


Epidemiology

• Data are not available before 2002. • One new case was reported in 2009.


• Not applicable.

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Part II. Country ProfIles : WallIs and futuna

Leprosy profile in Wallis and Futuna

Adult Child



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1983 1988 1993 1998 2003 2008 2013 2018 1983 1988 1993 1998 2003 2008 2013 2018

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132


Leprosy indicators in Wallis and Futuna

Year

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2002 14 0 0.00 0 0.00 NA NA NA NA 0.00

2003 14 0 0.00 0 0.00 NA NA NA NA 0.00

2004 14 0 0.00 0 0.00 NA NA NA NA 0.00

2005

2006

2007 14 0 0.00 NA NA NA NA NA NA NA

2008 14 0 0.00 0 0.00 NA NA NA NA 0.00

2009 14 1 0.73 1 7.30 100.0 0.0 0.0 0.0 0.00

2010 14 0 0.00 0 0.00 NA NA NA NA 0.00

2011

2012

2013 13 0 0.00 0 0.00 NA NA NA NA 0.00

2014

2015

2016 12 0 0.00 0 0.00 NA NA NA NA 0.00

2017 12 0 0.00 0 0.00 NA NA NA NA 0.00

2018 12 0 0.00 0 0.00 NA NA NA NA 0.00

133

Part III. Web-based Leprosy Dashboard

1. OverviewLeprosy surveillance data are reported annually from countries to the WHO Regional Office for the Western Pacific and then to the WHO Global Leprosy Programme, where the information is consolidated for a global leprosy report. Using the accumulated surveillance data, the Regional Office has developed a web-based Leprosy Dashboard that enables tabulation and visualization of all indicators and data presented in this epidemiological report. The Leprosy Dashboard is accessible to all and customizable according to the user’s preference. Figures and data generated by the Leprosy Dashboard can be downloaded.

The Leprosy Dashboard can be used for many purposes. For national leprosy elimination programmes, it can be used for assessing epidemiological trends, identifying programmatic gaps and for informed programmatic decision-making. International agencies, partner NGOs, donors and stakeholders may use the Leprosy Dashboard to find surveillance data for report writing and copying graphics for presentations.

2. Description of the Leprosy DashboardThe Leprosy Dashboard has four tabs: Profile, Dashboard, Table and Comparison.

The Profile tab generates four graphs showing key indicators of disease burden: 1) prevalence rate; 2) new case detection rate; 3) new case detection rate by disease type; and 4) new case detection rate for cases with Grade 2 disability. A control panel on the left-hand side has a select box, a tick box and several sliders that can be used to change a country selected, adjust year range of the data generated, enable an exponential fitting curve to show annual change, adjust year range of the fitting curve, and adjust the size of graphics.

The Dashboard tab generates a set of 10 graphs, including the proportion of MB cases, the number of cases with Grade 2 disability, the number of new cases in children, the proportion of new cases in children, the proportion of cases with Grade 2 disability and the proportion of new cases in females, in addition to the four graphs included in the Profile tab. The control panel enables the same customization as in the Profile tab.

The Table tab generates a country data table that includes all key indicators and raw data. The table can be sorted in ascending or descending order using a selected variable, and it can be downloaded as a comma-separated values (CSV) file.

The Comparison tab enables a comparison of a user-selected indicator, which can be selected from eight key leprosy indicators, across multiple countries, which can be selected from any countries and areas in the Region.

All graphics generated in the Leprosy Dashboard application can be downloaded as PDF files.

134


3. How to use the web-based DashboardAccess to the dashboard

• To open the web-based Leprosy Dashboard, access: https://wpro.shinyapps.io/leprosy_dashboard/

• When accessing the Leprosy Dashboard, the top page (below) will be displayed. The four tabs: Profile, Dashboard, Table and Comparison are shown in a red box. A green box indicates a main panel where graphs are generated. A purple box shows a control panel where users can select a country and adjust other settings.

Fig. 20. Top page of the web-based Leprosy Dashboard

https://wpro.shinyapps.io/leprosy_dashboard/

https://wpro.shinyapps.io/leprosy_dashboard/

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Part III. WeB-Based leProsy dashBoard

Profile tab

• The Philippines is selected as the default. Any country and area in the Western Pacific Region can be selected from the pull-down menu indicated in a red box. Once the country is selected, graphs will be automatically updated in the main panel.

