29 January 2009

Leprosy still with us

Thought leprosy was a disease of medieaval times? Think again. Today, 2 million people still live with it. World Leprosy Day sheds light on this misunderstood disease.

Leprosy ranks high up on the list of stigmatised diseases, and sufferers have consequently been marginalised for centuries. The disease was identified as far back as the ancient civilizations of China, Egypt and India, and the first written mention of the disease appears to date back to 600 BC. Today there are about two million sufferers in 119 countries worldwide, of which South Africa is one.

World Leprosy Day is celebrated each year at the end of January in 100 countries around the world.

Leprosy in South Africa
"There are currently 171 people receiving treatment for leprosy in South Africa," says Theo de Villiers, deputy director of the Leprosy Mission for Southern Africa. "And 66 of those cases were identified last year - 10 of which are children 14 years and younger." The Mission is in contact with a further 2 000 non-active sufferers – people whose infections have healed, but who suffer disabilities as a consequence.

These figures are way below the World Health Organisation standard of one per 10 000 people in the population but, far from being reassured, De Villiers argues that it is important not to lose focus of the disease at this stage. "When there aren't a lot of new cases, people might forget about the disease and infections could increase rapidly if treatment efforts aren't kept up".

Mpumalanga, KwaZulu Natal and the Eastern Cape are the provinces worst affected by leprosy, and most cases occur in rural areas. "Remote areas, far away from clinics and medical facilities, often stricken by poverty seem to be a breeding ground for leprosy."

It's a warning that our near neighbours Mozambique, Angola and Madagascar are amongst the world's worst affected countries. "Migrant populations carry it across our borders and could spread further infections," warns De Villiers.

How contagious is it?

It is widely believed that leprosy is highly contagious. This is why sufferers have historically been ostracised, banished from communities. From 1846 to 1931 our own Robben Island was a hospital where leprosy sufferers were practically imprisoned in the belief that this would control the disease.

Medical science has found, however, that leprosy is in fact not highly contagious. It is transmitted much like TB, via droplets from the nose and mouth during close and frequent contact with untreated sufferers, says the WHO.

"It is highly unlikely one can be accidentally infected," says De Villiers. "You can't get it from touching or hugging a person."

How treatment works
Leprosy is a curable disease and treatment provided in the early stages averts disability, says the WHO. It is caused be the mycobacterium leprae which affects the body's nervous system.

Treatment and medication for leprosy are free for all South Africans, thanks to a donation from the drug manufacturer Novartis. Depending on the type and severity of the infection, leprosy sufferers may have to use a "cocktail" of three drugs for six months to two years. "But the good news is that the medicine immediately kills the bacterium and patients are not infectious from day one of starting medication," says De Villiers.

For this reason, patients don't have to be hospitalised or quarantined, as is the case with some drug-resistant strains of tuberculoses. Sufferers are treated as outpatients to clinics and can stay at home with their families for the duration of their treatment. Only in extreme cases would a patient be hospitalised to treat wounds or disabilities caused by the infection.

Monthly clinic visits are sufficient to control the infection.

Leprosy Mission Southern Africa
The role of the Leprosy Mission is to teach communities about leprosy and to help patients and their families overcome physical, social, emotional and spiritual obstacles brought on by the disease.

For more information visit Leprosy Mission Southern Africa

(Wilma Stassen, Health24, January 2008)


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Dr Suretha Kannenberg holds a degree in Medicine and a Masters in Dermatology from the University of Stellenbosch. She is employed as a consultant dermatologist by Stellenbosch University and Tygerberg Academic Hospital, where she is involved in clinical duties and the training of medical students and dermatology residents. Her areas of interest and research include vitiligo, eczema and acne. She also performs limited private practice work in the Northern suburbs of Cape Town in general and cosmetic dermatology.

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