西アフリカ等諸国等から送られ、Armed Forces lnstitute of Patholory(AFIP、Washington DC、USA)に保管されているブルーリ潰瘍の皮膚生検組織の内、ベナンからの化学療法未施行41例を光学顕微鏡下で観察した。
所謂「AFIP分類」に従って、上記41例を、病理組織学的病期stageに区分すると、active27例、healing9例、active but healing3例、consistent with healing1例、consistent with active1例であった。
Activeおよびactive but healingの病期で、病原菌であるMycobacterium ulceransの増殖部位が皮下組織深部に限局しているにも拘わらず、上皮、真皮、皮下組織など、広範に凝固壊死像が観察されているが、これらの所見は、特異的毒素mycolactoneの作用によるものと考えられた。
また、healingやactive but healingの病期の真皮および皮下組織には、類上皮細胞および巨細胞を伴う肉芽腫性炎症像が観察され、細胞性免疫が機能している事が示唆された。

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Convinced with an effectiveness of MDT for curing leprosy as an infections disease since 1982, WHO has presented to the 44th World Health Assembly (WHA) in May 1991, a resolution on “The Elimination of Leprosy, as a public health problem, by year 2000”, with a numerical target of achieving a prevalence of leprosy of one case per 10, 000 population, and it was unanimously adopted. Since then all the leprosy endemic countries of the world has expanded their MDT programmes to cover the whole country, aided by free availability of MDT drugs through WHO since 1995, and succeeded in reaching the target on global basis at the end of 2000, with reduction of leprosy endemic countries down to 12 from nearly 100. At the WHA of 2000, WHO has put a new resolution to achieve the same target, at a national level, by 2005, and the programme is progressing reasonably well in terms of reducing the number of cases registered.
However this single minded endeavor of WHO is causing some difficulties, in terms of more comprehensive care of patients, specially in POD and rehabilitation activities. In addition, WHO's public announcements give a strong impression that by the end of 2005 all leprosy problems will be solved with nothing more to do beyond that time. In this presentation, what has been achieved so far, and what needs to be done will be presented briefly. Then various issues facing us currently will be discussed in relation to a realistically perceived final goal, which the speaker defines as “A World without Leprosy related Problems, both medical and social”, rather than more commonly accepted “Eradication of Leprosy” or “A World without Leprosy”, and explains the reasons.
Finally leprosy within the context of human history is discussed rather briefly, pointing out that leprosy patients, throughout history and almost everywhere in the world, suffered a worst case of human rights violation to any minority groups, because they have been conceived as a group of people totally alien to the society. The speakers believe that true understanding of the basic nature of leprosy problems and efforts to solve them will contribute to improved human relationship in general in the world, where any minorities need not to suffer any more, and able to coexist with the surrounding majorities.

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The frame work of international cooperative work was discussed toward the solution current problems of the leprosy on the view point of researcher involved in fundamental study. Prevention of further reduction of research activity was stressed.

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Many tropical and subtropical communicable diseases are prevalent in Myanmar still now. Leprosy also is not completely controlled in spite of making exertions by the Government of Myanmar and more than 10, 000 new leprosy patients were detected every year. In response to the pressure of World Health Organization ( WHO ), the government of Myanmar declared to eliminate this disease by the end of 2003, and all vertical staff concerned with leprosy control program concentrate to reach the goal of elimination ( Prevalence rate : less than 1.0 per 10, 000 population ).
Leprosy Control and Basic Health Services Project will be carried out in the project sites for 5 years, that is, from April, 2000 to March, 2001. Project purpose that was mentioned in the PDM were to support the leprosy control programme in Myanmar through the strengthening of Basic Health Service system by conducting training activities and other diseases' control programmes such as TB and Measles, by fully utilizing the above training opportunities. The Project started to conduct the main activities from 2001 as follows,
(1) BHS training (2) Training of microscopic diagnosis (3) Sewing training as one of social rehabilitations (4) Training of reconstructive surgery (5) Survey on disabilities of leprosy patients, etc.