Fig. 21a. Customization of the Profile tab of the Leprosy Dashboard

• Using the sliders in the red and green boxes, users can adjust the year range of the graphs and year range of the fitting curve for the new case detection rate. To disable the fitting curve, uncheck the checkbox in the green box of the control panel. Graphics are automatically updated every time users change the settings.

Fig. 21b. Customization of the Profile tab of the Leprosy Dashboard

136


• The size of the graphs, both width and height, can be adjusted by using sliders in the red box. The graphs generated in the main panel can be downloaded in an A4 PDF file by clicking “Download as PDF (A4)” (green box).

Fig. 21c. Customization of the Profile tab of the Leprosy Dashboard

137


Dashboard tab

• By clicking the Dashboard tab, a set of 10 graphs will be automatically displayed. In the same manner as the Profile tab, users can select a country and adjust other settings using the control panel (red box). The customization of the graphs is independent in each tab and not linked to the other tabs.

• To export all graphs in the main panel as an A4 PDF file, click “Download profile as PDF (A4)”. To export each graph in the main panel in a different page of PDF document, click “Download profile as PDF (slides)”.

Fig. 22. Snapshot of the Dashboard tab of the Leprosy Dashboard

Table tab

• By clicking the Table tab, the country data table will be automatically displayed.

Fig. 23. Snapshot of the Table tab of the Leprosy Dashboard

138


• A country can be selected from the pull-down menu (green box). To sort the data in ascending or descending order by a variable, click the upper or lower arrow beside a variable you want to sort by (red box). The table can be downloaded as a CSV file (purple box).

Fig. 24a. Customization of the Table tab of the Leprosy Dashboard

• The data may be displayed in multiple pages depending on the length. To see the next page, click “Next” or the next page number at the bottom right of the table (red box).

Fig. 24b. Customization of the Table tab of the Leprosy Dashboard

139


• The number of rows displayed in one page can be changed using a pull-down menu at the top of the table (red box).

Fig. 24c. Customization of the Table tab of the Leprosy Dashboard

Comparison tab

• By clicking the Comparison tab, the page below will be displayed as default.

Fig. 25. Snapshot of the Comparison tab of the Leprosy Dashboard

140


• First, choose an indicator for which you want to make a comparison from the list of eight indicators in the sidebar panel (green box). Second, click on a country selection box (red box) and add countries for which you want to make a comparison by typing a country’s name or choosing from the list that will appear when the box is selected. Graphs will be drawn for the selected country in different colours (red box). Up to eight countries can be compared using different colours. To remove the selected countries, click the country’s name and type “Delete” or “Back Space” key.

Fig. 26a. Customization of the Comparison tab of the Leprosy Dashboard

• Year range and graph size can be adjusted using sliders (red and green boxes, respectively). The graph can be downloaded as a PDF by clicking “Download as PDF(A4)” (purple box) on the top of the control panel.

Fig. 26b. Customization of the Comparison tab of the Leprosy Dashboard

141

AnnexesAnnex 1. Definitions1. A case of leprosy

A case of leprosy is a person, having one or more of the following, who has yet to complete a full course of treatment:

• hypopigmented or reddish skin lesion(s) with definite loss of sensation; • impairment or involvement of the peripheral nerves as demonstrated by: a) definite loss of

sensation; or b) weakness of hands/feet or face; or c) autonomic function disorders such as anhidrosis (dry skin) Presence of visible deformities; and

• signs of the disease with demonstrated presence of bacilli in skin smear or histopathological confirmation.

2. Prevalence and prevalence rate (registered cases)

• Prevalence: The number of cases registered for treatment at a given point of time. • Prevalence rate: The number of cases registered for treatment at given point of time per 10 000

population.

This indicator reflects the magnitude of the problem and helps in planning and evaluating control measures.

3. Detection and detection rate (newly detected cases)

• Detection: The number of cases newly detected during a given year and never treated before. • Detection rate: The number of cases newly detected during a given year per 100 000 population.

