Opinion India has been ‘leprosy-free’ for two decades. So why are children still being diagnosed with it?
Two decades after elimination was announced, persistent child cases reveal ongoing transmission, late detection, and critical gaps in India’s leprosy control strategy
Leprosy is caused by Mycobacterium leprae and spreads mainly through nasal droplets. (File Photo) India declared the elimination of leprosy as a public health problem in 2005. Two decades later, the country continues to report nearly 1,00,000 new cases annually — about 60 per cent of the global total. India also has the world’s highest number of new child cases, with 4,722 children under 14 diagnosed in 2024–25. This means every second child case globally occurs in India, and every two hours an Indian child is diagnosed with leprosy.
Although the national prevalence is now 0.57 per 10,000 population, several states continue to show rates two to three times higher. Among new child cases, 1.2 per cent presented with grade 2 disability (G2D), suggesting late diagnosis. The presence of the disease in children is a strong indicator of continuing transmission, undiagnosed cases in the community, and weaknesses in early case-finding. Stopping leprosy in children is therefore central to its elimination.
India’s National Strategic Plan and Roadmap for Leprosy 2023–2027 follows the WHO’s three-phase elimination framework. The first and most important phase — stopping transmission — requires zero locally transmitted child cases for five consecutive years. India aims to achieve this and much more by 2027 on the way to Leprosy Mukt Bharat, but several barriers make the goal challenging.
Understanding leprosy
Leprosy is caused by Mycobacterium leprae and spreads mainly through nasal droplets. Transmission generally requires prolonged close contact, making family members and close friends the most vulnerable. Children are at higher risk because their immune systems are still developing.
The disease has a long and variable incubation period — typically five years but sometimes up to 20. Only around 5 per cent of those infected develop symptoms. Many may remain asymptomatic carriers, but it is unclear how many of them continue to transmit the infection. Most child cases occur between 10 and 14 years of age, though nearly 30 per cent are younger than 10.
Leprosy affects the skin and nerves. Early signs include pale or reddish patches with reduced sensation. Untreated cases can progress to nerve damage, muscle weakness, deformities, and permanent disability.
Two major challenges impede the interruption of transmission:
Absence of an infection-detection test
There is currently no simple, widely available test to detect M leprae infection. Without the ability to identify asymptomatic infected individuals, transmission is difficult to monitor or interrupt. Relying on the absence of disease to infer the absence of transmission is unreliable due to the long incubation period. Tests already used in Brazil could help identify infections earlier and support targeted preventive strategies.
Lack of child-appropriate drug formulations
Multidrug Therapy (MDT) cures 99 per cent of patients, but existing child MDT packs are suitable only for children over 10 years and above 40 kg. About 30 per cent of child cases fall below this range and need weight-based dosing. However, current formulations cannot be divided accurately — rifampicin capsules, unscored dapsone tablets, and soft clofazimine capsules limit precise dosing. This contributes to a 10–20 per cent treatment dropout rate among young children, increasing the risk of disability.
India must urgently develop and introduce child-friendly MDT formulations to ensure safe, accurate dosing and improve treatment completion. India must also deploy reliable infection-detection tests to identify asymptomatic carriers and break the chain of transmission.
Timely investments in early detection and child-appropriate treatment are essential for achieving the 2027 targets.
The writer is infectious disease epidemiologist, associated with Global Partnership for Zero Leprosy. Views are personal
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