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Study Letter
89 (
6
); 894-896
doi:
10.25259/IJDVL_178_2022
pmid:
37067134

21-year trend of new leprosy cases in Guangdong, China: An analysis of surveillance data from 2000 to 2020

Departments of Leprosy Control, The Dermatology Hospital, Southern Medical University, Guangzhou, China
Corresponding author: Dr. Xiaohua Wang, Department of Leprosy Control, The Dermatology Hospital, Southern Medical University, Guangdong, Guangzhou, China. wxh_21773@163.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Wang X, Lin X, Zhao P, Chen L, Zheng D, Yang B. 21-year trend of new leprosy cases in Guangdong, China: An analysis of surveillance data from 2000 to 2020. Indian J Dermatol Venereol Leprol 2023;89:894-6.

Sir,

Leprosy is an infectious disease caused by Mycobacterium leprae. Guangdong Province was at one time, the centre of a severe leprosy epidemic and still has the largest migrant population in China. On December 31, 2020, the total number of leprosy patients was 96,000 in Guangdong. After 70 years of hard work, the incidence of leprosy has been declining year by year over the past 21 years, but the disability of leprosy patients is still a public health problem. We analyze here the epidemiological trends and characteristics of new leprosy cases in Guangdong Province between the years 2000 to 2020 (obtained from the leprosy management information system in China (LEPMIS)).

During this 21-year period, a total of 2043 patients, including 1344 males and 699 females, were diagnosed with leprosy. Sixty cases (2.99%) were children (≤14 years old). Permanent residents and temporary residents accounted for 78.02% (1594 cases) and 21.98% (449 cases), respectively. The mean age at diagnosis was 42.91 ± 17.86 years, and the average time delay in the diagnosis was 2.67 ± 3.58 years. Multibacillary type accounted for 63.53% (1298 cases). There were 376 cases (18.40%) of grade 2 disability [Table 1]. Although the annual number of new cases decreased from 99 cases in the year 2000 to 47 cases in 2020 (average annual percent change = −3.3, 95% CI = −5.8 – −0.6, P = 0.018 [Figure 1], the proportion of multibacillary type in new cases increased from 44.4 to 70.2%, along with an increase in grade 2 disability from 16.2 to 29.8%. Moreover, the number of new cases varied among different cities in Guangdong province.

