Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK.
Novartis Foundation, Basel, Switzerland.
Lancet Infect Dis. 2017 Sep;17(9):e293-e297. doi: 10.1016/S1473-3099(17)30418-8. Epub 2017 Jul 7.
Leprosy is present in more than 100 countries, where it remains a major cause of peripheral neuropathy and disability. Attempts to eliminate the disease have faced various obstacles, including characteristics of the causative bacillus Mycobacterium leprae: the long incubation period, limited knowledge about its mode of transmission, and its poor growth on culture media. Fortunately, the leprosy bacillus is sensitive to several antibiotics. The first antibiotic to be widely used for leprosy treatment was dapsone in the 1950s, which had to be taken over several years and was associated with increasing bacterial resistance. Therefore, in 1981, WHO recommended that all registered patients with leprosy should receive combination therapy with three antibiotics: rifampicin, clofazimine, and dapsone. Global implementation of this highly effective multidrug therapy took about 15 years. In 1985, 5·3 million patients were receiving multidrug therapy; by 1991, this figure had decreased to 3·1 million (a decrease of 42%) and, by 2000, to 597 232 (a decrease of almost 90%). This reduction in the number of patients registered for treatment was due to shortening of the treatment regimen and achievement of 100% coverage with multidrug therapy. This achievement, which owed much to WHO and the donors of the multidrug therapy components, prompted WHO in 1991 to set a global target of less than one case per 10 000 population by 2000 to eliminate the disease as a public health problem. All but 15 countries achieved this target. Since 2000, about 250 000 new cases of leprosy have been detected every year. We believe an all-out campaign by a global leprosy coalition is needed to bring that figure down to zero.
麻风病存在于 100 多个国家，是导致周围神经病和残疾的主要原因。消除这种疾病的努力面临着各种障碍，包括麻风分枝杆菌的一些特征：潜伏期长、对其传播方式的了解有限，以及在培养基中生长不良。幸运的是，麻风杆菌对几种抗生素敏感。上世纪 50 年代，第一个广泛用于治疗麻风病的抗生素是氨苯砜，它需要服用数年，并与细菌耐药性的增加有关。因此，1981 年，世卫组织建议所有登记在册的麻风病患者都应接受三种抗生素的联合治疗：利福平、氯法齐明和氨苯砜。这种高效多药疗法在全球的实施大约需要 15 年时间。1985 年，有 530 万患者接受多药治疗；到 1991 年，这一数字降至 310 万（减少 42%），到 2000 年降至 597232 例（减少近 90%）。接受治疗登记的患者人数减少，是因为治疗方案缩短，以及多药治疗的覆盖率达到 100%。这一成就主要归功于世卫组织和多药治疗成分的捐助者，这促使世卫组织于 1991 年设定了到 2000 年将每 10000 人口中少于 1 例的目标，以消除麻风病作为一个公共卫生问题。除了 15 个国家外，所有国家都达到了这一目标。自 2000 年以来，每年约有 25 万例新的麻风病病例被发现。我们认为，需要一个全球性的麻风病联盟发起一场全面运动，将这一数字降至零。
