Risks of treating leprosy in a general hospital

The Christian Medical College and Hospital, Vellore, with 1208 beds, is situated in an endemic area in which the prevalence of leprosy among adults is 3.4%. Two percent of the beds are occupied by leprosy patients, and about 4000 are seen as outpatients per year. They share with other patients all medical, nursing, laboratory, and other services. The impact of these attitudes and practices on the incidence of leprosy among staff and students was studied. This hospital has 2665 staff, including housekeeping personnel, technicians, nurses, and doctors. There are 777 medical, nursing, and paramedical students. Every employee and student is screened prior to entry into this institution and subjected to routine annual examinations. Of those who at initial screening had no evidence of leprosy, 24 acquired the disease. Sixteen had tuberculoid, two borderline, and six indeterminate leprosy. The attack rate of 0.7% is significantly lower than the incidence or prevalence of leprosy in the area. Factors contributing to this low attack rate are discussed with particular reference to age, sex, educational background, residential status, and area of work. It is suggested that staff and students serving leprosy patients for whom no isolation is practiced do not carry any additional risk of acquiring clinical leprosy.