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In the year 2002, leprosy situation in Thailand has been steadily progress. However, the prevalence rate and percentage of leprosy patients are still quite high in the North-Eastern part of Thailand. Therefore, we have focused our plan of action 2001-2 on “The strengthening of Leprosy Elimination and Prevention of Disability in the North-Eastern Region.” The objective of which is to improve and sustain the ability of leprosy related staff to conduct activities such as case finding, complication diagnosis, treatment of disabilities, rehabilitation, supervision and evaluation. The International Medical Co-operation for Leprosy in 2001, we received funds from Netherland Leprosy Relief Association (NLR) for 9 programmes concerning training of leprosy for health officers and assessment of the quality of life for leprosy affected persons living in northeastern colonies. There are 3 training courses of leprosy for new medical doctors, lab technicians from community and provincial hospitals and 2 workshops on Rehabilitation and Development of Leprosy Affected Persons “Quality of Life” under the Germany Leprosy Relief Association (GLRA) support. From Japan we received funding from Sasakawa Memorial Health Foundation (SMHF) for 4 projects in immunological studies since 1997 and 2 projects concerning dental services for Leprosy patients in the north and northeast regions from Umemoto Memorial Dental Service Group (UMDSG). The medical co-operation between Japan and Thailand should increase in many aspects especially. for new chemotherapy, immunotherapy and vaccine study in Leprosy. The future vision of Leprosy, we plan to set up the International Center of Leprosy for medical officers, technicians, etc. for the South-East Asian Countries. You are welcome to join and work together with us.

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Developing countries have their own unique characteristics, histories, and situation. There are great differences from country to country. From the experiences worked in both Bangladesh and Myanmar which share their border, some similarities and dissimilarities among these two greatly different countries are discussed. Considering this, common problems on leprosy in the developing countries are analyzed.
The needs of developing countries in the field of leprosy are studied, and the possible way of corroboration for us, Japanese leprosy workers, are suggested.

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1993年から2000年までの8年間におけるハンセン病新規患者調査を行った。日本人は56名で、内34名は沖縄県出身者であった。新規患者の平均年齢は63.9歳で高齢発症が増加していた。一方外国人は76名で、内ブラジル人が34名と多数を占めていた。平均年齢は34.5歳で、日本人と比較すると若かった。病型では多菌型が多く、B群(B群、BT型、BB型、BL型)が多かった。患者の受診科は皮膚科医が多く、治療内容はWHOの推奨する多剤併用療法(MDT)ないし、それを多少修飾した治療法が多かった。ハンセン病新規患者は皮膚科医を受診することが多く、皮膚科医の疾患に対する理解、診断、治療の習熟、サーベイランスへの協力などが必要になると思われた。

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ハンセン病医療の一般医療への統合に伴って、一般の医療施設でハンセン病の診療が行なわれることになった。このため、日本ハンセン病学会は2000年に「ハンセン病治療指針」¹⁾を発表し、化学療法はじめ診断と治療、障害の予防と治療についてのガイドラインを示した。
日本で臨床的に治癒の概念が定義され、公的に使用されるようになったのは、1989年の病型表示に関する協同研究の報告²⁾からである。その後、治療薬の種類が増え、多剤併用療法が普及するに伴って治療成績が向上し、従来の治癒判定基準を改訂する必要性が生じてきた。
WHO/MDT(1997)³⁾や上述の「治療指針」に基づいて治療を受けた患者の、新たな治癒判定の基準と判定後のハンセン病再発、後遺症や合併症などについての注意事項を明確にするため、厚生労働省「新興・再興感染症研究事業」のハンセン病研究の一環として、治癒判定の基準を設ける委員会が組織された。委員会は治癒判定基準について討議し、委員会案を作成して日本ハンセン病学会会員に検討を求め、この基準をまとめた。治療指針とともにこの基準が活用され、日本のハンセン病医療が施設や担当者に関わりなく、等質の医療を患者に提供するものとなることを希望する。

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