Directorate General of Health Services
Government of NCT of Delhi

National Leprosy Eradication Programme – Delhi

 

WHAT IS LEPROSY?

Leprosy, also known as Hansen disease, is a chronic infectious disease caused mainly by a type of bacteria called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes. Leprosy is curable and treatment in the early stages can prevent disability.The average incubation period is 5 to 7years. The disease is transmitted through droplets from the nose and mouth of an untreated case of leprosy, containing the causative agent, following prolonged, close contact. The disease does not spread through casual contact (like shaking hands or hugging, sharing meals or sitting next to each other). 

What are types of Leprosy?

Leprosy is characterized according to the number and type of skin sores you have. Specific symptoms and your treatment depend on the type of leprosy you have. The types are:

 

S.No.	Type	Skin lesions	Nerve (s) Involvement	Bacilli in laboratory-based test (Slit Skin Smear)
1.	Pauci-Bacillary (PB)	1-5	No Nerve (0)	Absent (Negative)
2.	Multi- Bacillary (MB)	More than 5 (>5)	One or more nerve involved (≥1)	Present (Positive)

How do you diagnose?

If patients have a suspicious skin sore, your doctor will remove a small sample of the abnormal skin and send it to a laboratory to be examined. This is called a skin biopsy. A skin smear test may also be done. With paucibacillary leprosy, no bacteria will be detected. In contrast, bacteria are expected to be found on a skin smear test from a person with multibacillary leprosy.

 

What is treatment of Leprosy?

Leprosy can be cured. In the last two decades, more than 14 million people with leprosy have been cured. Treatment duration depends on the type of leprosy that patients have. The drugs used are dapsone, rifampicin and clofazimine - these drugs are recommended in both paucibacillary and multibacillary leprosy. Public Health England (PHE) reports that since the introduction of multi-drug therapy (MDT) in 1982, the number of leprosy cases have been reduceddramatically.Before the introduction of MDT, many leprosy patients could expect to take medicine for life. MDT has been made available free to all leprosy patients in the world by the World Health Organisation.

• Dapsone: 2 mg /kg body weight daily.

Duration of treatment: Leprosy patients with PB leprosy need 6 months treatment that must be completed in maximum of 9 consecutive months. This means PB leprosy person cannot miss a total of more than 3 pulses during treatment. MB leprosy patient needs 12 months treatment that must be completed in 18 consecutive months. However, all efforts must be made to complete 6 pulses in 6 months for PB cases and 12 pulses in 12 months for MB cases. Note: Rarely, specialists may consider treating a person with high bacterial index for more than 12 months; decision is based on clinical and bacteriological evidence.

S. No.	Types		Duration of treatment	Dapsone	Clofazimine	Rifampicin
1.	Pauci- Bacillary (PB)	Adult	6 months	100mg Daily	300 mg once a month & 50 mg daily	600 mg once a month
		Child (9- 14 years)	6 months	50 mg Daily	150 mg once a month & 50 mg alternate day	450 mg once a month
2.	Multi- Bacillary (MB)	Adult	12 months	100 mg Daily	300 mg once a month & 50 mg daily	600 mg once a month
		Child (9- 14 years)	12 months	50 mg Daily	150 mg once a month & 50 mg alternate day	450 mg once a month

Advantages of Multi Drug Therapy (MDT)

 

• MDT kills bacilli (M. leprae) in the body. It stops the progress of the disease, prevents further complications and reduces chances of relapse.
• As the M. leprae are killed, the patient becomes non-infectious and thus the spread of infection in the body is reduced. Moreover, chances for transmission of infection to other persons are also reduced to a considerable extent.
• Using a combination of three drugs instead of one drug ensures effective cure and reduces chances of development of resistance to the drugs.
• Treatment with multi-drug therapy reduces duration of the treatment.
• Duration of treatment is short and fixed.
• MDT is safe, has minimal side effects and has increased patient compliance.
• Available in blister pack; easy to dispense, store and take.

