Leprosy in China

Introduction

Leprosy, also know as Hansen’s disease, is a chronic disease caused Mycobacterium leprae. Mycobacterium leprae was discovered in 1873 by Aramauer Hansen and was identified as the first bacterium to cause a human disease. Leprosy dates back to biblical times, with the first recording of leprosy in 600 BC. There are even accounts of leprosy cases in the oldest human civilizations. Leprosy has since affected every continent. Even to this day, leprosy is present. With the availability of antibiotics and vaccinations, the number of reported cases has dramatically decreased. However, the disease still very well present. As of 2006, the World Health Organization reported 219,826 cases.

Description of Leprosy

Leprosy is an infection of the skin, peripheral nerves, mucous membranes of the respiratory tract, and eyes. If it is not treated, it leads to gradual and permanent nerve damage. Mycobacterium leprae is spread in the repiratory tract and accumulates in body extremities. The bacterium infects Schwann cells of the peripheral nervous system. Infected Schwann cells can no longer produce myelin and as a result, nerves are damaged and there is sensory loss.

Types of Leprosy

Most people have strong enough immune responses to the disease and can resist infection by Mycobacterium leprae. People who are not able to resist the infection develop a mild form of leprosy called indeterminate leprosy. Indeterminate leprosy is characterized for its

Polar lepromatous leprosy (LL)

Polar tuberculoid leprosy (TT)

Borderline leprosy (BT)

Although leprosy primarily affects humans, there have been some cases where animals have also been affected. There is no sufficient evidence that transmission can occur from animal to human and vice versa.

Symptoms

Symptoms of leprosy include skin lesions, enlarged peripheral nerves, sensory loss, disfigurations, and disabilities. Symptoms can take up to twenty years to appear. Depending on a person’s immune system and response to bacterial infection, leprosy can take on many forms. Severe cases are due to a weak response of the immune system to the infection, as opposed to milder cases in which immune responses are more effective. Milder cases can be cured, but can also worsen into a more serious form of leprosy. Leprosy is curable. If treated in early stages, permanent damage can be avoided. Antibiotics are available and are very effective to target the bacterium causing the disease.

Treatment

Since the discovery of Mycobacterium leprae in 1873, thorough research on the microbe was done to come up with a solution. Finally, in the 1940’s, treatment for the disease was found in the form of the dapsone drug. However, within a span of twenty years, Mycobacterium leprae developed a resistance to the drug and this resistance spread. In 1981, a breakthrough was made when the World Health Organization (WHO) enacted a multidrug therapy, or MDT, which consists of the drugs dapsone, rifampicin, and clofazimine. MDT was successful in killing the pathogen and has now become accepted as the cure to leprosy. Since 1995, MDT has been made available and has been distributed for free by WHO.

Description of the microbe

Include a link if there is an existing microbewiki page.

Mycobacterium leprae is the bacteria that cause Leprosy. It was first observed in 1873 by Hansen in unstained wet mounts of tissue fluid from lepromas of patients in Norway. Hansen discovered that Mycobacterium leprae is a gram-positive, acid-fast, obligate intracellular pathogen. (2) It can infect many cells in vivo such as epithelial cells, muscle cells, and Schwann cells. In addition, it can also infect macrophages. These invasions and destructions by Mycobacterium leprae are responsible for many of the clinical manifestations seen in leprosy such as bacterial progression, immunological responses of the host, peripheral nerve damage, and preventable secondary deformities following nerve damage. (1)

Transmission of disease

How is it transmitted? Is there a vector (animal/insect)?

Why is this disease a problem in China

China had been suffered from Leprosy since at least two thousand years ago. The discovery of treatments and drugs such as Dapsone, Rifampicin, and Clofazimine has relieved sufferers at early stage from permanent damages of the skin, nerves, limbs, and eyes. Leprosy prevalence rate was peaked during 1960s, more than 2 per 10,000 populations, but the rate decreased annually to 0.05 per 10,000 populations in 1998. Currently, the prevalence of Leprosy in China is lower than 1 in 100000; However, stigma and prejudice about the disease and patients who affected before, and the uneven distribution occurrences in the country still cause problems in China. Due to the deep rooted social stigma and prejudice of Leprosy, patients and their families try to hide or not to admit that the disease resides in their households while sufferers do not show obvious symptoms. This social phenomenon causes an early stage of disease which is definitely curable, turning into an incurable disease or at least into the one that leaves permanent marks on patients. Patients who either carry now or used to, will also be eventually abandoned from their families as well as their villages. Abandoned patients are left with one choice to join the “lepers’ villages”, concentrated in mountain areas in Southwest of China. Once forsaken, even though cured, they hardly have any chance of rejoining the society and the community outside of their “lepers’ villages”. For the reason that measuring the accurate level of infection and the incidence of Leprosy is impossible, the epidemiology of the disease itself is still a problem in China. This problem becomes more difficult and complicated by the unwillingness and reluctance of the patients seeking help to cure the disease under the influence of social stigma.