Table 1 Epidemiological Characteristics newly detected leprosy cases in Guangdong, China, 2000 to 2020
Year Newly detected cases Case detection rate (1/100,000) Male Female Average age (Years) Cases of MB Proportion of MB (%) Cases of children Proportion of children (%) Average delay time (months) Cases with G2D Proportion of G2D (%) Permanent residential cases
Temporary residential cases
ANOVA of average age
Number of cases Average age (years) Number of cases Average age (years) F value P value
2000 99 0.16 61 38 41.66 ± 16.60 44 44.44 2 2.02 24.78 ± 23.32 16 16.16 90 42.58 ± 16.71 9 32.39 ± 12.78 3.025 0.053
2001 122 0.19 82 40 43.18 ± 17.17 79 64.75 3 2.46 34.06 ± 67.49 22 18.03 107 44.19 ± 17.07 15 35.94 ± 16.67 1.988 0.141
2002 118 0.16 82 36 41.44 ± 17.37 66 55.93 7 5.93 25.49 ± 28.99 17 14.41 106 42.16 ± 17.88 12 35.09 ± 10.43 1.317 0.272
2003 101 0.15 65 36 43.75 ± 18.17 54 53.47 1 0.99 24.78 ± 26.03 17 16.83 92 44.12 ± 17.61 9 39.87 ± 24.09 2.944 0.057
2004 125 0.17 76 49 43.24 ± 18.45 76 60.80 4 3.20 31.56 ± 34.58 20 16.00 111 44.70 ± 18.83 14 31.68 ± 9.14 3.287 0.041
2005 139 0.15 98 41 40.00 ± 16.96 82 58.99 5 3.60 31.07 ± 41.31 17 12.23 128 40.25 ± 17.28 11 37.11 ± 13.02 2.273 0.107
2006 138 0.15 91 47 41.80 ± 17.69 89 64.49 5 3.62 27.38 ± 30.10 22 15.94 121 43.36 ± 17.89 17 30.64 ± 11.44 4.032 0.02
2007 125 0.14 80 45 43.82 ± 18.15 78 62.40 8 6.40 28.94 ± 45.86 22 17.60 105 44.52 ± 18.42 20 40.11 ± 16.60 1.152 0.319
2008 123 0.13 79 44 43.85 ± 20.05 81 65.85 5 4.07 22.55 ± 24.65 15 12.20 101 45.53 ± 21.43 22 36.13 ± 8.61 2.11 0.126
2009 133 0.15 85 48 42.57 ± 19.22 93 69.92 5 3.76 36.64 ± 43.37 32 24.06 114 44.02 ± 19.80 19 33.87 ± 12.45 2.348 0.1
2010 118 0.13 80 38 40.34 ± 17.41 77 65.25 3 2.54 40.25 ± 61.35 24 20.34 85 41.02 ± 19.06 33 38.61 ± 12.25 1.189 0.308
2011 99 0.10 70 29 41.55 ± 16.32 70 70.71 3 3.03 39.41 ± 55.03 20 20.20 62 44.08 ± 18.02 37 37.32 ± 12.04 2.075 0.131
2012 101 0.10 64 37 42.91 ± 17.77 66 65.35 1 0.99 38.19 ± 45.28 20 19.80 72 46.67 ± 18.72 29 33.58 ± 10.62 6.202 0.003
2013 85 0.08 54 31 45.24 ± 18.97 64 75.29 1 1.18 28.78 ± 34.03 16 18.82 57 50.41 ± 19.70 28 34.71 ± 11.98 7.625 0.001
2014 70 0.07 49 21 44.53 ± 18.06 43 61.43 0 0.00 35.74 ± 47.27 20 28.57 46 47.86 ± 19.18 24 38.15 ± 13.93 2.77 0.07
2015 60 0.06 38 22 45.48 ± 18.32 39 65.00 2 3.33 37.58 ± 41.49 10 16.67 38 49.49 ± 20.12 22 38.57 ± 12.26 2.86 0.066
2016 62 0.06 45 17 43.38 ± 16.38 49 79.03 1 1.61 40.14 ± 42.06 13 20.97 36 45.62 ± 17.72 26 40.29 ± 14.06 1.658 0.199
2017 74 0.07 45 29 46.46 ± 18.20 52 70.27 2 2.70 40.67 ± 46.79 14 18.92 40 52.22 ± 18.79 34 39.68 ± 15.08 4.818 0.011
2018 57 0.05 42 15 45.35 ± 16.11 42 73.68 1 1.75 27.21 ± 29.33 11 19.30 28 52.75 ± 15.98 29 38.22 ± 12.85 8.136 0.001
2019 47 0.04 28 19 48.07 ± 17.52 33 70.21 1 2.13 41.26 ± 59.52 14 29.79 27 51.58 ± 18.54 20 43.35 ± 15.23 1.844 0.17
2020 47 0.04 30 17 46.25 ± 20.99 33 70.21 1 2.13 34.75 ± 43.57 14 29.79 28 55.15 ± 20.90 19 33.15 ± 12.89 8.155 0.001
Total 2043 0.10 1344 699 43.08 ± 17.93 1310 64.12 61 2.99 32.19 ± 43.10 376 18.40 1594 44.81 ± 18.69 449 36.95 ± 13.26 35.638 ﹤0.001
Figure 1
Trends of the incidence of leprosy over the last 21 years in Guangdong

Over 50% (233 cases) of temporary residential cases were originally from highly epidemic areas of China, such as Hunan (67 cases), Guizhou (57 cases), Sichuan (44 cases), Jiangxi (35 cases) and Guangxi province (30 cases) [Figure 2a]. Four cases were from abroad (three from Indonesia and one from Mali). The following eight cities accounted for 67.89% of the total new cases in Guangzhou province: Zhanjiang, Guangzhou, Shenzhen, Jieyang, Maoming, Shantou, Foshan and Dongguan [Figure 2b].

