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The tenth meeting of the WHO Technical Advisory Group (TAG) on Leprosy Control was held in New Delhi, India on 23rd April 2009. The meeting was chaired by Professor WCS Smith and attended by TAG members, several experts, WHO secretariat, and members of the technical bodies of International Leprosy Association (ILA) and the International Federation of Anti-Leprosy Associations (ILEP) also attended the meeting.

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The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2009 was reported. In almost all of the highly endemic countries, control activities have been integrated within the general healthcare system. However, early case detection and prompt treatment with MDT remain the cornerstone of leprosy. In order to reduce the physical, mental and socioeconomic burded of leprosy, much remains to be done.

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The main principles of leprosy control, based on timely detection of new cases and their treatment with effective chemotherapy in the form of multidrug therapy, will not change over the coming years. The emphasis will remain on sustaining the provisions for quality patient care that are equitably distributed, affordable and easily accessible. The Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy: 2011-2015 together with the updated Operational Guidelines of the Enhanced Global Strategy. The Strategy will require endorsement and commitment from everyone working towards the common goal of reducing the disease burden due to leprosy and its detrimental physical, social and economic consequences in order to move closer to achieving the common dream of "world without leprosy".

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The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2008 was reported. In almost all of the highly endemic countries, control activities have been integrated within the general healthcare system. However, maintaining political interest and mobilizing the necessary funds to implement activities in the field are challenges for many national programmes as the burden of disease declines further.

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The Ninth meeting of the WHO Technical Advisory Group (TAG) on Leprosy Control was held in Cairo, Egypt on 6th and 7th March 2008. The meeting was chaired by Professor W.C.S. Smith and attended by national leprosy programme managers from Brazil, the Democratic Republic of Congo, Cambodia, Egypt, Iran, India, Nigeria and Thailand. In addition, several experts and members of the Technical Commission of the International Federation ofAnti-Leprosy Associations (ILEP) also attended the meeting.

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This study included 200 randomly selected multibacillary leprosy cases who had completed 1 year of fixed World Health Organization recommended multidrug therapy (WHO-MDT) without prior dapsone (DDS) monotherapy. The time interval after release from treatment varied from a few months to 8 years. All cases were clinically reviewed in 2006 by comparison with their old clinical records. Reactions, particularly reversal reactions, occurred frequently among patients who had completed MDT within the last 3 years. It was difficult to distinguish relapse cases and late reversal reactions in skin smear-negative multibacillary cases. Based on bacteriological and histological analyses, one patient was confirmed to have relapsed 1 year after release from treatment. The overall relapse rate was 0.5%. No drug resistance mutations were detected by polymerase chain reaction or dot blot hybridization. The present study indicates that it is important to follow up patients for several years after completion of MDT in order to detect possible lepra reactions and relapses.

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The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2007 was reported. In almost all of the highly endemic countries, control activities have been integrated within the general healthcare system. However, Leprosy control programmes in many countries will need continued support from all partners to ensure that leprosy remains on the health agenda as long as necessary and that success does not lead to complacency.

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We have performed a questionnaire to survey the present conditions of the slit skin smear test, a method to diagnose leprosy. The answer was obtained from 40 (93.0%) out of 43 clinics, department of dermatology of university and other hospitals and leprosy sanatoriums. Slit skin smear test was carried out in most institutions. However, when inspection frequency was low, a laboratory technician performed Ziehl-Neelsen staining or its variation using a normal slide glass. A few institutions carried out fluorescence staining. Both physician and technician examined the slides in most cases, however, in more than half of the leprosy sanatoriums, technician was the only person examined. Bacterial index was evaluated in most institutions, while only for the presence of bacteria was examined 5 institutions. Slit skin smear test is simple and easy, but accuracy is different with skills, glass slides to be used and methods for staining and inspection. Supply of the glass slide with a marker, the spread of staining methods, technical improvement of an inspection are demanded in future.

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The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2006 was reported. Early case detection and treatment with multidrug therapy (MDT) remains the cornerstone of leprosy control. The challenge will be to establish these facilities as part of an integrated system that provides referral services for other diseases in the area.

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The elimination of leprosy with the advent of multidrug therapy (MDT) is one of the success stories in public health. Elimination will be achieved in the regions of Western pacific and South-East Asia in near future. A biregional consultation between the WHO South-East Asia and Western Pacific regions was held in the end of 2004 in Manila, the Philippines. A strategy document was developed during the consultation, to sustain quality leprosy services in Asia and the Pacific beyond 2005, and to further reduce the leprosy burden. The main strategy involves timely detection of new cases, multidrug treatment, and the key element of integration of leprosy services into general health services.

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CD23 is a low-affinity receptor for immunoglobulin E and expressed on various hemopoietic cells. Although human epidermal cultured Langerhans cells express CD23, the study to identify CD23 on murine Langerhans cells has so far failed. In this study, using highly enriched (> 95%) Langerhans cells from murine epidermis obtained by the panning method, we investigated whether murine Langerhans cells express CD23. As the result of a series of experiments using fluorescence activated cell sorter analysis and the polymerase chain reaction method, it was revealed that CD23 is expressed on cultured Langerhans cells, but not on freshly isolated Langerhans cells. Comparison of the DNA sequence of polymerase chain reaction products of CD23 from cultured Langerhans cells with that from spleen leukocytes demonstrated that there were the same sequences between the two polymerase chain reaction products. The expression of CD23 on cultured Langerhans cells was downregulated when Langerhans cells were cultured with keratinocyte-derived cytokines: interleukin-1alpha, interleukin-18, macrophage colony-stimulating factor, or granulocyte-macrophage colony-stimulating factor. Moreover, it was shown that murine IgE bound to cultured Langerhans cells and this binding was partially inhibited when Langerhans cells were cultured with monoclonal antibody against CD23 (B3B4). Thus this study revealed murine cultured Langerhans cells do express CD23 and the discrepancy from previous reports may be due to the influence of cytokines derived from keratinocytes. Furthermore, the finding that murine cultured Langerhans cells bind IgE through CD23 suggests that CD23 on murine Langerhans cells may be involved in IgE-mediated immune responses.

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