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In May 1991, the 44th World Health Assembly (WHA) adopted the resolution 44.9, declaring the commitment of the WHO to attain the goal of global elimination of leprosy as a public health problem by the year 2000. The goal was to reduce the known prevalence of leprosy to below 1/10 000 inhabitants. The implementation of multidrug therapy (MDT) turned, at the global level, a previously lifelong disease into a curable one. An important reduction of known prevalence was anticipated, given shorter disease duration.
The WHO's secretariat also predicted that a significant decrease in incidence is to be reflected in the case detection rate (CDR),1 despite the absence of any previous evidence of huge impact on transmission in consequence of leprosy or tuberculosis isolation or treatment programmes. From 1990 to 1999, the CDR increased in all regions of the world except in Eastern Mediterranean and Western Pacific regions, where the CDR was low since the beginning of the period.1 2
In 1997, without strong evidence, the WHO recommended the reduction of multibacillary (MB) leprosy treatment from 24 to 12 months (it was rated grade D, evidence according to Oxford Centre). This new disease duration reduction allowed the global elimination target to be achieved by the end of the year 2000. Without further WHA resolution and ignoring that after many years of using MDT there was no evidence of its impact on transmission, the CDR magnitude and its influence on prevalence, WHO then ‘established its …
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