Why is leprosy still not completely eliminated?

 

Historically referred to as leprosy, the condition is now treatable and not very infectious. Nonetheless, it continues to impact around 200,000 individuals annually throughout the globe, with Brazil ranking second in terms of the number of cases.

There ought to be no such thing as leprosy anymore. As early as the 1990s, the disease’s eradication by the year 2000 was established by the World Health Assembly, the decision-making body of the World Health Organization (WHO).

Motivated by the dramatic decline in leprosy cases after the implementation of the so-called Multidrug Treatment (MDT), an ambitious strategy was hatched.

Nevertheless, leprosy continues to affect around 200,000 individuals annually. India accounts for almost 50% of confirmed cases, with Brazil and Indonesia following closely after.

At least 19,219 new cases of leprosy were diagnosed in Brazil between January and November 2023, which is 5% more than the total number of notifications filed in the same time in 2022. The Ministry of Health’s Leprosy Indicator Monitoring Panel is the source of the data.

In Brazil, the Purple January campaign has been held every January since 2016. Its goal is to educate the public and government officials about the significance of early diagnosis and the fight against leprosy discrimination. World Leprosy Day is observed every year on the final Sunday of January on a global scale.

 

Disease still not completely eliminated

Despite neither being very infectious nor untreatable, there are little indications of eradication.

“Leprosy is considered a highly mysterious disease by experts,” said Rajib Dasgupta, a professor of social medicine at Jawaharlal Nehru University in New Delhi, India.

Curious because there are still many significant unknowns about the illness, despite our understanding of it, our ability to treat it, and our ability to manage it, which dates back many centuries. According to him, there are still a lot of things regarding leprosy that we don’t know for sure.

 

How much is known and how much is unknown

One of the world’s oldest illnesses is leprosy. Tales mentioning this disease date back hundreds of years before the birth of Christ, according to researchers. In 1873, Norwegian scientist Gerhard Armauer Hansen found the bacteria Mycobacterium leprae, the infectious illness’s causal agent. This was the first medical proof of the disease. The modern name of the illness, leprosy, is in his honor.

The germs may have traveled the globe via international commerce lines.

Individuals with compromised immune systems, such as those experiencing starvation, are more likely to get infected with the illness. The bacterium is primarily prevalent in lower socioeconomic groups in India, Brazil, and Indonesia, and this is thought to be one of the reasons why. This illness is often curable in those with strong immune systems.

“Leprosy is always clustered in certain vulnerable populations, who are located very remotely and have less access to [medical] treatments,” Dasgupta notes.

Prolonged incubation time

Droplets are most likely the vector by which Mycobacterium leprae is spread from one host to another. Close quarters for an extended period of time and a compromised immune system are necessary for transmission.

In 95% of situations, a healthy adult’s immune system is able to fend off microorganisms, according to the US Centers for Disease Control and Prevention (CDC).

It is possible for an infected individual to show no symptoms for a long time. There may be a two- to four-year lag between infection and the onset of symptoms, known as the incubation period. However, twenty years may be required.

According to Dasgupta, the extended incubation time makes it very difficult to regulate or eradicate. When the incidence of a disease in a nation falls below 1 per 10,000 people, it is deemed under control.

“Programs are reduced if this target is met. Dasgupta, who has been involved in many initiatives to manage infectious illnesses in India, notes that the controls and procedures that were previously in place have been compromised.

Therefore, when the incubation period finishes and the sickness breaks out, individuals may find themselves in circumstances without specialized treatment or rapid action. And that’s when the infection spreads to other individuals.

The current caseload is lower than the real community burden, according to Dasgupta. Adding, “There may be a little more bad news than meets the eye,” he concludes.

 

Could you tell me the signs?

Once leprosy has spread, there are a few telltale signs that might help with diagnosis: If you suddenly stop feeling pain, it might be a sign of nerve injury or skin abnormalities.

Nevertheless, numbness or tingling in the limbs might cause further damage and persistent inflammation; if this happens before a diagnosis is made, amputation of the limbs may be necessary. At times, this is just unavoidable.

Consequently, leprosy may cause permanent physical impairments in the worst-case scenario. However, the social aspect is not the only issue. People who contracted leprosy endured cruel treatment for centuries and continue to face discrimination and prejudice in modern society.

Because of this, the word “leprosy” was officially outlawed in Brazil in 1995. The word leprosy has been used to lessen societal stigma since then.

 

Is there a cure for leprosy?

No. It is possible to treat and cure leprosy. It is possible for people to get well and go on as usual.

It may take six to twelve months to cure from an infection that requires a mix of medicines for treatment.

Rifampicin, dapsone, and clofazimine are the three drugs that make up the treatment known as polychemotherapy.

The delay in diagnosis is a common issue. Although skin and lymph fluid may sometimes reveal the presence of bacteria, this is by no means a foolproof procedure, and many infections go undetected until symptoms manifest.

Also, this germ is very difficult to cultivate in labs or using animal models, which presents still additional obstacle. According to Dasgupta, this means that it is very difficult to get information via laboratory controlled experiments.

Scientists would use this information to create leprosy vaccinations or new medications if they could get their hands on it.

When everything is said and done, leprosy remains what Dasgupta calls “a minefield.”

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