Relapse and deformity among 2177 leprosy patients released from treatment with MDT between 2005 and 2010 in South India: A retrospective cohort study

OBJECTIVETo estimate the incidence of relapse among leprosy patients released after completing multi-drug therapy (MDT) during 2005-2010 under India's National Leprosy Eradication Programme in South India.METHODSWe conducted a retrospective cohort study of leprosy patients who were released from treatment (RFT) with MDT during April 2005 and March 2010 in four purposely selected districts from South India. We clinically examined them for signs of relapse, persistence and deformity. We collected slit skin smears from those reporting signs of relapse or persistence. We computed relapse rate per 1000 person years by dividing the number of relapses by person years of follow-up and 95% confidence intervals (CI) for rates.FINDINGSWe tracked 3791 RFT patients and examined 58% of them. The examined and those who were not examined were similar in terms of leprosy type, year of completing MDT and gender. We identified 58 relapses (relapse rate 6.1 per 1000 person years) among the examined. Majority of these relapses occurred within 3 years post-MDT. Eighteen (31%) of the relapsed patients had deformity.CONCLUSIONWhile low level of relapse indicates effectiveness of MDT, the burden of deformity is of concern. For maximizing treatment effectiveness and minimizing transmission, we recommend educating leprosy patients at treatment completion for self-monitoring of signs of relapse and advising them to visit nearby public health facilities or Community health workers for immediate evaluation and intervention.