Leprosy, a chronic infectious disease and one of the world’s oldest known illnesses, is now fully curable but continues to affect thousands of people every year, particularly in low- and middle-income countries.
Globally, according to the World Health Organisation (WHO), 188 countries, areas and territories reported leprosy data in 2024, accounting for 1.72 lakh new cases. Of these, 69,394 cases (40.2 per cent) were among females, while 9,397 cases (5.4 per cent) were among children. The global burden of disability also remains a concern, with 9,157 new cases detected with Grade 2 Disability (G2D), the most severe form involving visible deformities, and 289 of these cases (3.2 per cent) occurring in children.
When it comes to India, the picture is mixed. On one hand, government data shows a dramatic decline in prevalence over the past few decades. In 1981, about 57 out of every 10,000 people in India had leprosy. By 2025, this number dropped to 0.57 per 10,000 population, which is well below the elimination threshold.
Among newly detected cases, the percentage of child cases declined from 9.04 per cent in 2014–15 to 4.68 per cent in 2024–25. However, this still translates to nearly one Indian child being diagnosed with leprosy every two hours, highlighting that transmission continues in certain pockets.
Considering that, if left untreated, leprosy can lead to progressive and permanent disabilities such as paralysis, blindness, deformities of the hands and feet, chronic ulcers, and long-term pain, understanding what leprosy is, how it spreads, what India has achieved so far, and where the gaps remain becomes crucial in assessing whether the country is truly on track to interrupt transmission.
What is leprosy? Is it contagious?
Leprosy is a chronic bacterial infection that primarily affects the skin, peripheral nerves, muscles, eyes and the upper respiratory tract. It can lead to patches of pale or discoloured skin, loss of sensation (numbness), muscle weakness and, in severe cases, permanent disability. Because the disease progresses slowly, symptoms may take several years, and sometimes even decades, to appear after a person is exposed to the bacteria.
Historically, leprosy was surrounded by fear and misunderstanding, and people affected by the disease were often stigmatised and socially isolated. Today, medical science has clearly established that leprosy is a treatable and curable disease, and that it does not spread easily from person to person. Leprosy is also known as Hansen’s disease, a term many prefer to use to reduce the stigma associated with the word “leprosy.”
Common symptoms of leprosy include patches of skin that may appear discoloured, pale, red, thickened, stiff, swollen or numb compared to surrounding areas. Some patients develop red or purple nodules or lumps, painless ulcers on the soles of the feet, enlarged nerves, weakness or paralysis of limbs, loss of eyebrows or eyelashes, and vision problems. Nerve damage caused by the disease reduces the ability to feel pain, which increases the risk of unnoticed injuries, infections and long-term deformities.
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Leprosy is caused by the bacterium Mycobacterium leprae. Although the causative organism has been identified, experts still do not fully understand exactly how the disease spreads. Current evidence suggests that transmission occurs mainly through airborne droplets released from the nose and mouth of an untreated infected person during coughing or sneezing. This usually requires prolonged and close contact.
Leprosy does not spread through casual interactions such as shaking hands, hugging, sharing meals or sitting next to someone. Once treatment begins, the patient quickly stops being infectious.
However, if left untreated, leprosy can cause serious complications including permanent nerve damage, paralysis, deformities of the hands and feet, shortening of fingers and toes, chronic non-healing ulcers, vision loss and long-term pain. Early detection is therefore crucial to prevent irreversible disability.
According to the WHO, leprosy is completely curable. The standard treatment is Multi-Drug Therapy (MDT), which includes dapsone, rifampicin and clofazimine. The recommended duration is six months for paucibacillary (PB) cases and twelve months for multibacillary (MB) cases. WHO has been providing MDT free of cost globally, initially supported by The Nippon Foundation and later donated by Novartis since 2000. Early treatment not only cures the patient but also prevents disabilities and breaks the chain of transmission.
What is the current situation in India?
India has made significant progress in controlling leprosy over the past several decades. According to government data, “India’s leprosy prevalence rate has fallen from 57.2 per 10,000 population in 1981 to just 0.57 in 2025.” The country achieved elimination at the national level in December 2005, defined as a prevalence rate below one case per 10,000 population, and has sustained this status since then.
