The Impact of Leprosy Control: Epidemiological and modelling studies

This thesis addresses the impact of leprosy control on the occurrence of leprosy and its associated impairments. Chapter 1 introduces leprosy, an infectious disease. Its manifestations vary widely: from mild self-healing forms to chronic and destructive disease. Knowledge regarding transmission of the leprosy bacterium Mycobacterium leprae is limited. For instance, it is unknown to what extent individuals incubating for disease contribute to transmission. Leprosy is a public health problem because it may cause nerve function impairment, leading to secondary complications of eyes, hands and feet. Disability, handicap and social stigma are ultimate consequences. Activities to prevent impairment and disability are very important. Early detection of patients followed by chemotherapy is the mainstay of leprosy control. The introduction of highly bactericidal multidrug therapy (MDT) in the 1980s was a strong impetus for control programmes. However, evidence for an impact of MDT on transmission and incidence is still lacking.