Interruption of transmission and elimination of leprosy disease

This document provides technical guidance on concepts, definitions, indicators, criteria, milestones and tools to assist leprosy programmes in their journey towards the goals of interruption of transmission and elimination of leprosy disease and through the post-elimination period. Importantly, it provides criteria with benchmarks, where possible, for all key aspects of leprosy programmes and services. Not only those related to elimination efforts, but also those related to diagnosis and management of leprosy, leprosy-related disabilities, mental wellbeing, stigma and discrimination and inclusion and participation of persons affected by leprosy. The document emphasises that the elimination of leprosy is a long-term, continuous journey on the one hand, while, on the other, clear milestones can be recognised on the way and programme implementation can be assessed against benchmarks, guiding appropriate action to keep the programme on track.

The content of this technical guidance is based on the work of the WHO Task Force on definitions, criteria and indicators for interruption of transmission and elimination of leprosy (TFCEL). It has also used input from existing WHO guidance on elimination of other neglected tropical diseases (NTDs), such as lymphatic filariasis and trachoma, WHO documents related to control of infectious diseases, such as the WHO Global Leprosy Strategy 2021–2030, the WHO NTD Road map 2021–2030 and other authoritative sources.

The concept of ‘elimination’ is defined and used carefully and is discussed in relation to other relevant concepts. This is done to prevent confusion regarding this term as happened around the time when ‘elimination of leprosy as a public health problem’ was declared. At the time, this was misunderstood to mean that there would no longer be significant numbers of leprosy cases in countries that had achieved this target and thus had a negative impact on funding, perception of priority in public health agendas, etc. This document seeks to avoid this through carefully defining the concepts used, trying to align the terminology with that used in WHO guidance for other infectious disease programmes, notably that for infectious NTDs.