Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). Leprosy is also known as Hansen’s disease after the scientist discovered M. leprae in 1873.

More than 16 million leprosy patients have been treated with MDT over the past 20 years. Though gradual, a general reduction in new cases is observed in several countries. The new cases were reduced to 202 256 in 2019. Several countries reported less number cases, including 45 countries that reported zero leprosy cases.

Leprosy is endemic in several states and union territories of India, with an annual case detection rate of 4.56 per 10 000 population. The prevalence rate of leprosy is 0.4 per 10,000 population in the country. Of the new cases detected during 2020-2021, 58.1% were multibacillary, 39% were women, 5.8% were children less than 14 years of age, and 2.41% had visible deformities. The rate of visible deformities was 1.1 per million population.

Definitely not! Most patients are not highly contagious, and with the new drugs, all patients are rendered non-infectious within 48 hours. Patients are now being diagnosed and treated in the community while continuing their life and work. They are not admitted to the hospital unless their illness or treatment complications occur.

The type of leprosy a person will develop depends on their natural resistance to the disease, not the kind of germ. There is only one leprosy germ, but people react to it in different ways. If a person has no resistance, the germs multiply freely in the skin, the lining of the nose and even deep organs like the liver. This is lepromatous leprosy. Other types are tuberculoid, borderline and indeterminate, each with its typical symptoms. Many people naturally resist leprosy and will never develop clinical signs though exposed to untreated, active patients for long periods.

The early signs and symptoms of leprosy can vary considerably depending on a patient’s resistance to the disease. They can be easily missed or mistaken for some other disease by the untrained person. People with lepromatous leprosy usually develop a skin rash or nodules, while tuberculoid leprosy might first show itself as an area of numbness or pins and needles. Dark-skinned people sometimes have patches that are paler in colour than their normal skin and light-skinned patients show pinkish and reddish patches. There is no one first sign of leprosy. Careful consultation by a competent doctor to examine skin smears under a microscope is necessary for correct diagnosis.

Like the common cold, scientifically speaking, it is almost impossible to prove how the leprosy germ gets from one person to another. Still, people with lepromatous leprosy expel large numbers of germs from their noses and mouth. Like the common cold, the germs probably get into the body by inhalation or ingestion, as in other diseases such as tuberculosis and influenza. Researchers are still working on how the germ moves from one person to the next.

Yes…

Most people have a natural immunity that fights the bacteria in their system without human intervention. For those without this natural immunity, modern medicine can kill bacteria and help the patient be cured. The earlier the medical treatment is started, the better the hope of a complete cure without deformity. If deformity occurs, there is a chance that it may be permanent.

A single drug, Dapsone, was used for many years, but because of an increasing incidence of Dapsone resistance, the WHO now recommends a combination of drugs – Rifampicin, Clofazimine and Dapsone – known as MDT. This Multi-Drug Therapy (MDT) is more costly, but it reduces the length of time a patient needs treatment considerably. So far, it appears to be a very effective method of killing the germ. Depending on the strength of the germ, treatment is for 6 months to 2 years.

So far, no specific preventative measure against leprosy is available. A vaccine is being researched and may be available in the future, but its usefulness may well be limited. The best way to prevent disease transmission within the community is to reduce infectivity as quickly as possible. To this end, early detection and treatment are primary goals.

Less than one-third of all patients develop deformities. The leading cause of deformity in leprosy patients is nerve damage. This occurs because the leprosy germs have a peculiar liking for nerve tissue and multiply freely between nerve fibres. When the germs die or are killed by the medication, the resulting inflammation compresses and destroys these delicate fibres with more or less complete loss of function. So the feeling is lost and muscles paralysed, thus paving the way for ulceration, damage through injury and eventually deformity.

Yes! The techniques of physiotherapy and re-constructive surgery may be used. Physiotherapy maintains the mobility of the affected limb and strengthens weakened muscles. The patient is taught self-care and the prevention of recurring injury. Re-constructive surgery may be used to help restore function and social acceptance. Surgery may modify damage to hands, feet and face, but it is usually impossible to restore sensation. Even when nerves are only partly destroyed, patients need to carefully use their insensitive hands and feet so that they do not injure themselves unknowingly.

Occupational therapy can help patients learn how to gain a livelihood without damaging their hands and feet. This may mean new job skills or using protective appliances to save their hands from injury. Patients with insensitive feet require suitable protective footwear.

If treatment was received at an outpatient clinic, the patient would carry on with normal daily activities and report for re-examination at prescribed intervals. If the patient has been in hospital for a long time, a difficult period of social and domestic re-adjustment may be faced.

Many former leprosy patients are so permanently disabled that they need food and shelter for their remaining days. TLM operates, where possible, residential homes for people without families to care for them. For those who are able, TLM offers training courses and small business loans to give patients the ability to become self-supporting.

In 1874, an Irish missionary & teacher, Wellesley Bailey was moved by the plight of leprosy sufferers in Ambala, India. He promised to raise money to help these patients and thus ‘The Mission to Lepers’ was born. What began then as a little known society has grown into a worldwide mission, bring healing to leprosy affected in 28 countries. The Mission aims to meet the total needs (physical, spiritual, social and psychological) of people affected by leprosy and work towards eradicating the disease. Those affected can include children, families and the whole community.

The Leprosy Mission’s Global Fellowship works in 28 countries where people have been affected by leprosy to restore and enhance human dignity, self-reliance and quality of life. Mission focus on ten countries in Africa and Asia – Bangladesh, Ethiopia, India, Mozambique, Myanmar (Burma), Nepal, Niger, Nigeria, Sri Lanka and Sudan. These places have high rates of leprosy or lack the services or opportunities the people affected need.

As well as supporting people living with leprosy today, we serve future generations by working to end the disease transmission. So, they may be born into a world free from leprosy. We partner with governments and organisations. Most importantly, we work with people affected by leprosy to achieve our vision – healing, inclusion and dignity.