Among new cases, the percentage of child cases declined from 9.04 per cent in 2014–15 to 4.68 per cent in 2024–25, indicating a gradual reduction in active transmission. As of March 2025, 31 states and 638 districts have achieved prevalence rates below the elimination threshold, reflecting sustained programmatic efforts.
India’s leprosy control journey began in 1955 with the launch of the National Leprosy Control Programme (NLCP). The programme initially relied on dapsone monotherapy and operated through specialised leprosy units. In 1983, after the WHO endorsed MDT as the standard treatment, India transitioned to the National Leprosy Eradication Programme (NLEP).
The government notes that community-based strategies played a major role in improving detection and treatment. House-to-house surveys under the Survey, Education and Treatment (SET) approach helped identify patients early.
Monthly village clinics improved treatment compliance and created opportunities for counselling. NGOs were actively involved in awareness campaigns and service delivery.
Reflecting Mahatma Gandhi’s long-standing advocacy for people affected by leprosy, India’s strategy has also emphasised social reintegration. Early diagnosis, free treatment, and community education remain core pillars of the programme to prevent disability and reduce stigma.
What is the state-wise data?
As of March 2025, the government data shows that most states and union territories have maintained low prevalence rates. However, regional variations persist.
Among larger states, Chhattisgarh recorded the highest prevalence rate at 1.80 per 10,000 population, followed by Jharkhand (1.46), Odisha (1.37), Chandigarh (1.35) and Maharashtra (1.12). While these states remain close to or slightly above the elimination threshold, others such as Bihar (0.85), Madhya Pradesh (0.82) and Delhi (0.71) reported rates below one per 10,000.
States including Andhra Pradesh, West Bengal and Telangana each reported prevalence rates of 0.46, while Gujarat (0.38), Uttar Pradesh (0.37) and Ladakh (0.33) also demonstrated low endemicity.
Southern and northeastern states showed particularly low prevalence. Assam (0.26), Tamil Nadu (0.26) and Karnataka (0.27) continued to perform well. In the hill and northeastern region, Nagaland and Kerala reported rates of 0.11, while Manipur (0.05), Meghalaya (0.03) and Tripura (0.02) recorded some of the lowest figures nationwide.
Union Territories such as Dadra and Nagar Haveli and Daman and Diu (0.63), Lakshadweep (0.14) and Puducherry (0.11) also maintained low prevalence.
What are the possible challenges and why do children remain vulnerable
An editorial published in the Indian Journal of Medical Research highlights drug resistance as an emerging public health concern, especially in high-burden countries such as India. “While we set our eyes on the goal of a leprosy-free world by 2030, there are issues that we should not forget. Drug resistance in leprosy is an emerging public health concern, particularly in high-burden countries like India,” it added.
According to the editorial, resistance to key drugs used in standard multi-drug therapy (MDT), including rifampicin, dapsone and ofloxacin, is being reported with increasing frequency. India, which contributes a substantial share of the global leprosy burden, faces additional hurdles due to limited access to drug-resistance testing facilities and gaps in surveillance systems. These shortcomings, researchers warn, can result in prolonged treatment durations, higher relapse rates and continued transmission within communities.
The editorial further explained that the lack of robust laboratory infrastructure creates a vicious cycle of recurrent infections and treatment failures, often leading to deformities, social marginalisation and economic hardship. “Despite the WHO’s goal of eliminating leprosy by 2030, limited infrastructure for drug-resistance testing has hindered effective monitoring and treatment,” it stated.
It also added that the ‘lack of accessible, affordable, and effective diagnostic tools exacerbates this issue, calling for robust policy interventions and funding for specialized laboratories.”
Beyond physical illness, leprosy also carries a heavy psychological burden. “While considerable emphasis has been placed on combating stigma, the implementation of concrete measures to alleviate the psychological burden remains inadequate. Patients frequently grapple with depression, anxiety, and social isolation, which not only diminish their quality of life but also impede their recovery. Addressing these challenges requires the inclusion of mental health interventions as an integral component of leprosy management. Counselling, cognitive behavioural therapy, and peer-support programmes are essential tools to support affected individuals,” it added.
