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It is a disease that has affected humanity for thousands of years and yet, although many people are surprised by it, it is still present.
According to the latest figures from the World Health Organization (WHO) in 2019, a total of 202,185 new cases of leprosy or Hansen’s disease have been detected in 120 countries around the world.
But due to the enormous stigma that historically accompanies it, there could be many more and that they have not been diagnosed or treated.
Why has it been so difficult to eradicate, if not eliminate, this age-old infection?
“Leprosy is a chronic disease that in its early stages is rather silent and not easy to detect or diagnose,” said Dr. Santiago Nicholls, regional advisor in the Department of Neglected Infectious Diseases of the Pan American Organization. health (OPS).
“And it’s hard to estimate, but there must be a lot more undiagnosed people in the world,” he adds.
“Biblical curse”
Leprosy is caused by the bacillus Mycobacterium leprae, which is spread by droplets from the nose and mouth of infected people.
The infection mainly affects the peripheral nerves and the skin, and the patient may have serious complications such as disfigurement, deformity and disability, due to either neurological damage or blindness.
Early diagnosis and timely and appropriate treatment are two fundamental pillars for disease control.
But leprosy remains a disease poorly understood by society, experts say.
In some parts of the world, people with leprosy continue to be feared, and old perceptions of the disorder as a “biblical curse” persist.
“There is a lot of ignorance and prejudice,” notes Dr. Nicholls.
“Because he associated this stigma that comes from some biblical and from the moment when the patients were admitted to the famous leprosaria to isolate them from the community, because of the idea, already fully reassessed, that they represented a danger for the community and could infect them ”, adds- he does.
Impact
Leprosy is present in much of the world, mainly in Africa and Southeast Asia.
But about 80% of all new cases occur in India, Brazil and Indonesia.
Although some 200,000 new cases are reported worldwide each year, including thousands of children, specialists believe that there may be many more patients who go undiagnosed because they do not seek medical assistance.
“The infection begins with spots on the body that do not cause discomfort to many patients,” said Dr Erwin Cooreman, director of the World Health Organization’s (WHO) Global Leprosy Program (WHO ), at BBC Mundo.
“Pimples are not painful or itchy, so the person can ignore them and not see a doctor and they go undiagnosed.”
“It is until the body is filled with spots or they start to have deformities that they can no longer ignore the disease,” he adds.
Leprosy bacteria attack nerve endings and destroy the body’s ability to feel pain.
Without feeling pain, the person can inadvertently injure themselves and their wounds can become infected.
Skin changes that cause ulcers can also occur and, if left untreated, can lead to complications, injuries, and disfigurement of the face and extremities.
If the facial nerves are affected, the person may lose the ability to blink, which will eventually cause blindness.
Treatment
Many complications of leprosy can be avoided.
Since 1981, the disease has been successfully treated with a combination of three antibiotics, called multidrug therapy or PQT, which is offered free of charge to patients worldwide.
If treatment is given in the early stages of the disease many disabilities and deformities can be avoided, say the experts.
The problem is that diagnosis is often delayed by limited access to health services, as explained by Alice Cruz, Special Rapporteur on the elimination of discrimination against people affected by leprosy at the Office of the United Nations High Commissioner. United Nations for Human Rights (OHCHR).
“Leprosy is endemic in countries with undeveloped health systems, so it is not always possible to guarantee an early diagnosis,” the OHCHR rapporteur told BBC Mundo.
“And if the diagnosis is not adequate, the disease develops and damage to the nerves cannot be avoided, which is what generates a physical handicap in leprosy,” he adds.
There is also the problem of misdiagnosis, because in its early stages, leprosy can easily be confused with other skin diseases.
“There are problems due both to the nature of the disease and the fact that people consult on time, and also the fact that medical services, and even health professionals, sometimes do not know how to diagnose. , especially at the peripheral levels where they are found, more cases, ”says Dr Santiago Nicholls.
