Leprosy in Europe-towards zero leprosy

Although leprosy was widespread in Europe in the Middle Ages, the whole continent is now on the brink of declaring an end to local transmission of the disease. With the high level of international travel, leprosy is still diagnosed in many European countries, but rarely in people who have never traveled to or lived in a more endemic area of the world. The occurrence of leprosy in local children is an indication of recent transmission and this seems to have stopped throughout Europe, although confirming this with reliable data is a major challenge. Sporadic cases (occasional new cases occurring in a given area that are unrelated to other known cases) and autochthonous (locally acquired) cases in older adults point to some transmission in previous decades. In countries where local transmission has stopped, there is no evidence of any spread of leprosy from international travelers or migrants to the local population. Verification by WHO of the end of transmission of leprosy is beginning to occur in some countries, but crucially depends on good data concerning new cases diagnosed over previous years.Policies for the future should include: (a) sustainable provision within national health services for the diagnosis and treatment of leprosy in the few cases that do occur, usually in the migrant population, with meticulous recording and reporting of case data; (b) sustainable services for the care of people with leprosy-related disability, and the continued fight against stigma and discrimination towards those affected.