Epidemiology of leprosy

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World distribution of leprosy, 2003. Lepra 2003.png
World distribution of leprosy, 2003.
New case of leprosy in 2016. Leprosy new case detection 2016 rates, 2016 (cropped).png
New case of leprosy in 2016.
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Disability-adjusted life year for leprosy per 100,000 inhabitants in 2004.

Worldwide, two to three million people are estimated to be permanently disabled because of leprosy. [4] India has the greatest number of cases, with Brazil second and Indonesia third.

Contents

In 1999, the world incidence of Hansen's disease was estimated to be 640,000. In 2000, 738,284 new cases were identified. [5] In 2000, the World Health Organization (WHO) listed 91 countries in which Hansen's disease is endemic. India, Myanmar and Nepal contained 70% of cases. India reports over 50% of the world's leprosy cases. [6] In 2002, 763,917 new cases were detected worldwide, and in that year the WHO listed India, Brazil, Madagascar, Mozambique, Tanzania and Nepal as having 90% of Hansen's disease cases.

According to recent figures from the WHO, 208,619 new cases of leprosy were reported in 2018 from 127 countries. [7] A total of 16,000 new child cases were detected in 2018.

In the United States, Hansen's disease is tracked by the Centers for Disease Control and Prevention (CDC), with a total of 92 cases being reported in 2002. [8] Although the number of cases worldwide continues to fall, pockets of high prevalence continue in certain areas such as Brazil, South Asia (India, Nepal), some parts of Africa (Tanzania, Madagascar, Mozambique) and the western Pacific.

Risk groups

At highest risk are those living in endemic areas with poor conditions such as inadequate bedding, contaminated water and insufficient diet, or other diseases (such as HIV) that compromise immune function. Recent research suggests that there is a defect in cell-mediated immunity that causes susceptibility to the disease. Less than ten percent of the world's population is actually capable of acquiring the disease. [9]

The region of DNA responsible for this variability is also involved in Parkinson disease, [10] giving rise to current speculation that the two disorders may be linked in some way at the biochemical level. In addition, men are twice as likely to contract leprosy as women. [11] According to The Leprosy Mission Canada, most people –about 95% of the population –are naturally immune. [9]

Disease burden

Although the number of new leprosy cases occurring each year is important as a measure of transmission, it is difficult to measure in leprosy due to its long incubation period, delays in diagnosis after onset of the disease and the lack of laboratory tools to detect leprosy in its very early stages. Instead, the registered prevalence is used. Registered prevalence is a useful proxy indicator of the disease burden as it reflects the number of active leprosy cases diagnosed with the disease and receiving treatment with MDT at a given point in time. The prevalence rate is defined as the number of cases registered for MDT treatment among the population in which the cases have occurred, again at a given point in time. [12]

New case detection is another indicator of the disease that is usually reported by countries on an annual basis. It includes cases diagnosed with onset of disease in the year in question (true incidence) and a large proportion of cases with onset in previous years (termed a backlog prevalence of undetected cases).[ citation needed ]

Endemic countries also report the number of new cases with established disabilities at the time of detection, as an indicator of the backlog prevalence. Determination of the time of onset of the disease is generally unreliable, is very labor-intensive and is seldom done in recording these statistics.

