leprosy and leprosy program

Upload: anne-lee

Post on 07-Apr-2018

237 views

Category:

Documents


0 download

TRANSCRIPT

  • 8/4/2019 Leprosy and Leprosy Program

    1/26

    LEPROSY AND

    LEPROSY

    PROGRAM

  • 8/4/2019 Leprosy and Leprosy Program

    2/26

  • 8/4/2019 Leprosy and Leprosy Program

    3/26

    Leprosy existed in the Philippines long

    before the arrival of the Spanish in the16th century and was known locally by

    such terms as 'ketong' and 'cizaro'.

    In the early 1900s, there was a fairly high

    incidence of leprosy in the Philippines. TheAmerican colonial administration was keen

    to implement health and sanitation

    programmes, influenced by popular fieldsof public health and tropical medicine .

  • 8/4/2019 Leprosy and Leprosy Program

    4/26

    Given the absence of any known cure andinspired by numerous positive reports about

    the colony in Molokai in Hawaii, an activecampaign for the segregation of lepers wasinitiated. One such leper colony was locatedon Culion Island and opened in 1906. In order

    to provide a legal framework for the activecollection and incarceration of peoplesuspected of leprosy throughout thearchipelago, a segregation law, that

    practically criminalized the harbouring andnon-voluntary submission of lepers, wasenacted in 1907. At its peak, Culion was hometo over 5,000 people.

  • 8/4/2019 Leprosy and Leprosy Program

    5/26

    When the Philippines National Leprosy

    Control Program (NLCP) was established in

    1986, there were 38,570 registered leprosypatients in the country. According to WHO

    statistics, there were 2, 514 new cases

    detected in 2007.

  • 8/4/2019 Leprosy and Leprosy Program

    6/26

    What is Leprosy?

    Leprosy (also known as Hansens

    Disease) is a chronic, infectious

    disease involving the skin and nervesof infected individuals. Pale patches

    on the skin are usually the first sign of

    the disease they are painless and donot itch, so are often ignored by the

    patient.

  • 8/4/2019 Leprosy and Leprosy Program

    7/26

    In the past, nerve damage and other

    complications occurred as the disease

    progressed. The numbness and lack of

    feeling in the limbs often led to

    festering wounds on the hands and

    feet, and then to the characteristic

    deformities of the face and limbs. In

    many communities this led to stigma

    towards those affected and theirfamilies, causing them to be shunned

    and even excluded from everyday life.

  • 8/4/2019 Leprosy and Leprosy Program

    8/26

    Fortunately, antibiotics can now quickly killthe bacteria (germs) that cause leprosy, so

    the disease can be completely cured with afew months of treatment. If this is started atan early stage, most patients need neversuffer the terrible complications which used

    to be common. Nerve damage does still occurin some patients, but it can often be reversedwith other medical treatment. When it cannotbe reversed and the person remains with

    some disability, there are many differentstrategies of rehabilitation to help them liveas normal a life as possible.

  • 8/4/2019 Leprosy and Leprosy Program

    9/26

    How do you catch leprosy?

    Leprosy is probably spread like the

    common cold, but is much less contagious

    than the cold, or influenza. You really have

    to live for some years in an endemic area,where new cases of leprosy are continuallybeing detected, to run the risk of catching

    it. In a study of new cases being put ontreatment in the United Kingdom, it wasfound that all of them had lived abroad in a

    country with leprosy for at least eight

    years.

  • 8/4/2019 Leprosy and Leprosy Program

    10/26

    Transmission and Control of

    Leprosy Leprosy is caused by a bacterium,

    Mycobacterium leprae, which is closely

    related to the organism causing tuberculosis.The mechanism of infection is not fully

    understood, but it is generally thought to be

    by droplet spread through the upper

    respiratory tract. The incubation period islong, usually between 2 and 8 years, but it

    can be up to 20 years in some cases.

