Main challenges in fighting leprosy

World Leprosy Day is marked globally at the end of January to draw attention to those people who still suffer from leprosy.

Hansen's disease, also known as leprosy, is an infectious disease. Sufferers have been generally called lepers, although the term is falling into disuse both from the diminishing number of leprosy patients and as a result of pressure to avoid the demeaning connotations of the term.

Leprosy used to be incurable and severely disfiguring. Lepers were shunned and sequestered. Nowadays leprosy is easily curable by multidrug therapy.

The main challenges for Hansen's disease elimination efforts are to reach populations that have not yet received multidrug therapy services, improve detection of the disease and provide patients with high-quality services and free drugs.

This chronic infectious disease usually affects the skin and peripheral nerves but has a wide range of possible clinical manifestations.

Globally there are about 534,3111 sufferers, as reported by 110 countries, by the World Health Organisation. These cases mainly occur in South East Asia. The table shows the global leprosy situation in 2003.

Worldwide, 1-2 million persons are permanently disabled as a result of Hansen's disease. However, persons receiving antibiotic treatment or having completed treatment are considered free of active infection.

Although the mode of transmission of Hansen's disease remains uncertain, most investigators think that M. leprae is usually spread from person to person in respiratory droplets.

What is known is that the transmission rate is very low. Risk groups for transmission are persons who are close contacts with patients with untreated, active, predominantly multibacillary disease and persons living in countries with highly endemic disease.

Isolation of cases is unnecessary. Leprosy is contagious only in the untreated lepromatous form and even then it isn't easily transmitted to others.

Furthermore, most people are naturally immune to leprosy, and only those in a household with an infected person for an extended time are at risk of developing an infection.

In fact, about 95 per cent of people who are exposed to Mycobacterium leprae do not develop leprosy because their immune system fights off the infection. Doctors and nurses who treat people with leprosy do not appear to be at increased risk.

Antibiotics can arrest the progression of leprosy and cure the disease. Because some of the mycobacteria may be resistant to certain antibiotics, a doctor will prescribe more than one drug, particularly for people with lepromatous leprosy.

Information campaigns about leprosy in high-risk areas are crucial so that patients and their families, who were historically ostracised from their communities, are encouraged to come forward and receive treatment.

Today, diagnosis and treatment of leprosy is easy. Essential work is being carried out to integrate leprosy services into existing, general health services. This is especially important for communities at risk for leprosy, which are often the poorest of the poor and under-served.

Leprosy in Malta has long been eliminated as a public health problem and is nowadays hardly ever seen. To date, there are about 100 registered cases, all of whom have been cured a long time ago. Some of them still require continual care for their residual disability.

Dr Gauci is from the Disease Surveillance Unit, Public Health Department

Region Number of cases Africa 53,888 Americas 75,686 East Mediterranean 7,899 South East Asia 385,458 Western Pacific 11,335 Europe 45 World 534,311