Yes – leprosy is not a disease consigned to Biblical times. More than 200,000 new cases are recorded each year globally and three million people are living with irreversible disabilities, including blindness, because of leprosy.
The countries with the highest number of new diagnoses are India, Brazil and Indonesia followed by some of the African nations. More than half of all new cases of leprosy are diagnosed in India which remains home to a third of the world’s poor.
In 2015 there were 14 countries reporting more than 1,000 new cases of leprosy. These were Bangladesh, Brazil, DR Congo, Ethiopia, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, the Philippines, Sri Lanka and Tanzania.
Children account for around 9% percent of new cases (WHO: Global Leprosy Situation). Many developing countries classify children to be those 15 and under. Because the incubation period of leprosy is long, cases in very young children (under the age of six) are less commonly detected though not unheard of.
In short: no. Leprosy attacks the nerves in the cooler parts of the body, particularly those that relate to the hands, feet and face. The result is a loss of sensation in these areas meaning a person is at much greater risk of injury as they cannot feel pain. A stone in a shoe may go unnoticed or a burn while cooking with the resulting injury and infection sometimes severe enough to cause the bone to ‘shorten’. The feet of a leprosy-affected person are prone to ulcers which, if not treated properly, can lead to amputation.
Clawing of the hands or toes is a common disability caused by leprosy. Leprosy starts damaging the small nerves in the skin's surface, but if left untreated it begins affecting the large nerves in the elbow, wrist, knee and ankle. The resulting damage can lead to loss of sensation in the hands and feet and muscle paralysis, which causes clawed fingers and toes.
In the late 1940s, Dr Paul Brand became the first surgeon in the world to use reconstructive surgery to correct the deformities of leprosy in the hands and feet. Movement can be restored by using a muscle transfer technique where, with the help of a physiotherapist, a muscle is identified for transfer and strengthened. After surgery and several weeks in plaster, the patient is taught how to use their old muscle to do a new job and then apply the technique subconsciously. The results can see a leprosy-affected person walk again without dragging their foot on the ground or use their hand to grip items.
The WHO definition of elimination is “less than one in 10,000 of the total population actively taking leprosy antibiotics in the month of November of a given year”.
Less than a handful of nations report figures above this definition of elimination each year. However, leprosy in India has been technically eliminated according to the WHO definition for several years now, despite 150,000 new cases annually. The WHO numbers also do not include all the leprosy patients experiencing ongoing disease complications who may have already completed antibiotics.
Historically, as a population becomes more developed with people receiving adequate nutrition, housing, sanitation and access to health services, leprosy can mostly disappear within two to three generations (e.g. Europe in the last 150 years, and post-war Japan and South Korea). Multidrug therapy has made tremendous achievements against leprosy. However, antibiotics alone have never been enough for total eradication of any disease.
Leprosy is curable with multidrug therapy (MDT) – a combination of three drugs taken daily for six to 12 months. MDT is available free of charge. The sooner a person with leprosy is treated the better as they are less likely to suffer from irreversible disabilities as a result. While reconstructive surgery can correct a clawed hand, a foot drop or restore the blinking mechanism to the eyes, it cannot bring feeling back to areas where there has been nerve damage.
Leprosy is classified into two treatment groups by the World Health Organisation: PB (paucibacillary or tuberculoid) and MB (multibacillary or lepromatous).
Both are treated with MDT (Multi-Drug Therapy) which consists of dapsone, rifampicin and clofazimine. PB cases are treated with daily dapsone and monthly rifampicin for six months. While MB cases are treated with daily dapsone and clofazimine along with monthly rifampicin for 12 months.
There is much stigma surrounding leprosy and many people believe it is a punishment or a curse. The truth is it is simply a mildly infectious disease. It is not hereditary and cannot be caught by touch. Scientists believe it is caught through droplets of moisture passed through the air from someone who has leprosy but has not yet started treatment. Around 95 per cent of people are thought to be naturally immune to leprosy.
The first signs of leprosy are pale or reddish patches on the skin. Sometimes a person with leprosy discovers nodules on their skin. It can be difficult to diagnose and The Leprosy Mission works with governments around the world to ensure medical staff know what to look for and how to treat the disease.
*The above costs are based on averages for The Leprosy Mission’s global family. It is impossible to provide precise costings as The Leprosy Mission works in more than 20 countries, each with unique geographic and economic circumstances. For instance, the cost of transporting drugs to a patient in rural Niger differs greatly to supplying treatment to a large urban hospital in India. The figures, therefore, should be treated as an estimate.
Leprosy is an infection that is very effectively treated with multidrug therapy (MDT). However, some patients develop complications called reactions, which require additional treatment.
One characteristic of leprosy is the occurrence of reactions – periods of inflammation that can affect the nerves. This inflammation is caused by the body’s immune system attacking the leprosy bacteria.
Inflammation is the body’s usual response to infection, and its typical features are: swelling; redness; heat; pain; loss of function.
Because leprosy bacilli affect the skin and the nerves, leprosy reactions cause inflammation in those places. Inflammation in a skin patch can be uncomfortable, but it is rarely very serious. Inflammation in a nerve, on the other hand, can cause serious damage, with loss of function caused by swelling and pressure in the nerve.
About 25–30% of all people with leprosy experience reactions or nerve damage at one time or another.