This indicator is most appropriate for estimating the true incidence of the disease in a given population when analysed in conjunction with the proportion of patients with Grade 2 disability among newly detected cases.

4. Elimination of leprosy as a public health problem

The elimination of leprosy as a public health problem means reducing the prevalence of leprosy to less than 1 case per 10 000 population. For countries with a small population, WHO Regional Office for the Western Pacific Region considers the elimination level to have been reached if the number of prevalent cases is less than 10.

5. Prevalence/detection (P/D) ratio (presented in the web-based dashboard)

This is the ratio of prevalence divided by the number of newly detected cases during a given year. It reflects the mean duration of registration of leprosy patients for treatment. Theoretically, if all patients were MB cases and received their 12 monthly doses of MDT within 18 months, the ratio of prevalence to detection would not exceed 1.5. A higher value for this ratio indicates that patients are treated for longer than necessary, do not complete treatment in time or that registers are not updated.

142


6. Proportion of children among newly detected cases

This is the proportion of newly detected cases aged less than 15 years among the total number of newly detected cases during a given year and expressed as a percentage. This indicator reflects the level of transmission of the disease over the last few years.

7. Proportion of MB patients among newly detected cases

This is the proportion of MB patients among the total number of newly detected cases during a given year and expressed as percentage.

8. Proportion of female patients among newly detected cases

This is the proportion of female patients among the total number of newly detected cases during a given year and expressed as percentage.

9. Proportion of patients with Grade 2 disability among newly detected cases

This is expressed in a given year as a percentage. This indicator reflects the effectiveness of the programme in terms of early case finding and the level of community awareness of the disease.

10. Rate of patients with Grade 2 disability among newly detected cases

This is the number of cases with Grade 2 disability at the time of detection/diagnosis during a given year per 1 000 000 population. This indicator reflects the effectiveness of the programme in terms of early case finding and the level of community awareness of the disease. Reduction of new leprosy cases with Grade 2 disability to less than one case per 1 000 000 population is one of the core targets in the Global Leprosy Strategy 2016–2020.

11. Number of patients with Grade 2 disability among newly detected paediatric cases

This is given as an absolute number of newly detected cases aged less than 15 years with Grade 2 disability. This indicator reflects the effectiveness of the programme in terms of early case finding and the level of transmission of the disease over the last few years. Zero Grade 2 disability among newly detected paediatric cases is one of the core targets in the Global Leprosy Strategy 2016–2020.

12. Foreign-born leprosy cases

This is given as an absolute number of newly detected cases that are foreign born. This indicator allows calculation of the true prevalence of leprosy within the country as well as the prevalence of leprosy among the migrant population.

13. Treatment completion rate, by MB and PB

This is calculated in a cohort analysis, in which MB cases registered for treatment two years before and PB cases registered one year before are followed up until completion of the prescribed period of MDT and expressed as percentage. This indicator reflects the effectiveness of the programme in terms of achieving treatment compliance of patients.

14. Number of relapses among all leprosy-notified cases

This is given as an absolute number of all cases treated as relapse after treatment with MDT. This indicator reflects the effectiveness of treatment. The important predisposing factors for relapse include the presence of persisting or antimicrobial resistant bacilli, monotherapy and inadequate/irregular therapy.

143

annexes

Annex 2. Source of the dataThis leprosy epidemiological report was developed through the compilation of all historical leprosy data in the WHO Western Pacific Region. In the process of developing this present report, the historical leprosy data were reviewed and validated by national leprosy elimination programmes to ensure consistency with the nationally available data. The data presented in this report may therefore contradict with the data presented in previous WHO reports. The following countries and areas of the Region participated in the review and validation of historical data.

• Australia • Brunei Darussalam • Cambodia • Hong Kong SAR (China) • Japan • Macao SAR (China) • Malaysia

• Mongolia • New Zealand • Papua New Guinea • Singapore • Solomon Islands • Tuvalu • Viet Nam

Population data used for calculating new case detection rates and prevalence rates were sourced from the Population Division of the United Nations Department of Economic and Social Affairs. Programmatic information in the Country Profiles section was sourced from the previous WHO report Overview and epidemiological review of leprosy in the WHO Western Pacific Region, 1991–2001, published in 2003, with some updates reviewed by national leprosy programmes. In addition to the annual statistics on leprosy, the previous report sourced programmatic information from the following:

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

• Documents published by the WHO Regional Office for the Western Pacific, including socioeconomic and health indicators. Extensive use was made of the assignment reports to the WHO Regional Office on leprosy provided by most countries for 1983 to 2001.

