Leprosy

 
     
What causes leprosy?
Leprosy is a chronic disease caused by a bacillus, mycobacterium leprae. Mycobacterium leprae multiplies very slowly. The incubation period is about three to five years but signs and symptoms can take as long as 20 years to appear.

Does leprosy spread easily?
Leprosy is not highly infectious. It is transmitted via droplets from the nose and mouth or via the skin during close and frequent contact with untreated, infected persons.

What are the symptoms?
Leprosy mainly affects the skin and nerves and clinically appears in most of the cases as patches with discoloration and numbness of the affected area. If untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes. Paucibacillary (PB) leprosy results in one to five numb skin patches. Multibacillary (MB) leprosy results in more than five numb skin patches.

Can leprosy cause limbs to fall off?
Leprosy does not cause flesh to rot and fingers and toes to drop off. In the past, limbs that have been damaged because the person cannot feel pain have sometimes had to be amputated. Now that the disease can be detected early and cured completely, the need to amputate is very rare.

How long has leprosy been around?
Leprosy is as old as the ancient civilizations of China, Egypt and India. The first known written mention of leprosy is dated 600 BC. Throughout history, leprosy sufferers have often been ostracized by their communities and families.

Can leprosy be cured?
Leprosy is a curable disease and when treated in the early stages, disability can be avoided. With minimal training, leprosy can be easily diagnosed on clinical signs alone. A World Health Organization (WHO) Study Group recommended multidrug therapy (MDT) in 1981, in place of monotherapy with dapsone.

What is multidrug therapy?
MDT consists of three drugs: dapsone, rifampicin and clofazimine. This drug combination kills the pathogen and cures the patient. MDT is safe, effective and easy to administer in the field. MDT is available free of charge and distributed in monthly blister packs to all leprosy patients in the world.

What does "eliminating leprosy as a public health problem" mean?
This means reducing the proportion of leprosy patients in the community to very low levels, specifically below one case per 10 000 population.

Why has a prevalence of below one case per 10 000 population been chosen as the level of elimination?
There are indications that around the prevalence level of one in 10 000, there is a tendency for the disease to die out, and any resurgence of the disease is highly improbable.

Is there a risk of re-emergence of the disease after its elimination (less than one case per 10 000)?
Transmission of the disease is low and it is very unlikely that the disease will spread again provided that the elimination target has been achieved even in small communities.

What epidemiological advantages over other diseases does leprosy have that make elimination possible?
1. Treatment for leprosy is short, simple and available to all.
2. The infected human being is the only reservoir and source of infection.
3. Below a certain level of prevalence, any resurgence of the disease is very unlikely;
4. Unlike tuberculosis, where HIV-positive individuals have lower resistance to the disease, the leprosy situation does not appear to be adversely affected by HIV infection.

In some countries leprosy patients are being isolated from the rest of society. What is WHO doing about this?
WHO has been promoting ambulatory treatment of leprosy patients since the early 1960's and recommends that patients stay with family members and try to live as normal a life as possible. Currently, because of the Leprosy Elimination Campaign (a WHO initiative), leprosy patients are less stigmatised and it is treated as a skin disease, just like any other. Treatment is provided free of charge by any health facility with monthly MDT blister packs supplied through WHO.
     
 

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