Tool accompanying the WHO Technical guidance on interruption of transmission and elimination of leprosy disease

Leprosy/Hansen disease is a chronic infectious disease primarily impacting the skin and peripheral nerves. If left untreated, leprosy can have long-term consequences, including deformities and disabilities, which are associated with stigma. Leprosy is one of the 21 neglected tropical diseases (NTDs), a group of conditions prevalent in tropical regions. In the “WHO Roadmap for Neglected Tropical Diseases 2021–2030”, leprosy, human African trypanosomiasis (HAT) and onchocerciasis are targeted for interruption of transmission. Acknowledging the growing necessity for establishing a process to verify the absence of new autochthonous leprosy cases, a technical guidance has been developed outlining a clear pathway, demarcating phases with indicators and milestones leading towards the elimination of leprosy disease. Each country or subnational unit must progress through three phases before achieving zero leprosy: phase 1 involves interruption of transmission, followed by phase 2, which focuses on elimination of leprosy disease. After successfully reaching the elimination phase, the country must undergo a third phase of post-elimination surveillance.

Elimination of leprosy disease is a bottom-up process, and the milestones should be reached at all second level subnational administrative units. Only after achieving this across all second subnational units can a country be deemed eligible for the verification of leprosy elimination. 

Upon achieving the goal of leprosy disease elimination, countries will compile a comprehensive dossier and submit to WHO to verify the successful elimination of leprosy disease. The primary purpose of this dossier is to systematically and meticulously document the actions taken by the country in the process of elimination of leprosy disease. It serves as a detailed chronicle of the interventions implemented and the outcomes achieved throughout the journey of eliminating the disease.

Following the submission of the dossier, WHO responds by organizing a verification process conducted by an external independent committee of experts. This committee reviews the dossier, scrutinizes the evidence presented by the country and assesses the implementation of interventions and services in alignment with the national strategic plan including through on-site visits to observe the service delivery process. The objective is to confirm that the country has indeed reached the goal of elimination of leprosy as a disease. Upon completion of the appraisal, the committee recommends to WHO to officially acknowledge the country's achievement in eliminating leprosy disease.

The tools employed in the verification process are the leprosy programme and transmission assessment (LPTA) tool and leprosy elimination monitoring tool (LEMT). The LPTA encompasses a range of interventions/services carried out within the leprosy programme, spanning three distinct domains: political commitment, programme implementation, and surveillance. A report on the interruption of transmission and elimination of leprosy disease achieved at the second subnational level will be included in support of the dossier claiming the elimination of leprosy disease.

The technical document provides details of the dossier for the elimination of leprosy disease serving as a comprehensive guide for countries, offering systematic assistance in the preparation process. It provides essential guidance to ensure a methodical and organized approach when compiling the dossier. By following the guidance outlined in this document, countries can ensure a thorough and accurate representation of their efforts in achieving the elimination of leprosy disease.