• Articles in international medical journals, as available. • Unpublished reports: Unpublished data on leprosy collected by WHO, particularly during

international meetings, were also used.

144


Annex 3. List of countries/areas for which leprosy data were not available

Year Number of countries/areas

List of countries/areas for which leprosy data were not available

1983 13 China, Cook Islands, Cambodia, Hong Kong SAR (China),Kiribati, Lao People’s Democratic Republic, Micronesia (Federated States of), Mongolia, Niue, Singapore, Tokelau, Wallis and Futuna, and Samoa

1984 15 American Samoa, China, Cook Islands, Guam, Cambodia, Hong Kong SAR (China), Kiribati, Lao People’s Democratic Republic, Micronesia (Federated States of), Mongolia, Niue, Singapore, Tokelau, Wallis and Futuna, Samoa

1985 10 Cook Islands, Guam, Hong Kong SAR (China), Kiribati, Micronesia (Federated States of), Mongolia, Niue, Singapore, Tokelau, and Wallis and Futuna

1986 8 Hong Kong SAR (China), Kiribati, Micronesia (Federated States of), Mongolia, Niue, Singapore, Tokelau, and Wallis and Futuna

1987 7 Hong Kong SAR (China), Kiribati, Mongolia, Niue, Singapore, Tokelau, and Wallis and Futuna1988 6 Hong Kong SAR (China), Mongolia, Niue, Singapore, Tokelau, and Wallis and Futuna1989 9 Cook Islands, Guam, Hong Kong SAR (China), Mongolia, Niue, Republic of Korea, Singapore,

Tokelau, and Wallis and Futuna1990 5 Fiji, Hong Kong SAR (China), Mongolia, Niue, and Wallis and Futuna1991 4 Mongolia, Niue, Republic of Korea, and Wallis and Futuna1992 3 Mongolia, Niue, and Wallis and Futuna 1993 5 Hong Kong SAR (China), Mongolia, Niue, Tokelau, and Wallis and Futuna1994 7 American Samoa, Hong Kong SAR (China), Mongolia, Niue, Singapore, Tonga, and Wallis and

Futuna1995 5 Hong Kong SAR (China), Mongolia, Niue, Nauru, and Wallis and Futuna1996 10 Cook Islands, Guam, Hong Kong SAR (China), Mongolia, New Caledonia, Niue, Singapore,

Tokelau, Tonga, and Wallis and Futuna1997 3 Mongolia, Niue, and Wallis and Futuna1998 5 Hong Kong SAR (China), Mongolia, Nauru, Niue, and Wallis and Futuna1999 4 Mongolia, Niue, Palau, and Wallis and Futuna2000 3 Mongolia, Niue, and Wallis and Futuna2001 4 Mongolia, Niue, Palau, and Wallis and Futuna2002 2 Guam, Northern Mariana Islands (Commonwealth of the)2003 NA2004 1 Mongolia2005 4 American Samoa, New Caledonia, Northern Mariana Islands (Commonwealth of the), and

Wallis and Futuna2006 5 Hong Kong SAR (China), Mongolia, Republic of Korea, Singapore, and Wallis and Futuna 2007 7 American Samoa, French Polynesia, Hong Kong SAR (China), Mongolia, Republic of Korea,

Singapore and Tokelau2008 2 American Samoa and New Caledonia2009 NA2010 NA2011 3 French Polynesia, Niue, and Wallis and Futuna2012 2 Niue, and Wallis and Futuna 2013 3 French Polynesia, New Caledonia and Tonga2014 6 French Polynesia, New Caledonia, Niue, Tokelau, Tonga, and Wallis and Futuna2015 10 American Samoa, Cambodia, Cook Islands, French Polynesia, Mongolia, New Caledonia,

Niue, Tokelau, Tonga, and Wallis and Futuna 2016 NA2017 NA2018 NA