02203nas a2200337   4500000000100000008004100001260001300042653001600055653003300071653002400104653001600128653001800144653001100162653001400173653001200187653001500199653003200214653001700246100001200263700001300275700001800288700001700306700001400323245005800337856005600395300001100451490000700462050001500469520136700484022001401851       2004                            d  c2004 May10aBCG Vaccine10aCommunicable Disease Control10aComputer Simulation10aForecasting10aGlobal health10aHumans10aIncidence10aleprosy10aRecurrence10aSensitivity and Specificity10aTime Factors1 aMeima A1 aSmith WC1 aOortmarssen G1 aRichardus JH1 aHabbema D00aThe future incidence of leprosy: a scenario analysis.  uhttp://www.scielosp.org/pdf/bwho/v82n5/v82n5a11.pdf  a373-800 v82  aMEIMA 20043 a<p><b>OBJECTIVE: </b>To investigate the impact of the current strategy for the elimination of leprosy on its incidence and to assess the consequences of failure to sustain this strategy.</p><p><b>METHODS: </b>Scenarios for assessing the impact of the elimination strategy were implemented in a computer simulation program. The scenarios reflected the assumptions made regarding contagiousness, transmission and bacille Calmette-Guerin (BCG) vaccination. The trend in case detection rate for the main countries in which leprosy was endemic during 1985-98 was fitted, and incidence up to 2020 was projected.</p><p><b>FINDINGS: </b>Owing to the gradual shortening of delays in detection up to 1998, and because of the low relapse rate that occurs with multidrug treatment MDT, incidence is predicted to decrease beyond 2000 in all scenarios. The annual decline was a few per cent higher when favourable assumptions were made about protection and coverage of BCG vaccination. Overall, the predicted annual decline in incidences ranged from 2% to 12%.</p><p><b>CONCLUSION: </b>The elimination strategy reduces transmission, but the decline may be slow. Relaxation of control after 2005 is unjustified given the uncertainty about the rate of decline and the adverse effects of longer delays in detection. A long-term strategy for leprosy control should be adopted.</p>  a0042-9686