 

Indications for prescribing MDT

New case of leprosy: Person with signs of leprosy who have never received treatment before. Other cases: Under NLEP all previously treated cases, who need further treatment are recorded as “other cases”.

Cases from outside the state & Temporary migration or cross border cases.

Before deciding a case to be recorded as from other state, the residential status at the place of diagnosis is carefully examined. A person who has migrated and is residing for more than six months, is likely to stay till completion of treatment are recorded as indigenous case. Information regarding other cases is shown separately in the monthly progress reports. Once it has been decided that a person needs treatment, register the person in Leprosy Treatment register and make the Leprosy Record Card. Take care to indicate type of patient (new/others) correctly. Decide the regimen and counsel the person

Assessing fitness of a leprosy

Before starting treatment for patient with MDT, you must look for the following: Jaundice: If the patient is jaundiced, wait till jaundice subsides. Anaemia: If the patient is anaemic, start treatment for anaemia simultaneously along with MDT. Tuberculosis: If the patient is taking Rifampicin, ensure that he continues to take Rifampicin in the dose required for the treatment of tuberculosis along with other drugs in the regimen required for the treatment of leprosy. Allergy to sulpha drugs: If the patient is known to be allergic to sulpha drugs, avoid Dapsone. Refer person for prescription of alternate drug regimen.

Assigning appropriate MDT regimen based on the grouping, the patients may be given any one of the standard MDT regimens. In children, the dose must be adjusted suitably. When the patient has completed the required number of doses the treatment is stopped and RFT (Released from Treatment) is written against the name of the person in the leprosy treatment register.

Treatment of leprosy during pregnancy

MDT is safe and can be continued during pregnancy.

Treatment of leprosy & tuberculosis:

MDT is continued but rifampicin is omitted from MDT for leprosy and is given in the doses recommended as per guidelines of RNTCP.

Treatment of leprosy in HIV positive patients

MDT for leprosy can be safely given to HIV affected persons and to those on antiretroviral therapy.

 

Side effects of anti-leprosy drugs and its management

• Kidney damage (Nephritis)

Dapsone:

Dapsone may cause haemolysis of red blood cells. People with glucose-6- phosphatase dehydrogenase deficiency are more susceptible to haemolysis. It is usually mild and symptom less. Methaemoglobinaemia may also occur due to dapsone therapy. Lips and nails may develop blue hue that may disappear spontaneously or on reducing the dose and is not an indication to interrupt therapy. Both are rare in therapeutic doses used for leprosy.

Rifampicin

Red discoloration of body fluids

• Allergy

Clofazimine

 

The drug causes brownish black discoloration and dryness of skin. However, this disappears within few months after stopping treatment. This should be explained to patients starting MDT regimen for leprosy.

 

 

Ensuring regularity of treatment:

5. A poor relationship with health care providers

• Adopt accompanied MDT wherever essential, to ensure treatment adherence and timely release from MDT

 

Encourage regular and complete treatment

Patients who are not collecting drug on time should be contacted immediately to identify the reasons and take corrective actions. Flexibility in MDT delivery (more than one pulse at a time) may be adapted whenever it is essential.

Follow up of patient on MDT

Whenever a patient comes to the PHC, reassure the patient, ensure regularity of treatment, and look for side effects of MDT or sign /symptoms of reaction/ Neuritis.

Completion of treatment with MDT :

Skin lesions due to leprosy may not disappear immediately on completion of fixed duration treatment with MDT. In some people, light-coloured patches remain on the skin permanently. Persons with residual patches at the time of completion of treatment must be told this, otherwise, they may not understand why their treatment has been stopped and may try to take treatment from somewhere else. Loss of sensation, muscle weakness and other nerve damage may also remain. Educate the patient about the difference between persistence of light-coloured patches or loss of sensation despite successful therapy as an expected outcome, appearance of new lesions or new sensory loss, nerve involvement, ocular involvement or other signs and symptoms of reaction as danger signs for which the person should report immediately. Ensure that person with disability knows about “self-care” for prevention of disability or it’s worsening. Ask persons with low risk for development of reaction/ disability to report immediately on appearance of any of the signs/ symptoms and people with high risk to come for follow up after three months for first year after completion of treatment and every six months for next two years. Those taking steroid therapy are asked to come after two weeks.

