World Leprosy Day: Let’s Stop Stigma & Discrimination

World Leprosy Day is celebrated annually around the globe on the last Sunday of January and was first observed in 1953. The date was chosen by Raoul Follereau, the noted French journalist, poet, humanitarian, and lifelong crusader for people suffering from leprosy. He chose this date because it was the third Sunday from Epiphany in the Catholic calendar, which marks the day Jesus healed a leper. In this context, it should be noted that in India, World Leprosy Day is observed on 30^th January every year, which marks the day Mahatma Gandhi was assassinated in 1948. This day commemorates Gandhi’s lifelong efforts to help people afflicted with leprosy and fight against discrimination, stigma and prejudice to uplift their status in Indian society. World Leprosy Day provides a unique platform to raise global awareness about the dangers of this primitive deadly disease and highlight the fact that it is preventable, treatable and curable.

India has the highest burden of leprosy, accounting for 60 percent of the global burden. However, it is encouraging to know that in recent years, there has been a decline in the number of new cases by over 15,000 between 2016 and 2018. Childhood leprosy cases have also come down below 10,000. Besides India, other high burden countries include Indonesia and Brazil.

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History of Leprosy

Leprosy is one of the most ancient diseases known to man. It is also called Hansen’s disease after the Norwegian physician-scientist Gerhard Henrik Armauer Hansen, who in 1873 discovered the bacterium Mycobacterium leprae, the causative microorganism of leprosy. This discovery changed the prevailing belief that leprosy was a hereditary disease. The disease is also mentioned in the Bible. According to the Gospel of Matthew, following the Sermon on the Mount, Jesus descended from the hillside and cured a leper by touching and blessing him. Importantly, since pre-biblical times, lepers have been stigmatized and discriminated and considered as social outcasts.

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Leprosy and its Complications

Leprosy is a chronic infectious disease caused by the slow-growing bacterium M. leprae. Since the bacterium multiplies very slowly, its incubation period is very long. As a result, symptoms may appear even after 5 years post-infection. The disease affects the peripheral nerves, skin, eyes, and the mucosal lining of the upper respiratory tract.

The infection spreads from an untreated leprosy patient and is usually transmitted through droplets originating from the nose or mouth. Symptoms include the following:

• Skin patches and lesions
• Loss or reduced sensation in the skin patches
• Tingling/numbness /weakness in the hands and feet
• Swelling on the face and earlobes

The bacterium has a tendency to migrate to the skin and nerves, causing severe tissue damage. If left untreated, it can result in permanent disability and disfigurement. However, the disease can be successfully cured by using Multidrug Therapy (MDT), which is a combination of several drugs that effectively kills the bacterium.

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Leprosy: Facts & Figures

• Worldwide, 2-3 million people are currently living with leprosy
• Over 200,000 new leprosy cases are diagnosed annually worldwide
• Over 19,000 children are diagnosed with leprosy annually worldwide
• Prevalence rate of leprosy worldwide is 0.2 per 10,000 population
• Average incubation period of M. leprae infection is 5 years
• Symptoms can manifest within one year of infection, but may take as long as 20 years or even longer
• Leprosy primarily affects the peripheral nerves, skin, eyes and the mucosal lining of the upper respiratory tract
• Leprosy is transmitted through droplets from the nose or mouth
• Leprosy can be cured with MDT
• Untreated leprosy can lead to progressive and permanent damage to the skin, eyes, nerves, and limbs

How is World Leprosy Day Celebrated?

World Leprosy Day is fervently celebrated across the globe through various events and activities. On this day, both governmental and non-governmental organizations (NGOs) conduct public outreach programs to inform and educate the general public about the dangers of leprosy, as well as assure them that the disease is now curable. Doctors and other medical professionals advise people on how to recognize the symptoms and prevent the disease from spreading. Leading medical specialists also deliver popular talks to enlighten the public. In addition, rallies, walkathons, marathons and other fundraising events are organized to raise money for the care of those afflicted by the disease.

