Leprosy used to be incurable, and severely disfiguring. Lepers were shunned and sequestered in "leper colonies". Now known as Hansen's disease, leprosy is easily curable by multidrug antibiotic therapy.
The main challenges for Hansen's disease elimination efforts are to reach populations that have not yet received multidrug therapy services, improve detection of the disease, and provide patients with high-quality services and free drugs.
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This chronic infectious disease usually affects the skin and peripheral nerves but has a wide range of possible clinical manifestations. Patients are classified as having paucibacillary or multibacillary Hansen's disease. Paucibacillary Hansen's disease is milder and characterized by one or more hypopigmented skin macules. Multibacillary Hansen's disease is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis.
The cause of this disease is a bacillus, Mycobacterium leprae, that multiplies very slowly and mainly affects the skin, nerves, and mucous membranes. The organism has never been grown in bacteriologic media or cell culture, but has been grown in mouse foot pads. It is related to M. tuberculosis, the bacillus that causes tuberculosis.
Worldwide, 1-2 million persons are permanently disabled as a result of Hansen's disease. However, persons receiving antibiotic treatment or having completed treatment are considered free of active infection.
Although the mode of transmission of Hansen's disease remains uncertain, most investigators think that M. leprae is usually spread from person to person in respiratory droplets. What is known is that the transmission rate is very low.
Close contacts with patients with untreated, active, predominantly multibacillary disease, and persons living in countries with highly endemic disease.
Hansen's disease is nationally notifiable in the United States.
Incidence/prevalence has remained relatively stable in the United States. There are decreasing numbers of cases worldwide, with pockets of high prevalence in certain countries.
Hansen's disease in the Western Pacific is a particular problem and opportunities exist for participation in Hansen's disease elimination activities in endemic-disease countries, and in the Republic of the Marshall Islands.
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