A/HRC/41/47 into consideration the relation of the intersection of leprosy and gender with other axes of oppression such as ethnicity and/or race, age, disability, migration and poverty, merely highlighting the tip of the iceberg.22 37. By the same token, if there is a general underrepresentation of women in political and public life, the absence of women affected by leprosy in programmes and policies that directly affect them, as well as in the leadership of civil society organizations and organizations of persons affected by leprosy, is alarming. Giving voice to women affected by leprosy would lead to the recognition of the correlation between leprosy, gender-based violence, civil death and, in some cases, even material death.23 B. Leprosy in children 38. The age group in which leprosy is most commonly diagnosed in children under 15 years of age is between 10 and 14 years. This is due to the disease’s long incubation period following exposure. The next most affected age group is between 5 and 9 years of age. However, cases among younger children have also been found and, more rarely, cases in infants of less than 1 year have also been reported.24 39. Due to the immaturity of their immune system, children appear to be more prone to leprosy than other members of the same household,25 which should raise concerns about their vulnerability to leprosy and prompt special measures to protect them. 40. Of the total of 210,671 new cases reported by 150 countries to WHO in 2017, 16,979 (about 8 per cent) were children under 15 years of age, a shamefully high figure. Of the total of 5,591 new cases in children, among priority countries that reported new cases in children under 15 years of age with grade 2 disabilities, 202 presented visible physical impairments, including irreversible damage to the nerves, hands, feet, limbs and eyes, at the time of diagnosis. However, some countries with a high incidence of leprosy, such as India, Nepal, Nigeria and the Philippines, did not provide disaggregated data on grade 2 disabilities at the time of diagnosis for adults and children, meaning that the aforementioned 202 reported cases are a major underestimation. 26 41. Still, these data only reflect the situation at the time of diagnosis. Independent studies in delimited territories have found a substantial hidden prevalence of leprosy among children in endemic areas, which also indicates a hidden prevalence among adults. Up to 11 per cent of children with visible physical impairments at the time of diagnosis, increasing to 27.3 per cent during follow-up, have also been found.27 42. Data from independent studies suggest two critical concerns: (a) enduring underdetection of new cases of leprosy in children, accompanied by late diagnosis, are both causal factors of physical and psychosocial impairments and disabilities; and (b) physical impairments that can worsen over time without proper care require follow-up studies, the absence of which hinders a clear understanding of the real conditions faced by children affected by leprosy in the medium and long term. 22 23 24 25 26 27 8 leprosy in Cirebon District, Indonesia”, Disability, CBR and Inclusive Development, vol. 25, No. 4 (2014), pp. 5–21. A. Castro and P. Farmer, “Understanding and addressing AIDS-related stigma: from anthropological theory to clinical practice in Haiti”, American Journal of Public Health, vol. 95, No. 1 (2005), pp. 53– 59. Engelbrektsson, Challenged Lives. See also A/HRC/35/10 for the importance of addressing these intersections and their impact on women and girls. M.B.B. Oliveira, “Leprosy among children under 15 years of age: literature review”, Anais Brasileiros de Dermatologia, vol. 91, No. 2 (2016), pp. 196–203. Ibid. WHO, Weekly Epidemiological Record. J.G. Barreto and others, “Leprosy in children”, Current Infectious Diseases Reports, vol. 19, Issue 6 (2017), pp. 19–23.