Janice Chang, Contributor
THE THREE messages that need to be spread about leprosy (or Hansen's disease) are that leprosy is curable, free treatment is available, and there is no place for stigma and discrimination.
Leprosy is a chronic infectious disease caused by the bacillus mycobacterium leprae. The organism multiplies very slowly; the incubation period is about two to five years and symptoms take as long as 20 years to appear. Although it is a communicable disease, it is very hard to transmit and can't be caught by casual contact (for example, by touching or shaking hands), and is definitely not a result of a person's transgressions. It is transmitted via droplets from the nose and mouth, during close and frequent contact with untreated cases.
Leprosy affects mainly the skin and nerves, and if untreated can cause progressive and permanent damage to the skin, nerves, limbs and eyes. The condition is characterised by hyperpigmentation (deepening of pigment/colour) in reddened skin lesions, with clear loss of sensation in the area served by peripheral nerves which worsens as the disease progresses.
The clinical manifestations of the disease vary in a continuous spectrum between the two forms, lepromatous and tuberculoid leprosy (depending on the bacillary load):
In lepromatous (multibacillary/MB) leprosy, nodules, papules, macules and diffuse infiltrations are bilateral, symmetrical and usually numerous and extensive; involvement of the nasal mucosa may lead to crusting, obstructed breathing and nosebleeds; eye involvement leads to iritis and keratitis.
In tuberculoid (paucibacillary/PB) leprosy, skin lesions are single or few, sharply demarcated, with loss of or reduced sensation. The lesions are bilateral and asymmetrical; involvement of peripheral nerves tends to be severe.
Borderline leprosy has features of both polar forms and is more unstable.
Indeterminate leprosy is characterised by hypopigmented (lightened skin) maculae with ill-defined borders; if untreated, it may progress to tuberculoid, borderline or lepromatous disease.
To date, the American regional prevalence rate indicates that leprosy has been eliminated at regional level (that is, the prevalence of the disease is less than one case per 10,000 population).
LEPROSY IS CURABLE
Multi-drug therapy (MDT) makes elimination a real possibility. It, therefore, becomes absolutely necessary to disseminate information on the problem so that the medical community, especially at the primary-care level, can become sensitised on the issues and act accordingly. In addition to assuring universal access to appropriate diagnosis and high-quality treatment using MDT, the Jamaican Ministry of Health with technical support from PAHO/WHO is working to strengthen epidemiological surveillance and enhance the operational aspects of the leprosy control programme.
FREE TREATMENT IS AVAILABLE
Multi-drug therapy is safe, effective and easily administered under field conditions. MDT is available in convenient, monthly calendar blister packs to all patients. Since 1995, WHO provides free MDT for all patients in the world.
In Jamaica, anti-leprosy drugs (MDT) are in adequate supply and are given to Jamaican clients 'free-of-charge'. Other types of socio-economic assistance are provided for clients, such as bus/taxi fares to attend clinic, special footwear, prosthesis and wheelchairs.
NO PLACE FOR STIGMA AND DISCRIMINATION
In order to reach all patients, treatment of leprosy was fully integrated into general health services in Jamaica. This was the key to successful elimination status and can pave the way for future eradication (that is, zero prevalence) of the disease. Partners in leprosy elimination need to continue to ensure that human and financial resources are made available for the elimination of leprosy.
Dr. Janice Chang, Adviser - Promotion of Health and Disease Prevention and Control, PAHO/WHO (Jamaica).