  • 8/4/2019 Leprosy and Leprosy Program

    11/26

    Casual contact with a person affected by leprosydoes not seem to lead to infection. The evidencesuggests that residence for several years in an

    endemic area is needed before the risk of infectionbecomes appreciable. The current strategy tocontrol leprosy involves early case finding andtreatment with antibiotics, with the aim of stopping

    transmission of the disease to new contacts. WHO gives an overview of leprosy and leprosy

    control activities around the world. ILEP MemberAssociations support leprosy activities on a country-by-country basis throughout the world. In the USA,

    the Center for Disease Control (CDC) , gives generalinformation about leprosy. The Report of the ILATechnical Forum (394KB), held in Paris in 2002,reviews much of the scientific evidence underpinningcurrent efforts to control leprosy.

  • 8/4/2019 Leprosy and Leprosy Program

    12/26

    The Diagnosis of Leprosy Leprosy is essentially a clinical diagnosis,

    although a laboratory test (the slit skin

    smear) is important in some cases. Normally,

    the diagnosis rests on finding any one ofthree cardinal signs,

    one or more hypopigmented, anaestheticskin patches, typical of leprosy;

    one or more thickened peripheral nerves; or

    a positive skin smear.

  • 8/4/2019 Leprosy and Leprosy Program

    13/26

    WHO emphasizes the first of these signs for useby junior health workers in endemic areas and

    gives a clear description of how to examine theskin.

    As with many diseases, the most accuratediagnostic test is a biopsy, with subsequent

    staining and histopathologicalexamination ofthe tissues.

    One major topic for research at present, is thedevelopment of new diagnostic tests, which mayallow leprosy to be diagnosed with confidence ata much earlier stage; this would mean thattreatment could begin early, resulting in lessdisability and probably also in less transmissionof the disease to contacts.

  • 8/4/2019 Leprosy and Leprosy Program

    14/26

    The Classification of

    Leprosy Cases Leprosy exhibits quite a wide range of

    clinical features in different people and

    this is now thought to be due to

    differences in the body's immune responseto the infection. Most people have an

    effective response which completely

    prevents the disease, while others haveonly a moderate response which allows

    the disease to appear, but limits it to only afew skin patches.

  • 8/4/2019 Leprosy and Leprosy Program

    15/26

    In these patients, the number of leprosy bacilli inthe body is quite small (less than a million) and

    they don't show up on the skin smear test, whichis negative; the disease is classified aspaucibacillary (meaning 'few bacilli'). A verysmall minority of people, on the other hand,

    have such a weak immune response to theleprosy bacillus that it can multiply almostwithout any check and spread to almost all partsof the skin and the peripheral nerves.

    In these patients the skin smear is positive andthe disease is classified as multibacillary(meaning 'many bacilli').

  • 8/4/2019 Leprosy and Leprosy Program

    16/26

    For the purposes of treatment, all patients areput into one category or the other (eitherpaucibacillary - PB - or multibacillary - MB), butthis is somewhat arbitrary. The disease should beseen as a more or less continuous spectrum fromhigh to low immunity. It should be pointed outthat people who get multibacillary leprosy have

    no other immune deficiencies and have noparticular susceptibility to any other disease.

    The straightforward classification of leprosy intotwo treatment groups (PB/MB)is described by

    WHO. The older, but more detailed, classificationof leprosy is known as theRidley/Joplingclassification.

  • 8/4/2019 Leprosy and Leprosy Program

    17/26

    The Treatment of Leprosy

    As a bacterial infection, leprosy can

    be very effectively treated with

    certain antibiotics; the bacillus can be

    easily killed. If there has already beendamage to the nerves, however,

    antibiotics alone will not restore

    function and other forms oftreatment will be needed, including

    physiotherapy.

  • 8/4/2019 Leprosy and Leprosy Program

    18/26

    The first antibiotic to be widely used for leprosywas dapsone, from around 1950 onwards.Dapsone meant a major breakthrough for

    millions of patients who, until then, had beenconsidered incurable. However, many patientsstill had to take medicines for life.