Leprosy: Truths & Myths

Statement	Truth / Myth
Leprosy is curable	Truth
Leprosy causes fingers and toes to fall off	Myth
Leprosy is due to sin, curse or immoral conduct	Myth
Leprosy spreads very easily and can be contracted through touch	Myth
Leprosy is hereditary	Myth
Leprosy is a legal ground for divorce in India	Truth
157 laws that discriminate against leprosy patients exist worldwide	Truth
Leprosy doesn’t affect mental health	Myth
50 percent of leprosy patients suffer from anxiety and depression	Truth

Eradication of Leprosy

Global and country-level efforts are ongoing to expedite the eradication of leprosy. Efforts by the World Health Organization (WHO) and the Government of India are briefly highlighted below:

WHO’s Efforts

• Global Leprosy Strategy: This strategy is WHO’s vision for accelerating towards a leprosy-free world. The timeframe for this strategy is 2016 to 2020. It aims to strengthen government ownership, coordination and partnerships in order to halt leprosy and its complications, as well as stop discrimination and promote inclusion. The three major targets of the Global Leprosy Strategy are as follows:
• No disabilities should occur among new pediatric patients
• Grade-2 disability rate must be less than 1 case per million population
• No country should have laws promoting discrimination against leprosy patients

Indian Government’s Efforts

• National Leprosy Eradication Program (NLEP): The NLEP had its origins from the National Leprosy Control Program (NLCP), which was launched in 1955 by the Government of India. With the advent of MDT in 1982, the NLCP was converted to NLEP the following year, with the objective of eradicating leprosy from India. Early case detection and prompt treatment are the cornerstones for achieving eradication, as these will ensure infection source reduction, as well as halting transmission. By the end of March 2018, the prevalence of leprosy was reduced to less than 1 case per 10,000 population. This elimination goal was achieved in 572 districts (81.13%) out of 705 districts in 29 states/union territories. The ASHAs (Accredited Social Health Activists) played an instrumental role in this effort. Moreover, since 2^nd October 2018, post-exposure prophylaxis for close contacts of leprosy patients has been initiated under this program
• Sparsh Leprosy Awareness Campaign (SLAC): This campaign was conducted in 2018 between 30^th January and 13^th February to raise awareness about leprosy and its complications
• Sparsh Leprosy Elimination Campaign (SLEC): This yearlong campaign was conducted from 2^nd October 2018 to 2^nd October 2019 on the occasion of the 150^th Birth Anniversary of Mahatma Gandhi. The campaign was aimed at reducing the number of new leprosy cases with Grade-2 disability to less than 1 case per million population
• Leprosy Vaccine Development: A vaccine against leprosy has been developed by scientists at the National Institute of Immunology, New Delhi. The vaccine uses the bacterium Mycobacterium indicus pranii (MIP) that can effectively prevent the disease

Key Take-Home Messages

• Leprosy can be cured with timely initiation of MDT
• MDT ensures complete cure, reduces disease transmission, and prevents deformities
• Early case detection and prompt treatment with a full-course of MDT will prevent disability
• Leprosy is not a genetic disease and hence not transmitted from parents to children
• Leprosy can be spread through close and frequent contact with untreated patients
• Leprosy doesn’t spread through casual contact such as shaking hands or sharing office space
• Leprosy doesn’t occur as a divine punishment for past sins, but occurs as a result of infection by the bacterium M. leprae
• Leprosy patients shouldn’t be discriminated in society and should be allowed to live with dignity

So, on World Leprosy Day, let’s all get together to weed out stigma and discrimination associated with leprosy and tackle the disease with renewed efforts, so that it can be eradicated once and for all.

References:

1. World Leprosy Day 2020: National Health Portal, Ministry of Health & Family Welfare, Government of India - (https://www.nhp.gov.in/world-leprosy-day-2020_pg)
2. World Leprosy Day 2019: International Federation of Anti-Leprosy Associations - (https://www.ilepfederation.org/about-leprosy/world-leprosy-day/world-leprosy-day-2019/)
3. Leprosy: World Health Organization - (https://www.who.int/en/news-room/fact-sheets/detail/leprosy)
4. World Leprosy Day - Bust the Myths, Learn the Facts: Centers for Disease Control and Prevention (CDC) - (https://www.cdc.gov/features/world-leprosy-day/index.html)

Source-Medindia