CITATION: Brook, C. E. et al. 2015. Spatial heterogeneity in projected leprosy trends in India. Parasites & Vectors, 8:542, doi:10.1186/s13071-015-1124-7.The original publication is available at http://parasitesandvectors.biomedcentral.comBackground: Leprosy is caused by infection with Mycobacterium leprae and is characterized by peripheral nerve
damage and skin lesions. The disease is classified into paucibacillary (PB) and multibacillary (MB) leprosy. The 2012
London Declaration formulated the following targets for leprosy control: (1) global interruption of transmission or
elimination by 2020, and (2) reduction of grade-2 disabilities in newly detected cases to below 1 per million
population at a global level by 2020. Leprosy is treatable, but diagnosis, access to treatment and treatment
adherence (all necessary to curtail transmission) represent major challenges. Globally, new case detection rates for
leprosy have remained fairly stable in the past decade, with India responsible for more than half of cases reported
annually.
Methods: We analyzed publicly available data from the Indian Ministry of Health and Family Welfare, and fit linear
mixed-effects regression models to leprosy case detection trends reported at the district level. We assessed correlation
of the new district-level case detection rate for leprosy with several state-level regressors: TB incidence, BCG coverage,
fraction of cases exhibiting grade 2 disability at diagnosis, fraction of cases in children, and fraction multibacillary.
Results: Our analyses suggest an endemic disease in very slow decline, with substantial spatial heterogeneity at both
district and state levels. Enhanced active case finding was associated with a higher case detection rate.
Conclusions: Trend analysis of reported new detection rates from India does not support a thesis of rapid progress in
leprosy control.http://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-015-1124-7Publisher's versio