National Leprosy Eradication Programme
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Direct answer
The National Leprosy Eradication Programme (NLEP) is India's government programme for leprosy control, delivering free multidrug therapy through the general health services. Its elimination target is a prevalence below 1 case per 10,000 population at the national level, a level India has reached nationally, although new cases and pockets of higher prevalence remain. The strategy depends on early case detection, multidrug therapy, contact examination and chemoprophylaxis for household contacts.
What you must remember
- Elimination target: prevalence below 1 case per 10,000 population, as defined by WHO, at the national level.
- Prevalence rate: registered cases on treatment at a given time, expressed per 10,000 population.
- Detection rate: new cases detected in a year, expressed per 100,000 population, which reflects ongoing transmission.
- PB treatment: six months of multidrug therapy; from April 2025 India uses three drugs (rifampicin, dapsone and clofazimine), where the older regimen was rifampicin and dapsone only.
- MB treatment: twelve months of multidrug therapy with rifampicin, clofazimine and dapsone.
- Contact management: household contacts are examined, and those without disease receive chemoprophylaxis under current national guidance.
- Case detection: passive detection at health facilities, supported by active case-finding campaigns in endemic districts.
- Disability prevention: self-care education, footwear, eye care and referral for surgery are part of the programme.
How a leprosy case moves through the programme
A newly detected case passes through several steps, from detection to release, and each step is recorded for monitoring. The sequence below shows how the programme links treatment with prevention of transmission and disability.
- Detect the case: Cases are found through passive detection at health facilities and through active campaigns in endemic districts.
- Classify the case: Patients are classified as paucibacillary or multibacillary by the number of skin lesions and nerve involvement, as set out in current national guidance.
- Start multidrug therapy: PB patients receive six months of treatment and MB patients receive twelve months, with supervised dosing.
- Trace contacts: Household contacts are examined for signs of leprosy, and those without disease receive chemoprophylaxis under current guidance.
- Prevent disability: Patients receive self-care education, footwear and eye care, with referral for surgery when deformities develop.
- Monitor the indicators: Prevalence and detection rates are tracked to judge progress and to check whether case finding is effective.
- Release from treatment: Patients are released from treatment after completing the course, but they remain under observation for relapse.
Where the exam tries to catch you
Most traps involve mixing up the indicators or giving the wrong regimen for the classification.
- Trap: equating the prevalence rate with the detection rate Correct: prevalence counts cases on treatment at one point in time, whereas detection counts new cases in a year.
- Trap: assuming elimination means zero new cases Correct: elimination is defined as prevalence below 1 per 10,000, and new cases still occur.
- Trap: giving a PB course to an MB patient Correct: MB patients need twelve months of rifampicin, clofazimine and dapsone, whereas PB patients complete six months; older books list PB as two drugs without clofazimine.
- Trap: treating household contacts as cases Correct: contacts are examined, and those without disease receive chemoprophylaxis rather than full treatment.
Frequently asked questions
What is the elimination target of the National Leprosy Eradication Programme?
The elimination target is a prevalence below one case per 10,000 population at the national level. India has reached this national target, but new cases and pockets of higher prevalence still need attention.
How is the prevalence rate of leprosy calculated?
The prevalence rate is the number of registered cases on treatment at a given time, divided by the population and expressed per 10,000. It measures the burden of disease at a point in time rather than new infections.
What is the difference between paucibacillary and multibacillary treatment under the National Leprosy Eradication Programme?
Paucibacillary patients receive six months of multidrug therapy, which under the revised national protocol from April 2025 includes rifampicin, dapsone and clofazimine (older books list only rifampicin and dapsone). Multibacillary patients receive twelve months of the same three drugs because their bacillary load is higher.
What is contact chemoprophylaxis in the National Leprosy Eradication Programme?
Contact chemoprophylaxis gives preventive treatment to household contacts of a leprosy patient who do not have the disease. Under current national guidance this is a single dose of rifampicin, given after the contacts are examined.