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Background & objectives: Despite the large scale implementation of multidrug therapy (MDT), the incidence rates of leprosy have not declined in several hyperendemic countries. Before searching for non-human reservoirs of leprosy it would be necessary to look for hidden human sources. This would include destitute leprosy affected persons who resort to begging and operate in congested areas. Hence this study was undertaken.
Methods: One major town and three semi-urban areas in Vellore district of Tamil Nadu and Chittoor town in Andhra Pradesh were purposefully selected for the study. All beggars in these towns were systematically identified and examined by allopathic doctors. Skin smears were examined for bacteriological index.
Results : Among the 193 beggars screened, 58 had leprosy. Of these 10 were smear positive. Several beggars, although living separately, were in touch with their relatives. Most beggars were pavement dwellers and regularly begged at places of worship, bus stands and shopping centres.
Interpretation & conclusion : The fact that nearly 20 per cent of the leprosy affected beggars were skin smear positive highlights the need for regular screening and treatment of such beggars. Those positive should be actively treated and their close contacts frequently screened. This hidden reservoir should be completely eliminated.
Key words Beggars - India - leprosy - reservoir - smear positive - transmission
More than a decade after the large scale implementation of multidrug therapy (MDT) the incidence rates of leprosy have not shown any significant declines in several hyperendemic countries, including India1. Given the rapid bactericidal effectiveness of rifampicin, it was hoped that transmission would cease much earlier than with DDS2,3 and that incidence rates would steadily decrease once prior exposures to infection have taken their toll4. That it has not happened could be due to incomplete or inadequate coverage with MDT, missing early cases, especially multibacillary (MB) leprosy or other hidden sources of transmission. While non-human reservoirs cannot be excluded5, it is necessary first to examine all human sources. Almost every city or town or even a village in India has its share of beggars who operate near places of worship and in crowded areas such as bus stands, railway stations, markets and more fairly close to people. Many are disabled and a fairly large number are...