Why has leprosy, a treatable disease, not yet been eradicated?

Leprosy, formerly known as leprosy, should no longer exist. In the early 1990s, the World Health Assembly, the decision-making body of WHO, set a goal of eradicating the disease by the year 2000.

This was an ambitious plan, driven by the successful introduction of so-called multidrug treatment (MDT), a combination of several drugs that has significantly decreased the number of leprosy cases.

However, approximately 200,000 people are still diagnosed with leprosy each year. More than half of the known cases are in India, followed by Brazil and Indonesia. The last Sunday of January is World Leprosy Day every year.

There are few signs of eradication, although the disease is neither highly contagious nor incurable.

“Experts classify leprosy as a very enigmatic disease,” said Rajib Dasgupta, a professor of social medicine at Jawaharlal Nehru University in New Delhi, India.

“Enigmatic because, even after a few centuries of learning about the disease, treating it, or at least controlling it, there are still several important gaps in knowledge. We still don’t know many things about leprosy for sure,” he explains.

Between 2010 and 2019, more than 300,000 new cases of leprosy were diagnosed in Brazil between 2010 and 2019, including 20,600 in children under 15, according to the Ministry of Health. In November last year, about 29,800 patients were being treated at the SUS.

What is known and what is not yet known

Leprosy is one of the oldest diseases in the world. Researchers have found references to this disease in stories dating back hundreds of years before Christ.

The first medical evidence of infectious disease came in 1873, with the discovery of its causative pathogen, bacteria mycobacterium leprae, by Norwegian researcher Gerhard Armauer Hansen. In honor of him, the disease is now called leprosy.

The bacterium is suspected to have spread around the world through trade routes.

The disease usually affects people with weakened immune systems, such as those suffering from malnutrition. This is thought to be one reason why the bacterium is found mainly in poorer social groups in India, Brazil and Indonesia. A healthy immune system can usually defeat this disease.

“Leprosy is always concentrated in some vulnerable populations, who are in very remote places and have less access to treatment. [médicos]Dasgupta points out.

Incubation period of many years

THE mycobacterial leprosyand is likely spread from person to person via droplets. Transmission requires close and prolonged contact, as well as a weakened immune system.

The US Centers for Disease Control and Prevention (CDC) state that a healthy adult immune system can fight off bacteria 95% of the time.

If the person becomes infected, they may not get sick right away. The incubation period, i.e. the time between infection and the appearance of any initial symptoms, can be between two and four years. But it can take up to 20 years.

This extended incubation period makes its control and eradication very difficult, Dasgupta points out. A disease is considered under control when the number of infections in a country drops to less than one in every 10,000 people.

“If this landmark is reached, programs are scaled back. Controls and measures that were still in place are being weakened,” points out Dasgupta, who has worked on several programs to fight and control infectious diseases in India.

In this way, when the incubation period finally ends and the disease breaks out, people can find themselves in situations where there are no quick measures or specialists to treat patients. And this is where more people get infected.

“The number of cases we are seeing now is lower than the actual burden in the community,” Dasgupta said. “There might be a little more bad news than meets the eye,” he points out.

What are the symptoms?

Once a leprosy infection has broken out, a few common symptoms make it easy to detect: There may be visible skin changes or nerve damage that can be detected by the loss of pain sensation.

However, loss of feeling in the extremities can lead to further injury and chronic inflammation, and if it gets to that stage before a diagnosis is made, it could mean limb amputation. Sometimes this becomes unavoidable.

Thus, in extreme cases, people with leprosy can become physically handicapped. But there is also another problem, the social one. For many hundreds of years, people with leprosy have been treated inhumanely and still suffer from social stigma today.

For this reason, in 1995, Brazil legally abolished the term leprosy from being used in official documents to refer to the disease. Since then, the term leprosy has been used to reduce social stigma.

Is leprosy incurable?

No. Leprosy can be cured and cured. People can recover and continue their lives as normal.

Treatment involves a combination of medications, and depending on the severity of the infection, it can take six to 12 months to heal.

The treatment is known as multidrug therapy and consists of three drugs: rifampicin, dapsone, and clofazimine.

The problem is that the diagnosis often comes late. Mycobacteria can be detected in lymphatic fluid and skin tissue, but this is not always a reliable method and many infections remain undiagnosed until symptoms appear.

And there is yet another challenge: “This germ cannot be easily grown in the laboratory or in animal models. And therefore gaining knowledge through controlled experiments in the laboratory is almost impossible,” explains Dasgupta.

If they could get it, researchers would use that data to develop new drugs or even vaccines against leprosy.

All in all, leprosy is still, as Dasgupta describes it, “a minefield.”

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