Korean Lepr Bull.
2000 Jun;33(1):39-57.
Past, Present And Future Strategies For Hansen's Disease In Korea
- Affiliations
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- 1Institute of Hansen's Disease, College of Medicine, The Catholic University of Korea, Korea.
Abstract
- To prepare the postelimination phase of Hansen's disease in Korea, it is mandatory to review antileprosy strategies that we have pursued in the past, present and future in medical aspects of the plans. The status of Hansen's disease in Korea has reached beyond the elimination period defined as less than one case per 10000 population. The successful control of Hansen's disease up to postelimination stage totally due to the careful support from governmental level, endless efforts of medical staffs who have been engaging in leprosy works, and cooperations of patients. We can suppose that eradication of Hansen's disease will become a true dream within next 25-50 years. With one hundred percent coverage of MDT(multidrug therapy), gradual decrease of new cases and effective health care systems, no re-emergence of Hansen's disease as seen in 1960's and 1970's is conclusive. However we are in the period of elimination of the disease, new cases will continue to occur in small numbers not more than twenty. Special strategies will have to be developed for postelimination phase in Korea. The strategies for Hansen's disease surveillance system need to be different from the past Hansen's disease control system. It should contain regional core groups which includes surgical and medical rehabilitation experts, and a few research group and one referral center. The budget for the groups will come from contraction between government and scientists in medical schools, and NGOs. For national and regional plan of COT(completion of the treatment), it could be more reasonable to separate MB(multibacillary)cases into two groups depend on their possible reactions and relapse after cessation of MDT. First group contains those patients with high BI(bacterial index) more than 4+ need MDT for 24 months. The second group means those patients with low BI less than 4+ need for 12 months MDT as seen in recommendation of WHO short term regimen. In case of PB(paucibacillary) there is few report of relapse following 6 month MDT. In the past period implementation of MDT was so imperative that the other important things for patients cares like prevention of deformities and rehabilitation surgery are neglected and many of them lost golden opportunities to correct deformities in the field. When it is possible to find changes of nerve functions within 12 months, corresponding deformities could be preventable. The mission of mobile team in the past is focused on detection of new cases, but time changes to find no new cases with mobile works. The mobile teams from KLCA(Korean Leprosy Control Association) and NGOs should reshape their aims for care of foot ulcer and prevention of neurological deformities. Outpatient clinics for Hansen's disease will be integrated gradually to horizontal medical care system as like university affiliated hospitals which was done in Japan during from 1973 to 1983. It will give the patients more better quality of medical service. Though the elimination of leprosy does not mean elimination of leprosy research work, there happened brain drain from leprosy to tuberculosis or other research areas. There has been a sympathetic agreement to get gradual decline for support for leprosy research. This will hamper the development of new technologies which are needed for leprosy elimination and beyond. The priorities for research in leprosy have changed as a result of the success of the MDT. Possible recommended leprosy research priorities in Korea should include development of methods to improve the early detection of reactions and nerve damage, development of more effective methods of treatment for reactions and nerve damage, development of more effective and efficient prevention of disability(POD), development of more effective self-care and footwear for patients with impairment and other research works in leprosy.