Figure 2
Distribution of leprosy cases in different regions of China. (a) Temporary residentialleprosy cases in different provinces of China 2000 to 2020. (b) Distribution of leprosy cases in different regions of Guangdong 2000 to 2020

The present study demonstrates a constant decline in new leprosy cases over the last 21 years, which is in agreement with the findings of others.1 The decreased incidence of leprosy is primarily ascribed to the implementation of the advanced strategy of leprosy prevention and control. Particularly, early detection and prompt treatment with multi-drug therapy, the basic strategy of leprosy control, has resulted in a significant reduction in the incidence of leprosy in Guangdong. The “National leprosy Prevention and Control Program in China 2006–2010” effectively controlled and basically eliminated leprosy in China. Later on, the strategies 2016–2020 and 2021–2030 continued to focus on disrupting of the transmission chain and detection of active cases in both high and low-burden settings. The recommendations included promotion of equity and social justice, emphasising the inclusion of persons affected by leprosy, reducing stigma and discrimination, building partnerships and coalitions of stakeholders and endorsing increased ownership by the country. All these preventive approaches led to a sharp decline in the incidence of leprosy by the year 2009, as shown. Improvement in the information systems also contributed to the decreased incidence of leprosy. For example, switching the leprosy reporting method from paper-based report to internet-based report, Leprosy Management Information System in China (LEPMIS), and the utility of an app for all medical institutions to monitor suspected leprosy symptoms, make leprosy prevention and control more standardised and accurate.

Although the incidence of leprosy has decreased year by year, Guangdong still has about 50 new leprosy cases per year, imposing a challenge for the prevention and control of leprosy. The present study also showed that new leprosy cases in children accounted for 2.99% of total new cases in Guangdong Province, which is lower than that in other regions.2,3 The new leprosy cases were mainly found in males. The factors contributing to gender differences in the incidence of new cases remain unknown. Another notable finding in the present study is the increased grade 2 disability cases, from 16.2 to 29.8%, which is much higher than that in other provinces.4,5 Such a dramatic increase in grade 2 disability could be due to the increase (from 9 to 22%) in cases among temporary residents over the last 21 years. These results suggest that special attention should be paid to their healthcare.

Limitation

The study has these limitations: firstly the incidence of leprosy could have been underestimated because of under-diagnosis and under-reporting since individuals with mild symptoms may not seek medical care. Thus, these patients would not be registered in a leprosy data system. Secondly, it is not clear whether the cases among temporary residents acquired the infection prior to, or after they came to Guangdong Province.

Declaration of patient consent

Institutional Review Board (IRB) permission obtained for the study.

Financial support and sponsorship

The Dermatology Hospital, Southern Medical University.

Conflict of interest

There are no conflicts of interest.

References

  1. , , , , , . Temporal-spatial distribution characteristics of leprosy: A new challenge for leprosy prevention and control in Zhejiang, China. PLoS Negl Trop Dis. 2021;15:e0008956.
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  2. . Global leprosy (Hansen disease) update, 2020: Impact of COVID-19 on global leprosy control. Wkly Epidemiol Rec. 2021;96:421-44.
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  3. , , , . A study on gender differences in newly detected leprosy cases  in Sichuan, China, 2000–2015. Int J Dermatol. 2018;57:1492-99.
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  4. , , , , . Detections of new leprosy cases in Guizhou province, 2011– 2015. Chin J Public Health. 2017;3:1239-41.
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