Modified active surveillance system (MASS); a novel clinicopathological evaluation of PB leprosy patients after RFT, in Mangalore, India

The current recommendations for leprosy control programmes include stopping active surveillance in view of the very low relapse rates and a phased int egration of leprosy services with the general health services. Passive surv eillance may not be adequate, more so because of the introduction of newer, shorter drug regimens. This study is an effort to evolve a modified active surveillance, which is cost-effective, simple and also a novel substitute for the increased workload caused by the dwindling number of PMWS. One thou sand one hundred RFT-PB leprosy patients were recalled for a review under t he Modified Active surveillance System (MASS), carried out over two phases. Patients were divided into groups as per the mode of response to the maile d postcards: Responders (patients who reported to the OPD in person), Untra ceables (patients whose postcards returned back) and nonresponders (patient s who did not report to the OPD after receiving the mail). At the end of ph ase I, we had 120 Responders, 480 Untraceables and 500 Non-responders. In p hase II, which began 2 months later, the 500 non-responders were dispatched reminders. In this phase, there were 31 responders, 60 untraceables and 40 9 non-responders. Thus, at the completion of phases I and II, there were 15 1 responders, 540 untraceables and 409 non-responders. Of the 151 patients examined, 71 had no complaints (category 1), 41 had fresh leprosy-related c omplaints (category IIA), 14 had fresh leprosy-unrelated complaints (catego ry IIB) and 25 had persistence of old complaints (category III). Cumulative PYR of the 151 patients was 1155.42. Forty one patients had fresh leprosy- related complaints. Skin biopsy was done in the 17 patients with fresh skin patches, of whom four showed histopathological evidence of relapse. Relaps e rate in our study was 0.35/100 PYR. Mean duration after RFT at relapse wa s 4.9 years. Our scepticism towards passive surveillance systems is justifi ed by these 41 patients with fresh leprosy-related complaints, who voluntar ily reported only after receiving the postcards. We recommend the introduct ion of a phase III, wherein the services of PMWs may be used to contact the 409 patients who remained unresponsive at the completion of phases I and I I. We also recommend the introduction of a universal format for recording a ddresses of all new patients, which would be of immense help in patient ret rieval in all such surveillance systems in the future.