Global situation

Table 1: Prevalence at beginning of 2006, and trends in new case detection 2001–2005, and 2010, excluding Europe [registered prevalence is the national total of chronic cases]
RegionRegistered prevalence
(cases per 10,000 pop.)		New case detection during the year
Start of 2006200120022003200420052010
Africa40,830 (0.56)39,61248,24847,00646,91842,81425,345
Americas 32,904 (0.39)42,83039,93952,43552,66241,78037,740
South-East Asia 133,422 (0.81)668,658520,632405,147298,603201,635156,254
Eastern Mediterranean4,024 (0.09)4,7584,6653,9403,3923,1334,080
Western Pacific8,646 (0.05)7,4047,1546,1906,2167,1375,055
Totals219,826763,262620,638514,718407,791296,499228,474
Table 2: Prevalence and detection, countries still to reach elimination. [registered prevalence is the national total of chronic cases]
CountriesRegistered prevalence
(cases per 10,000 pop.)		New case detection
(rate/100,000 pop.)
Start of 2004Start of 2005Start of 2006During 2003During 2004During 2005
Flag of Brazil.svg  Brazil 79,908 (4.6)30,693 (1.7)27,313 (1.5)49,206 (28.6)49,384 (26.9)38,410 (20.6)
Flag of Mozambique.svg  Mozambique 6,810 (3.4)4,692 (2.4)4,889 (2.5)5,907 (29.4)4,266 (22.0)5,371 (27.1)
Flag of Nepal.svg  Nepal 7,549 (3.1)4,699 (1.8)4,921 (1.8)8,046 (32.9)6,958 (26.2)6,150 (22.7)
Flag of Tanzania.svg  Tanzania 5,420 (1.6)4,777 (1.3)4,190 (1.1)5,279 (15.4)5,190 (13.8)4,237 (11.1)
TotalsNANANANANANA
Plot of global new registered cases of leprosy per year, 2006-2022 NewCasesOfLeprosy2006to2022.png
Plot of global new registered cases of leprosy per year, 2006–2022

As reported to WHO by 115 countries and territories in 2006, and published in the Weekly Epidemiological Record, the global registered prevalence of leprosy at the beginning of the year was 219,826 cases. [13] New-case detection during the previous year (2005 – the last year for which full country information is available) was 296,499. The reason for the annual detections being higher than the prevalence at the end of the year can be explained by the fact that a proportion of new cases complete their treatment within the year and, therefore, no longer remain on the registers. The global detection of new cases continues to show a sharp decline, falling by 110,000 cases (27%) during 2005 compared with the previous year.[ citation needed ]

Table 1 shows that global annual detection has been declining since 2001. The African region reported an 8.7% decline in the number of new cases compared with 2004. The comparable figure for the Americas was 20.1%, for South-East Asia 32%, and for the Eastern Mediterranean 7.6%. The Western Pacific area, however, showed a 14.8% increase during the same period.[ citation needed ]

Table 2 shows the leprosy situation in the four major countries that have yet to achieve the goal of elimination at the national level. Elimination is defined as a prevalence of less than 1 case per 10,000 population. Madagascar reached elimination at the national level in September 2006. Nepal detection reported from mid-November 2004 to mid-November 2005. D.R. Congo officially reported to WHO in 2008 that it had reached elimination by the end of 2007 at the national level.

South America

Argentina

In 2013, there were 550 cases, of which 277 were considered as new cases. Between 350 and 400 cases of leprosy are diagnosed every year. [14] In 1926 the law 11,359 ordered compulsory quarantine for the leper, that law was abolished by the law 22,964 in 1983, that ordered compulsory quarantine for the leper only if they refuse medical indications and involve some risk for the healthy population.

Five leper colonies were built:

Only the Baldomero Sommer continues serving as a leper colony.

Brazil

Leprosy is a serious public health problem in Brazil. Between 2001 and 2013, over 500,000 cases were reported and in 2015 alone, over 25,000 cases were diagnosed. [15] There is evidence of hidden prevalence of leprosy. [16]

Asia

People's Republic of China

The People's Republic of China has many leprosy recovered patients who have been isolated from the rest of society. [17] In the 1950s, the Chinese Communist government created "Recovered Villages" in rural remote mountaintops for the recovered patients. Although leprosy is now curable with the advent of the multi-drug treatment, the villagers remain because they have been stigmatized by the outside world. [17] Health NGOs such as Joy in Action have arisen in China to especially focus on improving the conditions of "Recovered Villages". The number of leprosy cases in China has been showing a steady decline over recent years, with a prevalence of 2697 registered cases in 2017 which is a 55.3% reduction compared to that in 2010. [18]

