More than two decades after India declared the elimination of leprosy as a public health problem at the national level, the disease continues to surface in several districts in five densely populated states, giving sleepless nights to the government.
These five states—Maharashtra, Chhattisgarh, Jharkhand, Odisha and Madhya Pradesh—account for nearly half of India's leprosy burden. Several districts within these states continue to report prevalence rates exceeding one case per 10,000 population.
While leprosy no longer occupies the public consciousness as it once did, according to the Union Health Ministry, 91,783 new leprosy cases were detected during 2025-26, with a prevalence rate of 0.56 per 10,000 population. Among these, 4.18 per cent were children, indicating ongoing transmission within communities.
Additionally, 2.12 per cent of newly detected patients already had Grade-2 disabilities at diagnosis, suggesting delays in detection and treatment.
The issue was discussed threadbare at a regional workshop in Nava Raipur, Chhattisgarh, which was inaugurated by Aradhana Patnaik, Additional Secretary and Mission Director, National Health Mission.
She said India has made remarkable progress against leprosy, but intensified efforts are needed in endemic areas. The workshop which brought together public health officials, leprosy experts, researchers, development partners and representatives from high-burden states advocated a highly targeted, district-specific strategy rather than a one-size-fits-all approach.
They also highlighted the need for evidence-based microplanning and localised interventions tailored to district-level epidemiological patterns.
Leprosy, also known as Hansen's disease, is caused by Mycobacterium leprae, a slow-growing bacterium that primarily affects the skin, peripheral nerves, eyes and upper respiratory tract. Untreated disease can lead to permanent disability, deformities and lifelong social stigma.
Speaking on the occasion, Dr. Sunil V. Gitte, Deputy Director General (Leprosy), said that "of the newly 91,783 leprosy cases in India during 2025–26, 4.18 percent were children and 2.12 percent presented with Grade-2 Disability at the time of diagnosis.”
India officially achieved elimination as a public health problem in 2005, defined as less than one case per 10,000 population. However, elimination did not mean eradication. New infections continued to occur, especially in districts where transmission remained entrenched.
Health officials warn that the presence of child cases is particularly concerning because it signals recent transmission.
India remains the country reporting the highest number of new leprosy cases globally. According to the World Health Organization (WHO), more than 180,000 new cases are reported worldwide each year, with India contributing over half of the global burden.
Other countries reporting substantial numbers include Brazil and Indonesia. Together, these three nations account for the overwhelming majority of new cases worldwide.
Although the global prevalence of leprosy has fallen dramatically over the last four decades, complete interruption of transmission has proved difficult. The disease's exceptionally long incubation period—often ranging from two to twenty years—makes surveillance and control particularly challenging.
According to the experts, many infected individuals may not show symptoms for years, allowing silent transmission within households and communities.
Public health experts say stigma frequently delays healthcare seeking, leading to advanced disease and irreversible disability.
The social consequences can be devastating. Individuals affected by leprosy often experience social isolation, loss of livelihood and mental health challenges. Women and children frequently face additional layers of discrimination.
Recognising this, health authorities increasingly view stigma reduction as essential to disease elimination.
At the Nava Raipur workshop, officials emphasised the importance of community engagement, behaviour change communication and awareness campaigns to encourage early reporting of symptoms and treatment adherence.
The global fight against leprosy has entered a new phase driven by advances in diagnostics, preventive strategies and genomic research.
One of the most promising interventions is post-exposure prophylaxis using Single-Dose Rifampicin (SDR).
Under this approach, healthy contacts of newly diagnosed leprosy patients receive a preventive dose of rifampicin after screening and evaluation. Studies have shown that SDR can significantly reduce the risk of developing leprosy among contacts.
The Health Ministry has identified expansion of SDR coverage as a key strategy to break transmission chains in endemic districts.
Officials at the workshop stressed the importance of strengthening contact tracing and ensuring that eligible household and community contacts receive preventive treatment.
Periodic Leprosy Case Detection Campaigns are also being intensified in high-burden districts to identify hidden cases before disability develops.
The experts in the sector said researchers are exploring molecular diagnostic tools capable of identifying infection before symptoms become clinically apparent. Such tests could revolutionise early detection, particularly among household contacts.
Genomic studies of Mycobacterium leprae are helping scientists better understand transmission pathways and the evolution of the disease.
Artificial intelligence and digital health technologies are also beginning to play a role. Image-based screening systems are being evaluated to assist frontline healthcare workers in recognising suspicious skin lesions, especially in remote settings where specialist expertise may be limited.
Scientists are additionally investigating biomarkers that may predict which exposed individuals are most likely to develop active disease.
Public health specialists point to multiple reasons why leprosy continues to persist in specific regions.
Poverty, overcrowding, poor access to healthcare and delayed diagnosis create conditions that facilitate ongoing transmission.
Migration can further complicate surveillance efforts, while difficult geographical terrain may limit healthcare access in remote communities, said an official who had attended the meet.
In some areas, shortages of trained personnel and inadequate awareness among healthcare providers contribute to missed or delayed diagnoses.
India's current goal extends beyond elimination towards achieving zero transmission. This is a far more ambitious objective requiring sustained surveillance, rapid case detection, preventive therapy, strong community participation and continued political commitment, said an expert on the condition of anonymity.
The workshop was attended by Amit Kataria, Secretary, Chhattisgarh Health and Family Welfare Department, Sanjeev Kumar Jha, Commissioner-cum-Director, Health Services and Mission Director, National Health Mission, Chhattisgarh; and Nikhil Gajraj, Joint Secretary, Union Ministry of Health and Family Welfare along with Mission Directors, State Leprosy Officers, Regional Directors, and senior programme officials from participating states.