“Usually the first symptom is a spot on the skin where the person loses sensitivity.”
“A lot of doctors don’t suspect it’s leprosy, they think it’s a fungus or something and they don’t properly treat a patient who has a first sign of leprosy,” the expert said. from PAHO to BBC Mundo.
Discrimination
Although leprosy is spread the same way as the common cold, it is much less contagious than the common cold.
The bacillus multiplies slowly and most people have natural immunity, so they do not get the disease even if they are exposed.
But in many communities, leprosy is still considered a highly contagious disease.
And even those who have no visible disability, suffer from discrimination which often accompanies the word “leprosy”.
“There are still more than 100 discriminatory laws against people affected by leprosy in some 50 countries. Most of these laws exist in India, ”says Alice Cruz of OHCHR.
“We are talking about institutionalized discrimination that violates international human rights treaties.”
These laws, says the rapporteur, include segregation, filing for divorce because the spouse has leprosy, prohibiting the use of public transport, etc.
Amrica Latina
In 2019, 24 countries in the Americas reported new cases of leprosy, with a total of 35,231 cases.
The countries that reported having more than 100 cases were Argentina, Colombia, Cuba, the Dominican Republic, Mexico, Paraguay and Venezuela.
However, 94% of all cases in the region occurred in Brazil, where disease is associated with poverty and overpopulation.
“If we look at the distribution maps of leprosy in Brazil, the vast majority of cases are located in the poorest regions of the country: in the north, north-east and center-west”, explains Santiago Nicholls.
But in this South American country, progress has been made in the area of discrimination against leprosy, explains Acnudh rapporteur Alice Cruz.
“The last discriminatory law was removed in 1990,” says Cruz. “And even Brazil has laws that offer special protection to people with leprosy.”
In Brazil, for example, the use of the term “leprosy” was prohibited and when we talk about the disease, we talk about hansanase (for Hansen’s disease).
“It was important because it helped reduce stigma,” says Alice Cruz. “However, there is still stigma and discrimination.”
One of the biggest problems Brazil now faces is the lack of leprosy drugs.
The PQT treatment is distributed free around the world by agreement from the pharmaceutical company Novartis and the WHO.
But in 2020, explains Santiago Nicholls of PAHO, “especially due to the pandemic, Novartis had some difficulties and this caused a shortage of drugs.”
“It is something that worries us a lot “, Express.
The United Nations rapporteur also expresses his concern.
“There is an absolutely catastrophic situation for many people, sometimes entire families without medication, which means that the number of people disabled due to leprosy will increase,” Alice Cruz told BBC Mundo.
In addition, we cannot stop talking about the impact that the covid-19 pandemic will have on this disease.
Because many of the scarce resources, both human and financial, that were reserved for leprosy programs have been diverted to help the COVID-19 response.
Eradicate or eliminate
So can this disease one day be eradicated? The director of the WHO Global Leprosy Program, Erwin Cooreman, explains that leprosy eradication “is not on the agenda”.
“For the simple reason that there is an animal reservoir of the disease “, says BBC expert Mundo.
“Our strategy now is to work on eliminating new cases to interrupt transmission,” he adds.
This, however, is a very long term goal.
Because one of the main difficulties of this disease is the long incubation period that it presents.
This is the period from exposure to the pathogen until symptoms appear, which can be up to 10 or 20 years.
There is also the fact that leprosy, which is one of the so-called “neglected diseases”, is not a priority on the public health agenda of countries, where the “big three”: HIV, tuberculosis and malaria, which cause much more mortality, monopolizing all attention and resources.
“It is not only a neglected disease, but also forgotten, because most people think that leprosy does not exist any more or that it is something of the Middle Ages”, explains Alice Cruz.
“And this is a very important factor that contributes to the difficulty of reducing leprosy cases.
There are technical problems, but above all social and economic problems to achieve its elimination, ”adds the United Nations rapporteur.
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