India

British India enacted the Leprosy Act of 1898 which institutionalized those affected and segregated them by sex to prevent reproduction. The Act was difficult to enforce but was repealed in 1983 only after MDT had become widely available. In 1983, the National Leprosy Elimination Programme, previously the National Leprosy Control Programme, changed its methods from surveillance to the treatment of people with leprosy. India reported a far larger decline in leprosy cases than any other country – from 473,658 new cases in 2002 to 161,457 in 2005. [19] According to WHO, 16 million people worldwide were cured of leprosy since the past 20 years. India has estimated three million people with disability or health issues stemming from leprosy. India announced that leprosy had been “eliminated as a public health problem,” meaning that there would be fewer than one new case per 10,000 people (as defined by the WHO). Reported new cases exceed 125,000 per year (60% of the world total). 135,485 new leprosy cases were detected in India in 2017. [20] [21]

Malaysia

Malaysia was announced to be eliminated of leprosy by WHO in 1994, which signifies a reduction in the prevalence rate of the disease to less than 1 case per 10,000 people. However, it was reported that there is a rise in incidence across the country over recent years, reaching 1.02 cases per 10,000 people in 2014. [22]

Europe

Portugal

The Hospital-Colónia Rovisco Pais (the Rovisco Pais Hospital–Colony) was founded in Portugal in 1947 as a national center for the treatment of leprosy. It was renamed in 2007 as the Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais. It still retains a leprosy service in which 25 ex patients live. Between 1988 and 2003 102 patients were treated in Portugal for leprosy. [23]

Spain

The Sanatorio de Fontilles (Fontilles Sanatorium) in Spain was founded in 1902 and admitted its first patient in 1909. In 2002, the Sanatorio had 68 in-patients in the Sanatorium, and more than 150 receiving out-patient treatment. A small number of cases continue to be reported. [24]

Greece

Two indigenous cases were reported from Greece in 2009. [25]

France

One case was reported in France in 2009 [26]

Germany

Leprosy was almost eradicated in most of Europe by 1700 but sometime after 1850 leprosy was re introduced into East Prussia by Lithuanian rural workers immigrating from the Russian empire. The first leprosarium was founded in 1899 in Memel (now Klaipėda in Lithuania). Legislation was introduced in 1900 and 1904 requiring patients to be isolated and not allowed to work with others.

United Kingdom

The last confirmed case of Leprosy being transmitted within the UK was in 1953. [27] Between 2003 & 2012, an average of 139 cases/year of leprosy were diagnosed (and notified) in the UK, none of which are believed to have been acquired within the UK. [27] The UK's national referral service for leprosy is run by Prof. Diana Lockwood, the UK's only Leprologist, at the Hospital for Tropical Diseases, London. [28]

Malta

The first documented case of leprosy (erga corpore morbi leprae) in Malta in a Gozitan woman (Garita Xejbais) was in 1492 but it is certain that it was present on the island before this time. [29] The next recorded case was in 1630 in a Dominican friar. A report in 1687 recorded five cases. A further three cases were reported in 1808. Between 1839 and 1858 an additional seven cases were recorded. In 1890, a population survey recorded a total of 69 cases. A later survey in 1957 identified 151 people infected with leprosy.[ citation needed ]

In June 1972, an eradication programme was started. The project was based on the work of Enno Freerksen, Director of the Borsal Institute in Hamburg. Dr Freerksen's earlier trial had used rifampacin, izoniazid, dapsone and prothionamide. The Malta project used rifampacin, dapsone and clofamazine. The project formally concluded in 1999 having treated about 300 patients.[ citation needed ]

Romania

The last leper colony in Europe is at Tichileşti, Romania. Until 1991, patients were not allowed to leave the colony. At this colony patients get food, a place to sleep, clothes and medical attention. Some live in long pavilions and others in houses with vegetable and flower gardens. There are two churches in the colony – Orthodox and Baptist – and a farm where the colony grows its own corn.

