Public health priority: Routine
PHU response time: Respond to reported cases within 1 working days of notification. Enter confirmed cases on NCIMS within 1 working days.
Case management: Managed by a specialist physician. Case may be restricted under the Public Health Act.
Contact management: Managed with advice form a specialist physician. Contacts who have extended house like contact with a case should be counselled and assessed for risk of disease.
Only a confirmed case should be notified.
A confirmed case requires either laboratory definitive evidence or laboratory suggestive evidence and clinical evidence.
International reporting to WHO is based on the WHO working definition:
A person showing one or more of the following features, and who as yet has to complete a full course of treatment:
The difference should be noted to the WHO when reported.
Leprosy is to be notified by:
Only confirmed cases should be entered onto NCIMS.
The bacillus Mycobacterium leprae.
The exact mechanism of transmission is not well understood, although person to person spread via nasal droplets is believed to be the main route. Large amounts of M leprae DNA have been found in the nasal secretions of people with untreated lepromatous leprosy.
The incubation period varies widely from months to 30 years, with an average of 4 years for tuberculoid leprosy and 10 years for lepromatous leprosy. M leprae reproduces at a very slow rate and few cases are diagnosed in children less than five years old.
Leprosy loses its infectiousness after treatment with appropriate antibiotics.
The usual clinical presentation varies between the two polar forms, lepromatous and tuberculoid leprosy. Host immune response determines clinical features.
In lepromatous leprosy, there is a high bacillary load and more severe disseminated disease. Nodules, papules, macules and diffuse infiltrations are bilaterally symmetrical and usually numerous and extensive. The skin lesions may not be anaesthetic or Hypopigmented. The nasal mucosa may be involved, and iritis and keratitis can occur.
In tuberculoid leprosy there is a lower bacillary load, skin lesions are single or few, sharply demarcated, anaesthetic or hyperaesthetic and bilaterally asymmetrical; peripheral nerve involvement tends to be severe.
Within 1 working days of notification begin follow-up investigation.
Within 1 working days of notification enter on NCIMS confirmed cases only.
The World Health Organization requires the following data:
Enter these data on NCIMS under "Clinical Notes".
The response to a notification will normally be carried out in collaboration with a specialist physician and if necessary, the local chest clinic staff. Regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Medication should be administered under the supervision of a specialist physician. Chest Clinic staff can assist if necessary. Current treatment regimens consist of 6 months of daily dapsone and monthly rifampicin for paucibacillary leprosy, and 12-24 months of daily dapsone and clofazamine and monthly rifampicin for multibacillary leprosy for a 24 month period to reduce the risk of relapse. Specialist advice should be sought for detailed treatment regimens.
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission. In particular, emphasis should be placed on foot care and prevention of injury.
Misconceptions about leprosy are common and it is important to inform the patient and relatives that leprosy is curable, and the risk of transmission to contacts is low.
If hospitalisation is indicated for medical or other reasons, including management of immunological reactions, a patient with untreated lepromatous leprosy should be isolated with contact precautions for at least 72 hours after treatment is commenced. Consultation with a specialist physician is recommended to determine the length of isolation. The risk of transmission in this context is low.
No restriction is placed on attendance at work or school if the case is regarded as non-infectious.
Household, family and close social contacts should be identified. Anyone who has lived in a household-like setting with the case for more than one-month period is defined as a contact.
Contacts should be referred to a specialist medical practitioner for investigation and treatment. In non-endemic countries the risk of disease is rare and the role for chemoprophylaxis is uncertain. Given the extremely low risk to non household contacts, prophylaxis is not recommended for health care workers.
BCG vaccination is recommended for neonates born to cases.
Advise contacts (or parents/guardians) of the mode of transmission and the low risk of infection. Close household contacts should be advised to report any new skin lesions promptly and to tell their doctor if they have had contact with a known case of leprosy.