Leprosy in China

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Leprosy was said to be first recognized in the ancient civilizations of China , Egypt and India, according to the World Health Organization (WHO). [1] 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.

Contents

Epidemiology

Numbers

500,000 cases of leprosy were registered in China between 1950 and 2002. [2] Most of these sufferers have been cured but approximately 6,000 active cases remain today and about 2,000 new cases are detected and registered every year. Many more cases are not registered, partly through ignorance, but also because of the stigma associated with the disease. The number of cases reported has varied over time, with the number of cases declining between 1985 and 1993 but staying flat between 1994 and 2001. [3]

There are estimates that show that there are 200,000 people in China today who have recovered from the disease but more than half (110,000) are disabled due to the disease, with conditions ranging from blindness to disfigurement. Although these former leprosy sufferers were cured in the last 50 years, many of them still suffer serious pain and difficulties because of these disabilities/deformities and the stigma. This social stigma has become the main problem in leprosy diagnosis and treatment, today.[ citation needed ]

Areas affected

Mostly, cases of infection remain in impoverished parts in the southwestern provinces of Yunnan, Guizhou and Sichuan, and Tibet in the west and Hunan in the South. Other provinces/municipalities affected on a smaller scale, are Anhui, Qinghai, Chongqing, Guangdong and Shaanxi.[ citation needed ]

Transmission and pathology

Contrary to popular belief, leprosy ranks lowly in terms of infectiousness and is not congenital. It is passed via respiratory droplets among people in close and prolonged contact. The transmission rate is low and 95 percent of people are naturally immune to it. Caused by the bacterium Mycobacterium leprae , leprosy affects the skin, mucous membranes, peripheral nerves and eyes. As nerve damage is permanent, even those who have recovered can not feel pain. Minor cuts and abrasions on fingers and toes often turn into gaping, inflamed ulcers because of unsanitary living conditions. These open sores overrun the digits, which slowly shrink and many sufferers end up with stumps. Some have legs amputated.[ citation needed ]

Treatment

In China, dapsone was used from 1946 to treat leprosy, but treatment of the disease took a leap in 1982 with the introduction of a largely successful multidrug therapy (MDT) using dapsone, rifampicin and clofazimine. Today, therapy takes six months to a year. MDT treatment has been made available by the WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy. [4] If diagnosed and treated early, the disease leaves no traces. But in some places in China, stigma still surrounds the disease and victims do not seek treatment until it is too late.[ citation needed ]

Stigma

In current day China, leprosy is strongly associated with poverty and stigma remains a significant barrier to effective treatment. [5]

See also

Related Research Articles

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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">Gangrene</span> Type of tissue death by a lack of blood supply

Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent, it may present with a fever or sepsis.

<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. Although Western countries now generally treat cases of leprosy individually on an outpatient basis, traditional isolated colonies continue to exist in India, China, and some other countries.

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William Jopling was an Italian-born British leprologist who together with D. S. Ridley proposed the Ridley-Jopling classification of leprosy (1962), and wrote the widely read textbook of "Handbook of Leprosy" which had a fifth edition. He had a wide understanding of leprosy problems based on his experiences as the director of Jordan hospital, a leprosy hospital (1950–1967) in England and wrote various articles including "leprosy stigma".

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>

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

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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.

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

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:

References

  1. WHO | Leprosy Factsheet
  2. Chen XS, Li WZ, Jiang C, Ye GY (2001). "Leprosy in China: epidemiological trends between 1949 and 1998". Bull. World Health Organ. 79 (4): 306–12. ISSN   0042-9686. PMC   2566398 . PMID   11357209.
  3. Shen JP, Gupte MD, Jiang C, Manickam P, Yu MW, Li WZ (June 2005). "Trends of case detection and other indicators of leprosy in China during 1985–2002". Chin. Med. Sci. J. 20 (2): 77–82. PMID   16075742.
  4. WHO | Leprosy Today
  5. "Discrimination still plagues leprosy victims in mainland China".