North America

Canada

There were cases of leprosy in Atlantic Canada at the end of the nineteenth century, beginning in 1815. [30] The patients were first housed on Sheldrake Island in the Miramichi River and later transferred to Tracadie. Catholic nuns (the religieuses hospitalières de Saint-Joseph, RHSJ) came to take care of the sick. They opened the first French-language hospital in New Brunswick and many more followed. Many hospitals opened by the RHSJ nuns are still in use today. The last hospital to house lepers in Tracadie was demolished in 1991. Its lazaretto section had been closed since 1965. In a century of existence, it had housed not only Acadian victims of the disease, but people from all over Canada as well as sick immigrants from Iceland, Russia and China, among other nations. [31]

Cape Breton Island also suffered an outbreak, in the Lake Ainslie region. Nine people were affected, but it died out soon after 1882. Another outbreak of twenty cases occurred in the Lake O'Law region around 1852. [32]

United States

In the United States, the first definite reference to the disease was in Florida in 1758. In 2004, there were 131 total cases of the disease in the United States. Of the 131 cases, two-thirds were male. Also out of the 131 cases, 25 (19%) were of individuals who were born in the country. Mexico (18.3%), Micronesia (11.5%), Brazil (9.2%), and the Philippines (7.6%) were the next leading countries where those with the disease were originally born. A total of 20 cases were found to be white, not of Hispanic origin. As of October, 2005, 3,604 patients on the United States registry were currently receiving care. [33] In 2018 there are about 5,000 people who no longer have leprosy but have long-term complications of disease and continue to receive care. [34] The disease is tracked by the Centers for Disease Control and Prevention (CDC), with a total of 166 new cases reported in the US in 2005. Most (100 or 60%) of these new cases were reported in California, Louisiana, Massachusetts, New York, and Texas. [35]

Related Research Articles

<span class="mw-page-title-main">Leprosy</span> Chronic disease caused by infection of two mycobacterial species

Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur.

<span class="mw-page-title-main">Leper colony</span> Place to isolate people with leprosy

A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy.
M. leprae, the bacterium responsible for leprosy, is believed to have spread from East Africa through the Middle East, Europe, and Asia by the 5th century before reaching the rest of the world more recently. Historically, leprosy was believed to be extremely contagious and divinely ordained, leading to enormous stigma against its sufferers. Other severe skin diseases were frequently conflated with leprosy and all such sufferers were kept away from the general public, although some religious orders provided medical care and treatment. Recent research has shown M. leprae has maintained a similarly virulent genome over at least the last thousand years, leaving it unclear which precise factors led to leprosy's near elimination in Europe by 1700. A growing number of cases following the first wave of European colonization, however, led to increased attention towards leprosy during the New Imperialism of the late 19th century. Following G.A. Hansen's discovery of the role of M. leprae in the disease, the First International Leprosy Conference held in Berlin in 1897 renewed interest and investment in the isolation of lepers throughout the European colonial empires.

<i>Mycobacterium leprae</i> Bacterium that causes leprosy

Mycobacterium leprae is one of the two species of bacteria that cause Hansen's disease (leprosy), a chronic but curable infectious disease that damages the peripheral nerves and targets the skin, eyes, nose, and muscles.

Leprosy was said to be first recognized in the ancient civilizations of China, Egypt, and India, according to the World Health Organization (WHO). Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China's Ministry of Health. In the past, leprosy sufferers were ostracized by their communities as the disease was incurable, disfiguring, and wrongly thought to be highly infectious.

<span class="mw-page-title-main">Eradication of infectious diseases</span> Elimination of a disease from all hosts

The eradication of infectious diseases is the reduction of the prevalence of an infectious disease in the global host population to zero.

Leprosy stigma is a type of social stigma, a strong negative feeling towards a person with leprosy relating to their moral status in society. It is also referred to as leprosy-related stigma, leprostigma, and stigma of leprosy. Since ancient times, leprosy instilled the practice of fear and avoidance in many societies because of the associated physical disfigurement and lack of understanding behind its cause. Because of the historical trauma the word leprosy invokes, the disease is now referred to as Hansen's disease, named after Gerhard Armauer Hansen who discovered Mycobacterium leprae, the bacterial agent that causes Hansen's disease. Those who have suffered from Hansen's disease describe the impact of social stigma as far worse than the physical manifestations despite it being only mildly contagious and pharmacologically curable. This sentiment is echoed by Weis and Ramakrishna, who noted that "the impact of the meaning of the disease may be a greater source of suffering than symptoms of the disease".