Stigma and discrimination remain persistent global barriers. Despite the WHO’s Global Leprosy Strategy focusing on “zero stigma and discrimination”, as recently as 2023, at least 101 discriminatory laws targeting people affected by leprosy were still active worldwide. These legal and social barriers restrict access to education, employment and social participation. Researchers highlight that stigma operates at multiple levels - personal, interpersonal, community and institutional, requiring multi-layered interventions ranging from self-help groups and community awareness campaigns to legal reforms and policy enforcement.
Treatment challenges further complicate elimination efforts. Highly bacillated patients, relapse cases and non-responders continue to pose difficulties under the current WHO-recommended fixed-duration MDT regimen of 12 months for multibacillary disease.
Multiple studies have shown that patients with advanced forms such as polar lepromatous and histoid leprosy often continue to harbour viable bacteria even after completing treatment. This ongoing bacterial persistence contributes to chronic reactions, relapse and nerve damage, ultimately undermining efforts to interrupt transmission by 2030.
Against this broader backdrop, childhood leprosy presents a particularly worrying indicator of ongoing transmission. A 2018 district-level study analysing poverty, literacy and development indicators found only weak associations between poverty and detection rates, but reported that illiteracy and satellite radiance were statistically significant predictors. The researchers concluded, “We find no evidence of rapid decline over the period 2008–2015 in either new case detection or new Grade 2 disability.”
They further noted that under-reporting in poorer regions likely masks the true incidence of disease, complicating elimination strategies.
Hospital-based data also reveal the continuing vulnerability of children. A retrospective study from a tertiary care hospital in central Delhi, analysing records from 2005 to 2015, reported that childhood leprosy accounted for 7.6 per cent of total cases. Importantly, nearly half of these children had multibacillary disease, while deformities were already present in almost one-fourth of patients.
“The rate of childhood leprosy continues to be high. Lack of proper access to health facilities, ignorance among the general population, high susceptibility due to an immature immune system etc make this population highly vulnerable,” it concluded.
Another 2022 study conducted in Bihar, West Bengal and Uttar Pradesh examined delays in diagnosis among children newly diagnosed with leprosy. Researchers found that most affected children belonged to rural and low-income households, and nearly 70 per cent had multibacillary disease.
Alarmingly, 17 per cent already showed deformities at the time of diagnosis. Delayed diagnosis was more common among boys, children from poorer families, and those whose families had not migrated for work, compared to children from better economic backgrounds or migrant households.
Another long-term hospital-based study spanning two decades found that childhood leprosy continues to persist, particularly among migrant populations. Researchers observed high rates of nerve involvement, reactional episodes and treatment default.
“Childhood leprosy continues to be a significant problem. There is a clear need to strengthen early detection, treatment and regular follow-up of these cases in both high and low endemic settings,” the study concluded.
Leprosy elimination initiatives
The National Leprosy Eradication Programme operates as a centrally sponsored scheme under the National Health Mission. According to the Ministry of Health, “Introduction of MDT (Multi Drug Therapy), strong political commitment, decentralised implementation, and a robust Information, Education, and Communication (IEC) strategy brought about tremendous success in leprosy control.”
Between 1981 and 2004 alone, prevalence declined from 57.2 per 10,000 to 2.4 per 10,000, while the proportion of patients presenting with visible deformities dropped from 20 per cent to 1.5 per cent.
The World Bank-supported projects between 1993 and 2004 strengthened community participation and funded communication innovations. Partnerships with NGOs, WHO, and international agencies further expanded outreach.
India’s current leprosy response includes free diagnosis and MDT for all patients, post-exposure prophylaxis using single-dose rifampicin for close contacts, early case detection campaigns, disability prevention and medical rehabilitation services, and compensation support for reconstructive surgery patients.
The launch of Nikusth 2.0 in 2023 introduced a centralised reporting and drug stock management system. Leprosy was made a notifiable disease across public and private healthcare sectors in 2025, improving surveillance coverage.
India’s National Strategic Plan and Roadmap for Leprosy 2023–2027 aligns with the WHO Global Leprosy Strategy and aims to interrupt transmission by accelerating case detection in high-endemic districts while maintaining surveillance in low-burden areas. The roadmap targets zero child cases for five consecutive years at the district level, followed by the elimination of new cases altogether.
A “whole-of-government” and “whole-of-society” approach, combining digital surveillance, community engagement and institutional capacity building, is being implemented to achieve these goals.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