After completion of treatment, a very small number of patients may get new skin patches because of relapse. Refer such PAL to referral centre for confirmation of relapse and treatment. Criteria to restart course of MDT On relapse of disease, MDT is restarted. Relapse must be differentiated from Leprosy Reaction. Drop out cases that discontinued MDT for more than three months in PB and more than six months in MB leprosy regimen, restart treatment as other cases Any new lesion reappears after completion of full course of MDT. Refer the case to identified referral centre for confirmation of relapse.

Complications of leprosy can include:

• Approximately one to two million people worldwide are permanently disabled because of leprosy.

Milestones in Leprosy

 

1948	Hind KushtNivaran Sangh
1955	National Leprosy Control Programme (NLCP)
1983	National Leprosy Eradication Programme (NLEP) started, MDT introduced
1991	World Health Assembly resolution to eradicate leprosy by 2000 AD
1993	World Bank supports the MDT programme – NLEP phase I
2001-2004	NLEP Project Phase II
2002	Simplified Information System Introduced
2004	Leprosy was integrated into the Integrated Disease Surveillance Programme (IDSP)
2005	National-level elimination achieved
2005	NLEP services integrated under National Rural Health Mission
2007	Disability Prevention & Medical Rehabilitation Guidelines introduced
2014	Upgraded Simplified Information System Implementation
2016	Rights of Persons with Disabilities Act
2016	Introduction of NIKUSTH - A real-time leprosy reporting software across India
2017	"Sparsh Leprosy Awareness Campaign" was launched
2017	PEP introduced to prevent leprosy using single-dose Rifampicin for contacts
2019	Leprosy screening converged with Ayushman Bharat - Comprehensive Primary Health Care
2020	Convergence of NLEP with Rashtriya Kishore SwasthyaKaryakaram (RKSK)
2021	District award guidelines (August 2021)
2023	Revised classification of Leprosy & treatment regimen for PB & MB Cases in India
2023	Nukusht 2.0 launched
2023	AMR guideline and National Strategic Plan and roadmap (2023–27) launched
2025	Revised treatment implemented across India

Overview of NLEP

The National Leprosy Eradication Programme (NLEP) is a centrally sponsored scheme functioning under the umbrella of the National Health Mission (NHM). The programme offers free-of-cost services for prevention, diagnosis, treatment, and rehabilitation of leprosy through all public health facilities across India. Its goal is to make India leprosy-free by interrupting transmission, eliminating stigma, and ensuring dignified care for all affected individuals.

NLEP provides both technical and financial support to all States and Union Territories for implementation of activities related to prevention, early detection, case confirmation, treatment, disability prevention, and post-treatment care. It also facilitates convergence with other national health programmes and deploys digital platforms such as Nikusth 2.0 for surveillance and reporting. The programme is aligned with the Sustainable Development Goals (SDGs) and the WHO Global Leprosy Strategy, aiming to achieve zero transmission, zero disability, and zero discrimination by 2027.

 

Vision

“Leprosy-free India” is the vision of the NLEP.

Mission

The NLEP’s mission is to provide quality leprosy services free of cost to all sections of the population, with easy accessibility, through the integrated healthcare system, including care for disability after cure of the disease.

Objectives:

1. To reduce Prevalence rate less than 1/10,000 population at sub national and district level.
2. To reduce Grade II disability % < 1 among new cases at National level.
3. To reduce Grade II disability cases < 1 case per million populations at National level.
4. Zero disabilities among new Child cases.
5. Zero stigma and discrimination against persons affected by leprosy.

