Leprosy - Epidemiology in England & Wales

Since 1951, the incidence of leprosy has fallen: there has been no definite indigenously acquired case reported, and very few new cases have been reported in England & Wales in recent years. Between 1999 and 2008, 36 cases were notified, three quarters of which were male, mostly aged 15 to 44 years old (70%) and from the Indian subcontinent (50%). Some undernotification is likely as the rare nature of the disease leads to lower awareness of its clinical presentation and diagnosis, but the extent of this is unknown.

Leprosy patients in England and Wales still suffer considerable morbidity, and delays in diagnosis remain apparent with a recent study citing the median time from symptom onset to diagnosis as 1.8 years. Given the lengthy and variable lag time between infection and onset of symptoms, it is likely that cases from areas of the world where the disease remains endemic will continue to present for some years to come.

It is important, therefore, that members of the medical profession remain vigilant for the disease and particularly consider leprosy in the event of undiagnosed skin patches, unexplained neuropathy and foot ulcers in patients who have lived in endemic areas.