To prepare the postelimination phase of Hansen’s disease in Korea, it is mandatory to
review antileprosy strategies that we have we 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 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 re
commendation 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 form 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 need 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 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.
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