What is being done to address this problem

A leprosy control program was initiated during the 1950s by the Ministry of Heath in China. The Ministry of Heath and the National Centre for STD and Leprosy Control also initiated the National Leprosy Recording and Reporting System, which is a database to monitor all leprosy patients in the People’s Republic of China and the epidemic trend of the disease. From the 1950s to 1980s, China’s main focus was to control the infectious sources of leprosy. After the infectious sources of leprosy were controlled, the next step was to eliminate the disease and rehabilitate those affected.

Mass surveys were given in communities and schools to educate the public about the symptoms of leprosy. The survey found that the peak of the disease was during the 1960s, however, after 1970, it decreased annually with the help of multidrug therapy coverage. By 1998, leprosy was well controlled in parts of China, and the prevalence was 0.05 per 10,000 population. Although leprosy is very well controlled in certain areas of China, it not fully eliminated. Leprosy is still present in about 10% of the country where communities are economically poor with low health care.

In recent years, WHO has been trying to sustain the control over the disease with leprosy awareness campaigns and integrating leprosy services into general health services. This will decrease the leprosy burden as well as make leprosy services available for newly detected patients.

What could be done to improve the situation

Are there solutions that could be successful but haven't been implemented due to political or economic reasons? Are there successful efforts in other countries? Are there reasons why these efforts may or may not be successful in the country you've focused on? etc. etc.

In order to improve this situation, treatment of leprosy needs to be fully integrated into general health services. This is a key to successful elimination of the disease. China is among a number of countries that still has many cases of Leprosy disease. Historically, leprosy was greatly feared because of its visible disfigurement and disability, was incurable, and it was believed to be highly contagious. For that reason, there were many misconceptions of leprosy, even stigma and discrimination. China among other countries has created special colonies for people with leprosy called “leper colonies” which are located on islands or in remote location in order to ensure quarantine. There were not many articles addressing the problems of leprosy colonies in recent years. However, in one article “Current situation of leprosy colonies/leprosaria and their future in P.R. China” by Jianping Shen, Musang Liu & Min Zhou publish in May 18, 2007, they discuss the current situation of leprosy in China and make some recommendations for improving the quality of life of people affected by leprosy. The article stats that, “China had 605 leprosy colonies/leprosaria with 555 active leprosy patients (on treatment) and 18,175 ex-patients (people affected by leprosy) living in them at the end of 2004.” China has been successful in controlling and eliminating this disease when the World Health Organization (WHO) introduces a highly successful multidrug therapy (MDT) that can cure this disease. The MDT treatment was made available by the WHO free of charge to all patients worldwide. However, stigma and prejudice still exist among affected patients in China. For that reason, one of the serious problems that still arise for leprosy patient in China is due to discrimination which leads to the decrease in health workers working at leprosy colonies and a shortage of medical materials, the health care quality of these people was neglected. Another problem is that many colonies are established in isolated areas, making transportation very difficult. Note that not all leprosy patients reside in the leper colonies. There are a number of reported leprosy diseases still arising in the general population in China. Due to the discrimination and lack of leprosy knowledge and skills among the health workers, many leprosy patients in China did not get an early diagnosis to start the treatment.

The People’s Republic of China has acknowledged this situation and is now taking the proper steps on improving this situation. According to Mr. Wand Longde, Vice-Minister of Ministry of Health (MOH), the central government has allocated a certain amount of fund for leprosy control. Also the national government plans to invest 220 million Yuan for launching a national leprosy village/hospital repairing project which focuses on improving the living condition services of medical and rehabilitation care through building new & easy to access leprosy hospitals and renovate old facilities in isolated colonies. They are also carrying out leprosy education campaigns to improve the awareness of leprosy in local health care, hospitals, and communities in the isolated regions. Although leprosy sufferers and their families continue to suffer discrimination, China has showed it support in improving the life of leprosy sufferers.

Summary...

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae. M. leprae is a very slow developing disease. They multiply very slowly which the symptoms can take as long as 20 years to appear. A symptom of Leprosy mainly affects the skin and nerves. If a person leaves it untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes. But luckily, Leprosy is a very curable disease and if treated early patients can be cured within a few months. One of the main organizations that focus on improving and curing this disease is the World Health Organization (WHO). They recommend A Multidrug Therapy (MDT) which is consists of three drugs: dapsone, rigampicin, and clogazimine. These three drugs work together to kill the pathogen and is known to be a very effective cure for the patients.

References

[Sample reference] Takai, K., Sugai, A., Itoh, T., and Horikoshi, K. "Palaeococcus ferrophilus gen. nov., sp. nov., a barophilic, hyperthermophilic archaeon from a deep-sea hydrothermal vent chimney". International Journal of Systematic and Evolutionary Microbiology. 2000. Volume 50. p. 489-500.

Edited by [insert your names here!], students of Rachel Larsen

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