    In 1981, when resistance to dapsone wasbecoming widespread, WHO introduced Multi-Drug Therapy (MDT)which consisted of tworegimens: rifampicin and dapsone for PB leprosyand rifampicin , clofazimine and dapsonefor MBleprosy. (Note: rifampicin is also known asrifampin, especially in the USA). MDT has beenremarkably successful: there have been very fewside effects associated with its use and over 13million people have been cured of leprosyfollowing its introduction.

  • 8/4/2019 Leprosy and Leprosy Program

    19/26

    Prevention of Disability

    Nerve involvement starts quite early in a fewcases, but in others occurs only late in thedisease, especially if it is left untreated. Itcommonly leads to weakness of various

    muscles and loss of sensation in the handsand feet, so that the person no longer feelshot or cold, or even pain - this leads tounintentional damage, ulceration, infection

    and eventual destruction of fingers and toes,and the well-known deformities of untreatedleprosy.

  • 8/4/2019 Leprosy and Leprosy Program

    20/26

    The muscles around the eye may also beaffected and blindness is another importantcomplication of untreated disease. Efforts toprevent disability in people who already havesome nerve damage due to leprosy thereforeconcentrate particularly on the eyes, hands andfeet.

    Fortunately, the complications of leprosy, suchas nerve involvement and eye damage, canthemselves be treated, so that the problem maysometimes be reversed completely, or, if that is

    no longer possible, further deterioration can beprevented. As may be expected, more severedamage requires more complex and lengthytreatment, and is more likely to leave some

    residual disability or deformity.

  • 8/4/2019 Leprosy and Leprosy Program

    21/26

    Rehabilitation

    Some people who get leprosy areunfortunately left with some residual

    disabilities after the infection itself

    has been cured. The eyes, hands andfeet are the parts commonly affected.

    In addition, many also face long-term

    problems within their family andcommunity, simply because they

    once had leprosy.

  • 8/4/2019 Leprosy and Leprosy Program

    22/26

    Rehabilitation involves a whole range ofinterventions that attempt to restore the person

    affected to as normal a life as possible.

    There are two major categories of rehabilitation:

    1. Firstly, physical rehabilitation seeks to help

    people with their normal daily activities; themethods include physiotherapy andoccupational therapy, and sometimesspecialized forms of reconstructive surgery to

    improve the functioning of the hands or feet;special treatment of certain eye problems mayalso be possible. The aim is to help with thephysical demands of daily life.

  • 8/4/2019 Leprosy and Leprosy Program

    23/26

    2. The second major category is socio-economic

    rehabilitation, which seeks to help peoplerebuild their lives, including their relationshipsand household economies, both of which areoften severely disrupted by having leprosy.

    Many people with leprosy face the loss of their

    jobs and divorce or other forms of rejection bysociety. Rehabilitation involves informing andreassuring the families and communities of thefacts about leprosy, as well as developingspecific interventions that help to restore

    dignity to those affected. One of the majoraims is to empower individuals, enabling themto have more control over their own situations.

  • 8/4/2019 Leprosy and Leprosy Program

    24/26

    The International

    Classification of Functioning

    Health

    This WHO program has attempted, with

    considerable success, to standardize the

    terminologyused in relation to health anddisability. The ICF uses a conceptual

    framework for long term consequences of

    health conditions that is very helpful in thecase of POD and rehabilitation of peopleaffected by leprosy.

  • 8/4/2019 Leprosy and Leprosy Program

    25/26

  • 8/4/2019 Leprosy and Leprosy Program

    26/26

    Leprosy Control Program envisions to eliminate Leprosyas a human disease by 2020 and is committed to eliminateleprosy as a public health problem by attaining a nationalprevalence rate (PR) of less than 1 per 10,000 population by

    year 2000. Its elimination goals are: reduce the national PRof