While leprosy was declared eliminated in India in 2005, such a large population allows for the definition of one case per 10,000 population to still maintain a substantial number of individuals who still suffer from the disease.
Current reports may even indicate the disease is showing a resurgence. However, this has been disputed by the government as simply being the result of increased surveillance drives cover population numbers well into the hundreds of thousands.
Whatever the case may be, this ancient disease is still alive and well in India.
India is considered to be the point of origin for leprosy. Skeletal evidence exists within India that dates leprosy cases as far back as 2000 BC. It is worth noting that the disease may not have originated from India, the skeletal remains are simply the earliest known records of human remains displaying symptoms of leprosy.
The disease is consequently known as an ancient disease, and has been well documented across civilisations from India, to Europe and Africa. The disease has long been stigmatised across every civilisation it touches due to its chronic infectious nature, often being attributed to religious punishment for some perceived sin.
Stigmatisation often progressed to isolation, with colonies established across the globe to isolate those affected. Human rights of those afflicted were often not held in high regard, this practice is only recently being addressed in some areas.
In the modern day, India accounts for a majority of the world’s leprosy cases. Despite the elimination status being in place since 2005 India had the largest number of leprosy patients in the world, accounting for sixty percent of new cases globally, claimed the WHO noted in 2016.
The Central Leprosy Division of the health ministry reported that 135,485 new leprosy cases were detected in India in 2017. Though figures have fallen in the last few decades, India still has a long way to go to truly eradicate the disease.
The hallmark symptom of leprosy is skin lesions. These appear in the early stages of the disease, though may be few in number at this stage. The lesions may be lighter or darker than the original skin tone, or may take on a red colouration, hair loss may also be noticed on and around the area.
As the disease progresses the lesions may become numb. It is this aspect of the disease that is most damaging. Numbness may lead to loss of function and contortion in muscles resulting in disfigurement. If affecting the facial muscles the ability to blink may be removed, risking infection and subsequent blindness.
The progressive nature of the disease means that what may start out as a simple lesion can result in life altering disability. The associated deformities are often a focal point of the stigma towards the disease, as its pathogenicity is often overestimated, sufferers tend to be avoided for fear of infection.
The common perception of limbs falling off is untrue. However, nerve damage limits the sufferer’s ability to feel pain in the area, this can result in minor injuries being overlooked and may lead to infection. As the infection may also go unnoticed, tissue loss may occur.
Prevention and treatment
Though the disease is difficult to study due to the causative bacteria being difficult to study in a laboratory setting, it is well known that the disease is unlikely to be contracted over short term contact. Though the disease is passed through coughing and sneezing, it is usually only observed to be transferred to other individuals over long-term, sustained contact.
In the last few decades leprosy has become a treatable condition, with antibiotics such as dapsone, rifampicin, and clofazimine available to fully cure the disease. Ideally the disease should be treated in its earliest stages, by doing so, treatment time is reduced as well as reducing the potential for long term damage to the body.
If left to develop the disease can still be treated in its late stages, though will require a longer treatment period possibly lasting a year or more. Any resultant nerve damage will also be permanent and unaffected by treatment, highlighting the need to treat the disease in its early stages.