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Leprosy Now

In Current Issue, Panorama on October 29, 2009 at 11:13 pm

An Ancient, But Still Neglected Disease

Kira Mengistu, Staff Writer

Courtesy Wikimedia Commons

Since its first documentation, leprosy has been one of the most heavily chronicled diseases. Unfortunately, some aspects of the disease and its treatment have remained obscure for thousands of years. It was not until the early years of modern medicine, in 1873, that Dr. Armauer Hansen of Norway made the astonishing discovery that leprosy was caused by a bacterium (Mycobacterium leprae) that this disease became known as a public health issue instead of a curse from God.

Over a hundred years later, technological advances have facilitated a greater understanding of the science behind the disease. Leprosy is a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract and that it causes extensive damage to the skin, limbs, nerves and eyes. Fortunately, research has led to development of effective multidrug therapies (MDTs). The MDT treatment course consists of 2 – 3 powerful drugs that, taken together, can prevent transmission after the first dose and can cure patients within 6 – 12 months.

However, what our technology has not afforded us is the insight into how we stomp this tragic disease out of existence. Since the introduction of MTDs in 1985, 14.5 million people have been cured of leprosy. Sadly, this number is very low compared to what it could potentially be. But, the World Health Organization (WHO) still reports over 200,000 new cases of leprosy each year in addition to the tens of millions already infected. Most of these new cases occur in Sub-Saharan Africa, Brazil, India, and other countries in Southeast Asia.

In these developing areas of the world, combinations of social, economic, and political issues impede delivery to victims of leprosy of an already effective treatment. But millions more could be helped if the barriers to treatment delivery could be crossed.

One of the biggest barriers to treatment delivery is the stigma associated with being a leper. Although most of the developed world now recognizes that leprosy is caused by a pathogen, many in the developing world still fear the disease is a divine sign and shun or segregate lepers in leper colonies. Fear of this segregation leads individuals with newly acquired infections to deny or hide their disease for as long as possible and avoid getting treatment in order to not reveal their status.

And yet, difficult as such cultural problems may be, economic obstacles to treatment delivery are even higher. Because leprosy, and other neglected tropical diseases, are often segregated to rural areas in the developing world, infrastructure development has often not reached the communities that are most hard hit. Roads to deliver the medicines from WHO headquarters, hospitals to carry them, and doctors capable of prescribing the medicines and watching their progress are hard to come by in these impoverished situations. Although the WHO provides MTDs free of charge in endemic countries, the lack of crucial infrastructure makes regular administration of MTDs – regardless of their availability – an ongoing challenge.

Courtesy Wikimedia Commons

Leprosy is not alone in its frustrating barriers to eradication. The thirteen other diseases, which 1/6 of the world’s population suffers from, are included in the category of neglected tropical diseases share the same problem.

Of the 14 disease listed as Neglected tropical diseases (NTD), most can be prevented or eliminated at a low cost. They do not transmit easily, but instead result from are instead the result of unsanitary living conditions, unsafe water, and insufficient access to medical care. And though they cause much pain and social stigma to their victims, they do not receive much attention from the international health community. International public health bodies believe that, because these diseases are isolated in rural areas, carry such heavy stigmas, and – unlike SARS or AIDS – do not cause international outbreaks, they go relatively unnoticed.

Public health experts are trying to promote increased awareness around NTD. According to former U.S. Health and Human Services Secretary Tommy Thompson, controlling NTD is the key to not only reducing the amount of needless suffering in the developing world, but also to fostering positive relationships between developed and developing nations. Despite remaining infrastructural challenges for treatment implementation, many share Thompson’s passion and optimism as they look the future.

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