 

Strategy:

To achieve the aforementioned objectives, the main strategies to be followed are:

1. To reduce Prevalence rate less than 1/10,000 population at sub national and district level.
2. Early detection and complete treatment of new leprosy cases.
3. Carrying out household contact surveys involving Accredited Social Health Activist (ASHA) in the early detection and completion of treatment of Leprosy cases on time.
4. Strengthening of Disability Prevention and Medical Rehabilitation (DPMR) services.
5. Information, Education and Communication (IEC) activities in the community to improve self-reporting to the Primary Health Centre (PHC) and reduce stigma.
6. Intensive monitoring and supervision at Health and Wellness Centers and Block Primary Health Centre/Community Health Centre.

 

The following are the programme components:

 

1. Case Detection and Management
2. Disability Prevention and Medical Rehabilitation (DPMR).
3. Information, Education and Communication (IEC), including Behaviour Change
4. Communication (BCC)
5. Human Resources and Capacity Building
6. Programme Management

 

How to achieve these objectives?

A large number of voluntary organizations have been playing a pioneering role in anti-leprosy work in India. While some of them were engaged in training, education and research, others were also engaged, in case detection, treatment, rehabilitation and control work. A large number were voluntary, while some received grants from governmental organizations and others from international agencies.

What is prevalence and New case detection?

• New Cases Detection Rate: Number of new cases detected during the year per 100000 populations.

PR and NCDR for last sixteen years.

Proportion (State wise) of New Leprosy Cases in Delhi (2025-2026)

1226New Leprosy Cases were reported Delhi in the year 2025-26.About 54% patients come to Delhi for treatment from neighbouring states like UP, Bihar, Haryana Madhya Pradesh and Jharkhand. UP alone contributes almost 31% of new leprosy patients diagnosed in Delhi.

 

Proportion of patients- Delhi &neighbouring states, receiving Treatment for Leprosy from Delhi

S. No.	States	No. of Cases
1	Delhi	568
2	Uttar Pradesh	382
3	Bihar	198
4	Haryana	35
5	Uttarakhand	06
6	Jharkhand	11
7	Himachal Pradesh	02
8	Madhya Pradesh	14
9	Odisha	01
10	Rajasthan	05
11	Chhattisgarh	01
12	West Bengal	02
13	Punjab	01

 

Rehabilitation in Leprosy

Leprosy may have already permanently damaged the nerves.  As they no longer feel pain, a person is then at risk of injuring their hands and feet while completing daily tasks such as walking and cooking.  We train people within communities to lead self-care groups which help minimize the risk of injury. 

We have specialist shoemakers to build shoes to support a leprosy-affected person’s damaged feet. These have thick soles, often made from old vehicle tyres, so that they cannot be perforated by glass or debris and injure numb feet. Recently more cosmetic MCR footwears are available for better acceptance.

Reconstructive Surgery (RCS)

The most common leprosy-caused disabilities that can be corrected by surgery are a clawed hand, foot drop and a clawed toe. Movement can be restored by using a muscle transfer technique where, with the help of a physiotherapist, a muscle is identified for transfer and strengthened. After surgery and several weeks in plaster, the patient is taught how to use their old muscle to do a new job and then apply the technique subconsciously. The results can see a leprosy-affected person walk again without dragging their foot on the ground or use their hand to grip items. In a similar way, leprosy patients no longer able to close their eyes as a result of nerve damage (called Lagophthalmos), can undergo Temporalis Muscle Transfer. This sees a muscle used for chewing transferred to the eyes so that, after a period of recovery, a person can close their eyes once again by clenching their teeth. This protects the eyes and can spare a person from blindness.

Prostheses

The fitting of ‘life-like’ prostheses can transform the lives of people who have lost lower legs as a result of leprosy. We offer this opportunity in many of the countries in which we work. A particularly pioneering prosthetic limb service has been launched in Myanmar (Burma). It sees a truck manned by four physiotherapists touring the country making fitting prostheses for leprosy-affected people.

