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04/27/2023

a. I think the most revealing aspect I learned by studying Hansen's disease is the increased need for public health education. I am sure there are many diseases to which this need applies, but it is clear that more lives could be improved, changed, and spared if communities that are affected by this disease had a better understanding of the causes and treatments available.

b. I was very surprised by the number (250,000) of new cases diagnosed each year given that there is an effective treatment to cure the disease. This show the need for an increase in collaboration between public health officials, medical professionals, and governmental agencies in order to attain complete global eradication of the disease.

c. For Padlet 7, I came across an eye-opening research paper that quantified the social impact of Hansen's disease. I think having at least one published paper (whether it be on virulence, treatment effectiveness, societal impacts, or perhaps even original source discovery) would be a great way to highlight data on the chosen disease.

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04/27/2023

The physical disfigurement that accompanies many cases of Hansen's disease has led to severe social effects. For hundreds of years, the fear of disease transmission was usually met with patients being expelled from society. This isolation often came with severe consequences. Before treatments were available, patients would spend the remainder of their lives in colonies, asylums, leprosariums, or even on isolated islands. Many were prohibited from marrying, some were sterilized to prevent the transmission of disease to future children. If a patient did have a child, the child was often removed from the family and placed in an orphanage, or otherwise had to spend their entire lives under the same restrictions as their parents. Today, many patients with Hansen's disease still suffer from rejection, loneliness, job loss, and divorce even if isolation is no longer required.

Only through the work of compassionate members of society have the lives of patients improved. In the 1800s, a priest in Bergen, Norway by the name of Johan Ernst Welhaven called the local hospital conditions a "graveyard for the living." His ability to bring awareness to the issue helped persuade the community to build new homes for patients. His actions supported events which lead to improved legislation and increased disease research. By the 1900s, missions became established to seek out communities in need of service, treatment, and education.

However, in many illiterate regions of the world, the stigma towards leprosy still exists. Physical symptoms worsen with delayed treatment, but many put off getting diagnosed due to fear of discrimination. It can be a vicious cycle.

"Yohei Sasakawa, the WHO ambassador for leprosy elimination and the chairman of the Nippon Foundation...[stated] "A leprosy campaign can be likened to a motorcycle,... The front wheel is the medical cure, and the rear wheel is the elimination of stigma and discrimination. The motorcycle will not run smoothly unless the two wheels are balanced and moving at the same speed"."

More education is needed to reach these regions of the world if the disease is to be fully eradicated.

References:
International Leprosy Association - History of Leprosy. (2016, March 3). Detention, Isolation, Institutionalisation | International Leprosy Association - History of Leprosy. https://leprosyhistory.org/impact/detention-isolation-institutionalisation

Joseph. (2019). What is Leprosy & How Do We Overcome It? Missions Box. https://missionsbox.org/essays/misunderstandings-stigma-of-leprosy/

Marahatta, S., Ghimire, A., Jha, N. K., Pokhrel, S. M., Rayamajhi, S., & Jirel, S. (2015). Social stigma in leprosy. Journal of Chitwan Medical College, 5(2), 6–10. https://doi.org/10.3126/jcmc.v5i2.13148

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 National Leprosarium in Carville, Louisiana

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04/19/2023

While the infectious agent that causes Hansen's Disease was discovered in the 1870s, an effective treatment was not discovered for another century. In the US, the government worked to isolate infected patients in order to help stop the spread. In Hawaii, patients were sent to an island called Kalaupapa. Here, they would spend the remainder of their life in isolation. In 1917, the National Leprosarium was opened in Carville, Louisiana.

In the 1981, after a multi-drug therapy proved affective, outpatient clinics were established to help treat cases of Hansen's disease. Different organizations have established missions to help treat and educate regions that are still affected by the disease. One of these is the Global Partnership for Zero Leprosy. Their goal is global eradication of Hansen's disease. This is through detection, treatment, prevention and education.

Recently, Alert India (a leprosy mission group) worked with Euro School Thane and Bollywood star, Jackie Shrott, to help bring awareness to this issue, which is still quite prevalent in India. In addition, the WHO has provided free MDT through partnerships with the Nippon Foundation and Novartis.

One of the challenges to fighting the spread of leprosy is slow symptomatic development. However, the sooner it is caught, the better serious disfigurement can be prevented. Leaders might do better by providing education from a early age in schools and communities. This can include providing resources for testing and treatment.

Resources:
Global Partnership for Zero Leprosy. (2022, November 2). About the Partnership - Global Partnership for Zero Leprosy. Global Partnership for Zero Leprosy - Accelerating Progress Toward a World Without Leprosy. https://zeroleprosy.org/about-the-partnership/

MSN. (n.d.). https://www.msn.com/en-in/news/other/jackie-shroff-creates-leprosy-awareness-among-school-kids-says-young-minds-need-to-be-sensitised-about-social-issues/ar-AA19Oeu1

National Hansen’s Disease (Leprosy) Program Caring and Curing Since 1894 | HRSA. (2021, June 1). https://www.hrsa.gov/hansens-disease

Quarantined for Life: The Tragic History of US Leprosy Colonies. (2020, March 31). History.com. https://www.history.com/news/leprosy-colonies-us-quarantine

World Health Organization: WHO. (2023).
Leprosy. www.who.int. https://www.who.int/news-room/fact-sheets/detail/leprosy

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04/14/2023

The journey to finding a treatment for Hansen's disease accelerated during the 20th century. Prior to the 1980s, those diagnosed with leprosy were usually isolated from society to help stop the risk of further disease transmission. Doctors and scientists began to administer medications to treat the disease in the 1940s. Some antibiotics were moderately successful, but drug resistance also became a issue.

