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Biomedical subjects

S K Noordeen

Publications and source records attributed to S K Noordeen.

At least 19 recordsLinked to original sources
PubMed2000

Leprosy research and elimination.

The contribution of leprosy research to the progress being made toward elimination of leprosy has been critical. A major development in the promotion of leprosy research during the last 25 years has been the initiative taken by the WHO Special Programme for Research and Training in Tropical Diseases (TDR) through two of its scientific working groups, one on the immunology of leprosy (IMMLEP) and the other on the chemotherapy of leprosy (THELEP), which were set up in 1974 and 1976, respectively. IMMLEP and THELEP have greatly facilitated inputs from scientists not usually active in leprosy research. The coordinated efforts of IMMLEP and THELEP also facilitated goal-oriented research toward high-priority target areas such as an anti-leprosy vaccine and newer and better drug-combinations for the treatment of leprosy. Whereas the prospects for a leprosy vaccine appeared very promising in the early years, the first vaccine produced did not meet expectations for several reasons. Moreover, the possibility of using a vaccine in leprosy is not bright, because of both the technical problems as well as the reduced relevance of a vaccine at a time when leprosy is becoming less and less common. On the other hand, the modest expectations for newer and better drug combinations led to multi-drug therapy (MDT) for the control of leprosy. It is the introduction of MDT that is credited with the current global reduction of leprosy and the progress thus far made toward eliminating the disease as a public health problem. Nevertheless, many areas in leprosy, such as nerve damage, remain that require major research inputs in the future.

Government Programs↗
PubMed2000

Prophylaxis--scope and limitations.

Attempts to prevent leprosy by one or another prophylactic method began with the use of dapsone as a chemoprophylaxis. Following early, small-scale studies, which were promising, large-scale studies with dapsone and acedapsone, both among contacts and in the general population, demonstrated that it is possible to prevent the occurrence of leprosy to a modest extent. With regard to immunoprophylaxis, BCG had long been considered a possibility, particularly in view of its potential to convert the skin test reaction to lepromin. Over the years, major, large-scale field trials of BCG had been carried out in Uganda, Burma, Papua New Guinea and India. All of the studies demonstrated that BCG was capable of preventing leprosy. However, protective efficacy varied from around 20% to greater than 80%. Killed Mycobacterium leprae mixed with BCG has also given varying results. Other vaccines based on cultivable mycobacteria have also been tried, and at least one of them appears promising. An approach to prophylaxis must take into account (a) the level of risk addressed and the perception of risk by the community; (b) the level of efficacy of the method of prophylaxis; (c) the possibility of easily identifying high-risk groups; (d) the operational feasibility; and (e) the focus of the prophylaxis, whether the individual or the community, or both. However, in view of the enormous progress being made towards elimination of leprosy by the widespread application of MDT, prophylaxis is becoming less and less relevant and less and less cost-effective, except in very special situations.

Bacterial Vaccines↗
PubMed1996

Eliminating leprosy as a public health problem--is the optimism justified?

Systematic use of multidrug therapy has proved to be so effective that leprosy can be eliminated as a public health problem by the end of the century. However, because of the long incubation period of this disease, together with the time-lag in case detection, the factors involved in achieving and sustaining its elimination have to be very carefully defined.

Communicable Disease Control↗
PubMed1995

Elimination of leprosy as a public health problem: progress and prospects.

Leprosy is still an important problem in about 80 countries of Asia, Africa and Latin America, some 2.4 million persons being estimated to have the disease in 1994. The WHO-recommended standard multidrug therapy (MDT) was introduced in the 1980s and has been shown to be effective in combating the disease. Experiences based on many thousands of patients treated with MDT over the past decade indicate extremely low relapse rates (cumulative relapse rates around 1%). By the end of 1993, some 5.6 million patients had been cured, and the global cumulative MDT coverage of registered patients had reached 89%. The number of registered cases fell from 5.4 million in 1985 to 1.7 million in 1994. The significant progress made in leprosy control enabled the World Health Assembly in 1991 to set a goal for eliminating leprosy as a public health problem by the year 2000. One important epidemiological factor is that leprosy is very unevenly distributed: 80% of the problem is confined to only five countries and 92% to just 25 countries. The elimination strategy envisages identifying and treating with MDT a total of about 5 million cases from 1994 to the year 2000. The cost of dealing with these cases has been estimated at US$ 420 million, including US$ 150 million for the drugs.

Africa↗
PubMed1993

Leprosy today.