Counselling:

Counselling and tending to the spiritual and emotional needs of people affected by leprosy are an integral part of our care and health services. Counselling is more important than the drug treatment. It’s the heart and soul that matters. The body is temporary, people can overcome physical challenges, but the spirit takes the longest time to heal. For many people the diagnosis of leprosy has taken away all hope. I allow people affected by leprosy to vent their feelings, to cry; emotional healing is so important. Healing is not just medical, it’s a healing of the heart and soul, empowering a person to achieve a life of dignity and worth.”

What services are provided to the affected persons?

State Initiatives

• Delhi has adopted a State-specific Strategic Plan to interrupt leprosy transmission in line with the National Strategic Plan (2023–27) for advancement towards SDG Target 3.3 of eliminating communicable diseases by 2030. For 2026–27, the focus is on early detection and targeted interventions, including two rounds of Leprosy Case Detection Campaigns (LCDC)stands for Leprosy Case Detection Campaign which is an intensive, proactive, house-to-house screening initiative implemented in high-endemic areas to uncover hidden or undiagnosed leprosy cases, halt community transmission, and prevent permanent disabilities.
• Active Leprosy Case Search (ALCS) is proposed which would involvehouse-to-house screening and contact tracing covering 300 Houses around the Leprosy Case in approximately 700 newly identified resident cases annually.
• Rehabilitation and disability prevention are being strengthened through DPMR camps in leprosy colonies and the distribution of MCR footwear.
• Awareness initiatives include the Sparsh Leprosy Awareness Campaign, Bal Jagrukta Abhiyaan for children, and a QR code-based self-assessment tool to encourage early reporting.
• Community-level surveillance and patient support have been enhanced through ASHA worker involvement, a toll-free helpline, and the “Sahayak” initiative, which provides reminders and counselling to improve treatment adherence. Additionally, pharmacovigilance and antimicrobial resistance surveillance have been introduced, with over 200 samples tested since 2024.
• To support effective program implementation, Delhi has adopted the Drug and Vaccine Distribution Management System (DVDMS) for efficient drug supply, and is conducting trials of MIP vaccination in high-endemic districts to boost immunity and reduce disease transmission.

• Repeat Online/Offline reporting system training shall be given to the NMS/LA/PMW/MIS experts.
   

Implementation structure at district level

At district level NLEP is implemented through district leprosy societies. Each district has a district leprosy officer to implement the programme.

Reporting system in Leprosy

Reports are collected in SIS format, compiled and sent to government of India on regular monthly basis. Nikusth Portal an integrated, web-based Information and Communication Technology (ICT) portal launched by the Indian government under the National Leprosy Eradication Programme (NLEP) which serves as a centralized digital platform for real-time leprosy case tracking, patient management, and medical supply monitoring. Monthly, Quarterly and annual reports are being collected from thirteen districts, compiled and sent to state and Government of India.

What is the role of International, National and Local NGOs?

International Federation of anti-leprosy Associations (ILEP) is providing technical support from time to time. ILEP agencies are also helping in reconstructive surgeries and provision of microcellular rubber/customized footwear. They are also conducting sensitization programme for hospital and district administrators. Through their collaborative efforts, NGOs complement public health initiatives by supporting medical care, disability prevention and management, socio-economic rehabilitation, community engagement, and the promotion of the rights and dignity of persons affected by leprosy.

Involvement of peripheral workers:

Monthly refresher trainings are being imparted to the ASHAs in dispensaries of districts in which a session about the leprosy is included.

Accredited Social Health Activists (ASHAs) involvement in Leprosy:

• Active Community Searching: ASHAs conduct ABSULS ( Asha Based Surveillance of Leprosy Suspects) active door-to-door screenings for leprosy symptoms while managing their routine duties.

For further information /suggestions write to:

State Leprosy Officer
Govt. of NCT of Delhi
Directorate General Of Health Services
Vikas Bhawan-II, 6^th Floor, B Wing, Delhi State Health Mission, Civil Lines, Delhi-54
Email: dghsleprosydelhi1[at]gmail[dot]com
Tel: 011-20832406, Toll free No:1800112488