Leprosy Mailing List – March 22, 2024
From: Joel Almeida, India
Dear Pieter and colleagues,
People who experience(d) HD (leprosy) are disproportionately found in HD "colonies". Not many diseases of mind or body result in such extreme exclusion. Anecdotes of extreme or even criminal cruelty towards persons believed to have HD are not difficult to find.
Even the family members of people who experience(d) HD tend to be treated less favourably than others merely because their address is recognised as being in an HD colony. It does not seem to matter that these family members have no signs of disease and are virtually incapable of transmitting HD bacilli to anyone.
Persons with self-healing forms of HD and zero bacilli in nasal smears are often depicted as dangerous to their contacts. This fear-mongering is contradicted by evidence.
(Figure reproduced from Butlin et al, Lepr Rev (2019) 90, 305–320)
Persons with few or no bacilli seem to have negligible capacity to transmit bacilli to anyone. Anti-microbial treatment often reduces their own risk of permanent nerve damage, but apparently makes little or no difference to the risk of new HD among their household contacts.
The ostracism of persons who experience(d) HD is an important avoidable cause of destitution. Prior destitution might increase the risk of all diseases including HD, but HD itself currently increases the risk of destitution in a way that few if any other diseases do..
Are we opposed to spreading the message that only highly bacillated patients have tens of millions of bacilli in nasal discharges, either before or after MDT (through reinfection)? Is it a bad idea to stop transmission by protecting these few patients with anti-microbials? Is it a ridiculous idea to spare the remaining patients and their families from suspicion?
HD currently seems to require a tailor-made scale of socio-economic status, to capture its extreme social consequences. These consequences persist in too many endemic areas. As more fact-based notions about the epidemiology of HD gain traction, persons with non-infectious forms of HD will face less ostracism, exclusion of highly bacillated patients from anti-microbial protection will be remedied, and transmission will be reduced more rapidly.
Best,
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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