Leprosy Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...

was said to be first recognized in the

ancient civilization A civilization (or civilisation) is any complex society characterized by the development of a state, social stratification, urbanization, and symbolic systems of communication beyond natural spoken language (namely, a writing system). Civ ...

s of

China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...

Egypt Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...

and

India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...

, according to the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...

(WHO). Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China's Ministry of Health. In the past, leprosy sufferers were ostracized by their communities as the disease was incurable, disfiguring and wrongly thought to be highly infectious.

Epidemiology

Numbers

500,000 cases of leprosy were registered in China between 1950 and 2002. Most of these sufferers have been cured but approximately 6,000 active cases remain today and about 2,000 new cases are detected and registered every year. Many more cases are not registered, partly through ignorance, but also because of the stigma associated with the disease. The number of cases reported has varied over time, with the number of cases declining between 1985 and 1993 but staying flat between 1994 and 2001. There are estimates that show that there are 200,000 people in China today who have recovered from the disease but more than half (110,000) are disabled due to the disease, with conditions ranging from blindness to disfigurement. Although these former leprosy sufferers were cured in the last 50 years, many of them still suffer serious pain and difficulties because of these disabilities/deformities and the stigma. This social stigma has become the main problem in leprosy diagnosis and treatment, today.

Areas affected

Mostly, cases of infection remain in impoverished parts in the southwestern provinces of

Yunnan Yunnan , () is a landlocked Provinces of China, province in Southwest China, the southwest of the People's Republic of China. The province spans approximately and has a population of 48.3 million (as of 2018). The capital of the province is ...

Guizhou Guizhou (; formerly Kweichow) is a landlocked province in the southwest region of the People's Republic of China. Its capital and largest city is Guiyang, in the center of the province. Guizhou borders the autonomous region of Guangxi to t ...

and

Sichuan Sichuan (; zh, c=, labels=no, ; zh, p=Sìchuān; alternatively romanized as Szechuan or Szechwan; formerly also referred to as "West China" or "Western China" by Protestant missions) is a province in Southwest China occupying most of the ...

, and

Tibet Tibet (; ''Böd''; ) is a region in East Asia, covering much of the Tibetan Plateau and spanning about . It is the traditional homeland of the Tibetan people. Also resident on the plateau are some other ethnic groups such as Monpa people, ...

in the west and

Hunan Hunan (, ; ) is a landlocked province of the People's Republic of China, part of the South Central China region. Located in the middle reaches of the Yangtze watershed, it borders the province-level divisions of Hubei to the north, Jiangxi to ...

in the South. Other provinces/municipalities affected on a smaller scale, are

Anhui Anhui , (; formerly romanized as Anhwei) is a landlocked province of the People's Republic of China, part of the East China region. Its provincial capital and largest city is Hefei. The province is located across the basins of the Yangtze River ...

Qinghai Qinghai (; alternately romanized as Tsinghai, Ch'inghai), also known as Kokonor, is a landlocked province in the northwest of the People's Republic of China. It is the fourth largest province of China by area and has the third smallest po ...

Chongqing Chongqing ( or ; ; Sichuanese dialects, Sichuanese pronunciation: , Standard Mandarin pronunciation: ), Postal Romanization, alternately romanized as Chungking (), is a Direct-administered municipalities of China, municipality in Southwes ...

Guangdong Guangdong (, ), alternatively romanized as Canton or Kwangtung, is a coastal province in South China on the north shore of the South China Sea. The capital of the province is Guangzhou. With a population of 126.01 million (as of 2020) ...

and

Shaanxi Shaanxi (alternatively Shensi, see #Name, § Name) is a landlocked Provinces of China, province of China. Officially part of Northwest China, it borders the province-level divisions of Shanxi (NE, E), Henan (E), Hubei (SE), Chongqing (S), Sichu ...

Transmission and pathology

Contrary to popular belief, leprosy ranks lowly in terms of infectiousness and is not congenital. It is passed via

respiratory The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies grea ...

droplets among people in close and prolonged contact. The transmission rate is low and 95 percent of people are naturally

immune In biology, immunity is the capability of multicellular organisms to resist harmful microorganisms. Immunity involves both specific and nonspecific components. The nonspecific components act as barriers or eliminators of a wide range of pathogens ...

to it. Caused by the bacterium ''

Mycobacterium leprae ''Mycobacterium leprae'' (also known as the leprosy bacillus or Hansen's bacillus), is one of the two species of bacteria that cause Hansen’s disease (leprosy), a chronic but curable infectious disease that damages the peripheral nerves and ...

'', leprosy affects the skin, mucous membranes, peripheral nerves and eyes. As nerve damage is permanent, even those who have recovered can not feel pain. Minor cuts and abrasions on fingers and toes often turn into gaping, inflamed ulcers because of unsanitary living conditions. These open sores overrun the digits, which slowly shrink and many sufferers end up with stumps. Some have legs amputated.

Treatment

In China,

dapsone Dapsone, also known as 4,4'-sulfonyldianiline (SDA) or diaminodiphenyl sulfone (DDS), is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy. It is a second-line medication for the treatment a ...

was used from 1946 to treat leprosy, but treatment of the disease took a leap in 1982 with the introduction of a largely successful multidrug therapy (MDT) using dapsone,

rifampicin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), mycobacterium avium complex, ''Mycobacterium avium'' complex, leprosy, and Legionnaires’ disease. ...

and

clofazimine Clofazimine, sold under the brand name Lamprene, is a medication used together with rifampicin and dapsone to treat leprosy. It is specifically used for multibacillary (MB) leprosy and erythema nodosum leprosum. Evidence is insufficient to sup ...

. Today, therapy takes six months to a year. MDT treatment has been made available by the WHO free of charge to all

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...

s worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy. If diagnosed and treated early, the disease leaves no traces. But in some places in China, stigma still surrounds the disease and victims do not seek treatment until it is too late.

Stigma

In current day China, leprosy is strongly associated with poverty and stigma remains a significant barrier to effective treatment.

References

External links

Leprosy and the Buddhist Tradition
— eRENLAIMAGAZINE

Xinhua. 26 January 2008. {{Asia topic, Leprosy in Health in China