Leprosy is a disease common to developing countries. It is relatively rare in Europe. There are an estimated 5.5 million patients in the world, of which two-thirds are found in South East Asia. Currently, 3.1 million are registered for treatment. Mycobacterium leprae, the causative organism of leprosy, is an intracellular acid-fast organism not cultivable in vitro. The disease is transmitted from man to man mainly through inhalation. The disease occurs in several types depending upon the immunological status of the individual. They are generally grouped into two main categories, multibacillary and paucibacillary. The diagnosis of leprosy, which is generally not difficult, is based on characteristic skin lesions, sensory loss, thickening of the nerve trunks and the presence of acid fast organisms in the skin smears. Complications in leprosy include reversal reaction and erythema nodosum leprosum. Currently, the treatment of leprosy is based on the administration of a combination of drugs, referred to as multidrug therapy, which for multibacillary leprosy is treatment with rifampicin, clofazimine and dapsone and for paucibacillary treatment with rifampicin and dapsone. The treatment of complications such as reversal reaction and erythema nodosum leprosum essentially involves the use of prednisolone. Multidrug therapy has been found to be highly effective in curing leprosy and in preventing relapse, although the duration of treatment is still considered long. The optimistic situation in leprosy treatment has led to WHO establishing a target of eliminating leprosy as a public health problem by the year 2000, defining elimination as attaining a level of prevalence below one case per 10,000 population.(ABSTRACT TRUNCATED AT 250 WORDS)

Developing Countries↗
PubMed1992

Estimated number of leprosy cases in the world.

Planning for leprosy control requires estimates of the number of leprosy patients at different levels. During the period between the mid-1960s and the mid-1980s, global estimates had remained constant at between 10 and 12 million. The introduction of multidrug therapy (MDT) in many countries and the consequent reduction of the disease's prevalence has necessitated a reassessment of this. Based on available information and its interpretation, the number of leprosy cases in the world for 1991 has been estimated at 5.5 million. The number of individuals deformed by leprosy, including those cured of the disease, has been estimated at between 2 and 3 million.

Humans↗
PubMed1992

Estimated number of leprosy cases in the world.

Planning for disease control requires estimates of the number of leprosy patients from local to global levels. From the mid-sixties to the mid-eighties, global estimates appeared to be constant at between 10 and 12 million. The introduction of multidrug therapy (MDT) in many countries and the consequent reduction of prevalence of the disease has necessitated a reassessment of the global estimate. Based on available information and its interpretation, the number of leprosy cases in the world in 1991 has been estimated at 5.5 million. The number of individuals with deformities due to leprosy, including persons now cured of the disease, has been estimated at between 2 and 3 million.

Epidemiologic Methods↗
PubMed1991

Recent developments in leprosy control.

Leprosy continues to be a major problem in the developing world with over 3.9 million cases registered in 1989. The control of leprosy had been considerably handicapped by the widespread occurrence of resistance of M. leprae to dapsone the most commonly used anti-leprosy drug. Together with problems of treatment compliance and social stigma this lead to leprosy control losing considerable ground. In response to the situation and taking advantage of the availability of more potent drugs, in 1981, WHO recommended standard multidrug therapy (MDT) regimens for treatment of leprosy in control programmes. The experience of implementating MDT all over the world over the last eight years has shown the regimens to be highly effective and acceptable. By 1990, nearly 50% of all the registered leprosy cases in the world were benefitting from MDT. The future prospects for leprosy control appear bright with major reductions in prevalence foreseen in the coming years.

Developing Countries↗
PubMed1991

Leprosy control through multidrug therapy (MDT).

Multidrug therapy (MDT) is a major advance in leprosy control and has raised hopes among patients, health workers, and programme managers alike. Where its implementation is vigorous and sustained, the results are extremely gratifying; but problems, both technical and operational, need to be constantly reviewed and solutions found. The opportunities to markedly reduce leprosy in the next decade are immense, but it remains to be seen whether these opportunities are utilized so that leprosy will ultimately be eliminated as a public health problem.

Communicable Disease Control↗
PubMed1991

Global review of multidrug therapy (MDT) in leprosy.

Leprosy continues to be an important public health problem in most countries of Asia, Africa and Latin America. While there has been a steady increase in the number of registered leprosy cases from 1966 to 1985, since then there has been a substantial reduction of over 30% in the number of registered cases. This is mainly attributed to the introduction of multidrug therapy (MDT) as recommended by a WHO study group on chemotherapy of leprosy for control programmes in 1981. The coverage for MDT has steadily increased over the last 5 years, reaching a global figure of 55.7% of all registered cases by October 1990. Over 2 million leprosy patients are currently undergoing MDT and, in addition, over 1 million patients have completed MDT since 1985. MDT has been found to be generally well tolerated with a high level of acceptability leading to improved treatment compliance. MDT coverage shows wide variations among WHO regions and among individual countries. The prospects for further reductions in prevalence of registered cases in the next decade are very bright. However, problems such as early case detection, and prevention and management of disabilities after patients have been curred for several years, will continue to pose significant challenges.

Africa↗