<span class="mw-page-title-main">The Leprosy Mission</span>

The Leprosy Mission is an international and inter-denominational Christian NGO, the largest and oldest organisation working in the fight against leprosy. Founded as the Mission to Lepers, it has the goal of zero leprosy transmission by 2035.

Leper colony money was special money which circulated only in leper colonies due to the fear that money could carry leprosy and infect other people. However, leprosy is not easily transmitted by casual contact or objects; actual transmission only happens through long-term, constant, intimate contact with leprosy sufferers and not through contact with everyday objects used by sufferers.

Leprosy currently affects approximately a quarter of a million people throughout the world, with the majority of these cases being reported from India.

<span class="mw-page-title-main">Epidemiology of syphilis</span> Eradication efforts and prevalence of syphilis

Syphilis is a bacterial infection transmitted by sexual contact and is believed to have infected 12 million people in 1999 with greater than 90% of cases in the developing world. It affects between 700,000 and 1.6 million pregnancies a year, resulting in spontaneous abortions, stillbirths, and congenital syphilis. In Sub-Saharan Africa syphilis contributes to approximately 20% of perinatal deaths.

<span class="mw-page-title-main">Promin</span> Chemical compound

Promin, or sodium glucosulfone is a sulfone drug that was investigated for the treatment of malaria, tuberculosis and leprosy. It is broken down in the body to dapsone, which is the therapeutic form.

<span class="mw-page-title-main">Leprosy in Louisiana</span>

Although leprosy, or Hansen's Disease, was never an epidemic in The United States, cases of leprosy have been reported in Louisiana as early as the 18th century. The first leprosarium in the continental United States existed in Carville, Louisiana from 1894-1999 and Baton Rouge, Louisiana is the home of the only institution in the United States that is exclusively devoted to leprosy consulting, research, and training.

There has, historically, been fear around leprosy and people with the disease have suffered stigma, isolation and social exclusion. Expulsion of individuals infected with leprosy to quarantined areas or special institutions has been the general protocol since ancient times and was the recommended course of action by the Leprosy Conference of Berlin 1897. As a result, the exclusion and quarantining of people infected with leprosy became law, hence leprosy colonies were formed. The inhabitants of these colonies had very little legal recourse in preventing their exclusion and, even after they were treated and cured, many had trouble reintegrating into society. Even by the 1960s, when leprosy was highly treatable and curable, it still resulted in repulsion, and the exclusion of sufferers, by the general populace. As leprosy became curable, the focus of study shifted towards investigating the social aspects of the disease. This has become relevant due to the fact that the disease is making a resurgence and is proving resistant to previous remedies.

The Culion leper colony is a former leprosarium located on Culion, an island in the Palawan province of the Philippines. It was established by the U.S. government in order to rid leprosy from the Philippine Islands through the only method known at the time: isolating all existing cases and gradually phasing out the disease from the population. In addition to segregating the disease from the rest of the population, the island was later established in order to offer a better opportunity for people afflicted with leprosy to receive adequate care and modern treatments.

<span class="mw-page-title-main">MORHAN</span>

MORHAN or Movement of Reintegration of Persons Afflicted by Hansen's disease in English, is a non-profit organization that operates to reduce leprosy and the stigma of leprosy in Brazil. This organization was initially created to ensure the rights of patients from leper colonies due to their isolation, and today it is one of the most successful Brazilian social movements, with representation in the National Health Council. The group has used several methods to disseminate information about leprosy including, but not limited to, handing out pamphlets, hosting seminars, and organizing puppet shows for children. Morhan also creates its own publications as a means of mobilization and news regarding leprosy. Furthermore, Morhan has worked with anthropologists to provide explanatory models and lay explanations of leprosy within the Brazilian context. Morhan's work has been exemplary in creating partnerships between social groups and the government and received an award from the United Nation’s Millennium Development Goals. The current National Coordinator is Artur Custodio Moreira de Souza.

