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Leprosy control: knowledge shall not be neglected
  1. Maria Lúcia Fernandes Penna1,
  2. Jose Gomes Temporão2,
  3. Maria Aparecida de Faria Grossi3,
  4. Gerson Oliveira Penna4
  1. 1Epidemiology and Biostatistics Department, Universidade Federal Fluminense, Rio de Janeiro, Brazil
  2. 2National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
  3. 3Health Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
  4. 4Medical and Senior Researcher of Tropical Medicine Centre, University of Brasilia, Brazil
  1. Correspondence to Dr Maria Lúcia Fernandes Penna, Epidemiology and Biostatistics Department, Universidade Federal Fluminense, R. Min. Raul Fernandes 180 ap 401, Rio de Janeiro, RJ 22260-040, Brazil; mlfpenna{at}id.uff.br

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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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