DEFINING CRITERIA TO DECLARE ELIMINATION OF LEPROSY Report of an informal consultation Mexico City, Mexico, 10-12 February 2020 1 Defining criteria to declare elimination of leprosy: Report of an informal consultation meeting, Mexico City, Mexico, 10-12 February 2020 ISBN 978-92-9022-833-2 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this license, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons license. 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Inaugural session .....................................................................................................................................5 1.1. Introductory messages ........................................................................................................... 5 1.2. Statement by partners ............................................................................................................ 5 1.3. Introduction of participants.................................................................................................... 6 1.4. Objectives and expected outcomes ....................................................................................... 6 2. Overview of leprosy control .................................................................................................................7 2.1. Current global leprosy situation ............................................................................................. 7 2.2. History of leprosy control ....................................................................................................... 8 3. Elimination of leprosy as a public health problem ......................................................................8 3.1. Generic framework for control, elimination and eradication of NTDs ................................... 8 3.2. World Health Assembly resolutions, definition of leprosy as a public health problem and global progress .............................................................................................................. 10 3.3. From control to elimination as a public health problem: experience from Mexico ............ 11 3.4. Validation of elimination as a public health problem: example of other diseases .............. 12 3.5. Validation of elimination of leprosy as a public health problem: outcome of a consultation in the Region of the Americas ......................................................................... 13 3.6. Group work: elimination of leprosy as a public health problem .......................................... 14 4. From elimination as a public health problem to interruption of transmission ............. 15 4.1. NTD Roadmap 2021‒2030 .................................................................................................... 15 4.2. Leprosy profile in NTD Roadmap 2021‒2030 and post-2020 Global Leprosy Strategy ....... 15 4.3. Conceptual framework: interruption of transmission and elimination of disease .............. 17 4.4. Possible strategies to achieve interruption of transmission ................................................ 17 4.5. Defining interruption of transmission retro-actively............................................................ 20 4.6. Modelling to predict future trends ....................................................................................... 21 4.7. Elimination criteria for other diseases.................................................................................. 21 4.8. Verification of elimination for other diseases – “Elimination dossier” ................................ 21 4.9. Further research needs ........................................................................................................ 23 5. Other business ........................................................................................................................................ 24 5.1. Lucio phenomenon ............................................................................................................... 24 5.2. Global Partnership for Zero Leprosy .................................................................................... 24 6. Conclusions and recommendations ............................................................................................... 25 7. References ............................................................................................................................................... 26 Annex 1: List of participants ..................................................................................................................... 28 Annex 2: Programme................................................................................................................................... 30 3 Abbreviations BCG bacille Calmette-Guérin G2D grade-2 disability GPZL Global Partnership for Zero Leprosy HAT human African trypanosomiasis ILEP International Federation of Anti-Leprosy Associations LEM leprosy elimination monitoring MB multi-bacillary MDA mass drug administration MDT multidrug therapy MIP Mycobacterium indicum pranii NTD neglected tropical disease PAHO Pan-American Health Organization PEP post-exposure prophylaxis SDG sustainable development goal SHF Sasakawa Health Foundation TAS transmission assessment survey TT trachomatous trichiasis WHA World Health Assembly WHO World Health Organization 4 1. Inaugural session 1.1. Introductory messages Mr Cristian Morales, Pan-American Health Organization (PAHO)/World Health Organization (WHO) Representative to Mexico formally opened the Informal consultation on defining criteria to declare elimination of leprosy. On behalf of the host country, Dr Ruy López-Ridaura, Director-General of the Disease Control and Prevention Centre, Ministry of Health, welcomed all participants to Mexico. In his opening remarks he highlighted the achievements of Mexico’s leprosy control programme. Leprosy was once a very prevalent disease, but new cases have become rather rare and are increasingly confined to fewer geographic areas. 1.2. Statement by partners Ms Arielle Cavaliero, Global Franchise Lead (Leprosy) of Novartis International AG, reiterated the long-time commitment of Novartis, donating medicines for multidrug therapy (MDT) since 2001. She