<span class="mw-page-title-main">History of leprosy</span>

The history of leprosy was traced to its origins by an international team of 22 geneticists using comparative genomics of the worldwide distribution of Mycobacterium leprae. Monot et al. (2005) determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs:

The Leprosy Act was an act of the Parliament of Canada regarding the establishment and direction of lazarettos, or leper homes, in Canada to ensure the segregation and treatment of people afflicted with leprosy. The Leprosy Act gave responsibility to the Minister of Agriculture for the management of the lazarettos, apprehension and confinement of the ill, capture of escaped inmates, and punishment of those found to be harbouring or concealing a person afflicted with leprosy.

Neglected tropical diseases in India are a group of bacterial, parasitic, viral, and fungal infections that are common in low income countries but receive little funding to address them. Neglected tropical diseases are common in India.

Ernest Muir FRCS, CIE, CMG was a Scottish medical missionary and educator in British-controlled India and Nigeria most noted for his work with Hansen's disease (leprosy).

<span class="mw-page-title-main">Leprosy Mission Australia</span> Christian medical and aid organisation

The Leprosy Mission Australia (TLMA) is a Christian medical charity dedicated to eradicating leprosy, and supporting those affected by the disease. An independent Australian charity, it is an active member of Leprosy Mission International (LMI) a global federation working in 28 countries. With a history dating back to 1913, TLMA focuses on providing medical treatment, rehabilitation, education, and advocacy for people affected by leprosy, especially those in marginalised communities.

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  25. ↑ Neonakis IK, Gitti Z, Kontos F, Baritaki S, Zerva L, Krambovitis E, Spandidos DA (July 2009). "Report of 2 indigenous cases of leprosy from a European country: use of polymerase chain reaction-restriction fragment length polymorphism analysis of hsp65 gene for identification of Mycobacterium leprae directly from a clinical sample". Diagnostic Microbiology and Infectious Disease. 64 (3): 331–33. doi:10.1016/j.diagmicrobio.2009.03.006. PMID   19376672.
  26. ↑ Ezzedine K, Malvy D, Beylot C, Longy-Boursier M (January 2009). "Autochthonous leprosy in metropolitan France presenting with a diffuse infiltration of the face and febrile illness". International Journal of Dermatology. 48 (1): 69–72. doi:10.1111/j.1365-4632.2009.03831.x. PMID   19126055. S2CID   12562513.
  27. 1 2 Fulton N, Anderson LF, Watson JM, Abubakar I (May 2016). "Leprosy in England and Wales 1953–2012: surveillance and challenges in low incidence countries". BMJ Open. 6 (5): e010608. doi:10.1136/bmjopen-2015-010608. PMC   4861109 . PMID   27142858.
  28. ↑ "Archived copy". Archived from the original on 2017-04-13. Retrieved 2017-04-12.{{cite web}}: CS1 maint: archived copy as title (link)[ full citation needed ]
  29. ↑ Buttigieg GG, Savona-Ventura C, Micallef Stafrace K (2008). "History of leprosy in Malta". Malta Medical Journal. 20 (4): 34–38.
  30. ↑ Stewart, William Brenton (1974). "Leprosy in New Brunswick". Medicine in New Brunswick: a history of the practice of medicine...from prior to the arrival of the white man in America to the early part of the twentieth century. Moncton: The New Brunswick Medical Society. p. 32.
  31. ↑ La Plante C. "R.H.S.J. Grande dévotion envers les malades". Fondation en Acadie (in French). New/Nouveau-Brunswick. Archived from the original on 16 January 2009. Retrieved 24 July 2011.
  32. ↑ Stewart 1974 , pp. 35–36
  33. ↑ Frankel RI, Scollard DM (2009). "Leprosy". Bacterial Infections of Humans. pp. 415–38. doi:10.1007/978-0-387-09843-2_20. ISBN   978-0387098425.
  34. ↑ "World Leprosy Day: Bust the Myths, Learn the Facts". CDC. Retrieved 22 April 2019.
  35. ↑ "U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). National Hansen's disease (leprosy) program". Archived from the original on February 10, 2011.

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