In the 1970s, a multi-drug therapy was developed that included dapsone, rifampicin, and clofazimine. These medications, when used for 6-12 months, have provided an effective cure of the disease.

New technologies continue to be developed to help further eradicate leprosy worldwide. In 2018, research began to look at a vaccine for Hansen's disease. In addition, Novartis is creating a screening technology that uses artificial intelligence to speed up the diagnosis timeline for new patients. The system uses algorithms to compare new cases against a database of images and symptoms collected from world regions that continue to carry high leprosy cases, such as Brazil and India.

References:
AI4Leprosy. (n.d.). Novartis Foundation. https://www.novartisfoundation.org/transforming-population-health/healthtech-innovation/ai4leprosy

BBC NEWS | Health | Leprosy is not dead. (n.d.). http://news.bbc.co.uk/2/hi/health/4799993.stm

History of the National Hansen’s Disease (Leprosy) Program | HRSA. (2018, July 1). https://www.hrsa.gov/hansens-disease/history

World Health Organization: WHO. (2020). Leprosy (Hansen’s disease). www.who.int. https://www.who.int/health-topics/leprosy#tab=tab_3

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04/05/2023

Virulence of a disease is marked by the post-infection harm done to a host. Although the term can be relative, it often describes the severe symptoms or even death rates caused from infectious agent.

Leprosy is not highly transmissible. Around 95% of adults are naturally immune to the bacteria that causes the disease. Furthermore, those who are diagnosed can easily be cured with antibiotic treatment. The death rate for leprosy is currently estimated to be around 0.1% due to improved medical treatment.

Since leprosy can be latent for many years before showing symptoms, those who are infected can eventually develop advanced stages of the disease, if untreated. Symptoms can include skin lesions and ulcerations that lead to infection, damaged nerve endings that cause blindness and loss of sensation, pain, disfigurement of the nose, and even re-absorption of the toes and fingers.

References:
Martins-Melo, F. R., Assunção-Ramos, A. V., Ramos, A. N., Alencar, C. H., Montenegro, R. M., De Oliveira, M. I. C., & Heukelbach, J. (2015). Leprosy-related mortality in Brazil: a neglected condition of a neglected disease. Transactions of the Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trv069

Signs and Symptoms | Hansen’s Disease (Leprosy) | CDC. (n.d.). https://www.cdc.gov/leprosy/symptoms/index.html

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Worldwide map of new leprosy cases in 2019

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03/30/2023

Hansen's disease is still transmitted worldwide. It can be difficult to track the timeline of disease spread because it can take up to 20 years to develop symptoms after infection due to very slow bacterial growth.

The World Health Organization reported that between 1985-2011 cases of leprosy decreased globally from 5.4M to 219,000. This was due to treatment developed in the 1980s.

However, a new diagnosis is still made about every 2 minutes. Around 250,000 people are diagnosed annually with leprosy. Approximately 150 of those individuals reside in the United States. India reports the largest proportion of new cases each year, followed by Brazil and Indonesia.

References:
About Leprosy - American Leprosy Missions. (2022, March 21). American Leprosy Missions. https://leprosy.org/about-leprosy/

Martins-Melo, F. R., Assunção-Ramos, A. V., Ramos, A. N., Alencar, C. H., Montenegro, R. M., De Oliveira, M. I. C., & Heukelbach, J. (2015). Leprosy-related mortality in Brazil: a neglected condition of a neglected disease. Transactions of the Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trv069

World Leprosy Day. (2021, January 29). Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/index.html

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03/24/2023

Leprosy has been described for thousands of years. However, it is unclear if ancient cases are of the same origin as the known infectious agent today. The cause of leprosy was formally discovered between 1871-1874 in Bergen, Norway by physician Gerhard Henrik Armauer Hansen. The disease now also named after Hansen. Hansen's disease is caused by the bacteria Mycobacterium Leprae.

Once believed to be highly contagious, it is now know to only be mildly contagious. The disease is thought to be passed through indirect transmission of airborne particles, although it's complete mode of transmission is not currently well understood. Additionally, it is known to be zoonotic, meaning the disease can pass between animals and humans. Armadillos are known carriers of Mycobacterium Leprae. It is possible to become infected through contact with Armadillos, although the risk is minimal.

References:
Grzybowski, A., Sak, J., Pawlikowski, J., & Iwanowicz-Palus, G. (2013). Gerhard Henrik Armauer Hansen (1841-1912)—The 100th /anniversary of the death of the discoverer of Mycobacterium leprae. Clinics in Dermatology, 31(5), 653–655. https://doi.org/10.1016/j.clindermatol.2012.10.001

Transmission | Hansen’s Disease (Leprosy) | CDC. (n.d.). https://www.cdc.gov/leprosy/transmission/index.html

World Health Organization: WHO. (2023, January 27). Leprosy. https://www.who.int/news-room/fact-sheets/detail/leprosy

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Hansen's Disease, also known as Leprosy, is an infectious disease that leads to damage of the skin, eyes, mucous membranes and nerves. It is caused by the bacteria Mycobacterium Leprae. 

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Hansen's Disease, also known as Leprosy, is an infectious disease that leads to damage of the skin, eyes, mucous membranes and nerves. It is caused by the bacteria Mycobacterium Leprae. 