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A significant number of cases have ben detected since 1997 
Health: Although Bhutan achieved the leprosy elimination phase in 1997, a significant number of new cases detected over the years has left health officials worried.

Eliminating leprosy, a distant dream

A significant number of cases have ben detected since 1997 

Health: Although Bhutan achieved the leprosy elimination phase in 1997, a significant number of new cases detected over the years has left health officials worried.

This year from January until May, the Gidakom hospital recorded seven new cases of leprosy.  Of the five new cases, one female and four males were reported from Pemagatshel, Punakha, Sarpang and Gasa. The youngest patient was aged 24 while the oldest was 54. All the cases are in multi-bacillary (MB) stage.

Gidakom hospital also serves as the national leprosy and rehabilitation centre. Records with the hospital show 59 leprosy cases were treated from 2013 to 2015. There are 15 cases on treatment currently.

Gidakom hospital’s chief medical officer Dr Chencho Dorji said that although Bhutan has achieved the elimination phase,  the number of new cases detected to date is a concern.

Health officials said leprosy patients are provided Multi-drug Treatment (MDT), which is the only chemotherapy that kills the bacilli. A high proportion of bacilli are killed within a few days after initiation of the treatment.

“MDT contains a combination of three drugs. The treatment with MDT is very effective,” he said. Multi-bacillary patients are treated for 12 months and pauci-bacillary (PB) patients are treated for six months.

There are 130 cases under surveillance as of 2015. Health officials said that the duration for surveillance for PB leprosy is four years and 10 years for MB leprosy.

At total population of 720,679, leprosy prevalence rate today stands at 0.29 per 100,000. In 2011, it stood at 0.40 per 100,000.

Dr Chencho Dorji said the deformity rate has shown an increasing trend, which is worrying as it indicates delay in case detection. “The patients are presenting with a high bacilli load, which indicates that it’s highly infectious and therefore must have been spreading in the community,” he said.

Challenges

Stigma associated with leprosy in the community, according to health officials, prevents the patients from seeking health care. They said patients conceal positive family history to the health workers in most cases.

Health officials agree that even today leprosy is often overlooked clinically and is diagnosed as a skin disease in the early stages.

Dr Chencho Dorji said that many health workers and people are of the impression that leprosy is completely eradicated, which is a distant dream given the fact that more MB leprosy cases are diagnosed.

Patient carrying many leprosy bacilli are called multi-bacillary patients and they are the main source of infection. Since incubation period for leprosy can be as long as 30 years, he said Bhutan will still continue to have a few cases of leprosy even after 30 years from now regardless of the country’s developmental status.

“We need more awareness on the disease to general public,” he said. “The social consequences for those affected with leprosy and for their families is devastating,” he said.

Health ministry’s programme officer for national leprosy control programme, Dorji Khandu said that of the various programmes to combat leprosy, the focus is on awareness programmes at the district level. The programme is also encouraging people with leprosy symptoms to come forward.

“We also conduct focus survey in places where the new cases are detected besides contact tracing of family members,” he said. “Training programmes for health officials are also being continued.”

Causes and symptoms

Health officials said that leprosy is a chronic infection of the skin and peripheral nerves caused by the obligate intracellular bacterium, mycobacterium leprae, also known as  “Hansen’s Bacillus”. Similar to Tuberculosis, leprosy bacilli are mainly transmitted through infectious droplets that are spread by an infectious individual through coughing and sneezing.

Symptoms include pale or reddish patches on the skin with lost or impaired sensation for heat, cold, fine touch and pain on pinprick besides numbness or tingling and weakness of hands and feet, and painless ulcers in the soles and palms.

The World Health Organisation states that leprosy was recognised in the ancient civilisations of China, Egypt and India with afflicted people often ostracised by their communities and families.

The first breakthrough occurred in the 1940s with the development of the drug dapsone. The duration of the treatment was many years, often a lifetime, making it difficult for patients to adhere to it. In the 1960s, M leprae started to develop resistance to dapsone, the world’s only known anti-leprosy drug at that time. In the early 1960s, rifampicin and clofazimin were discovered and subsequently added to the treatment regimen, which was later labelled as MDT.

Kinga Dema

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