These are images that we almost got used to, despite their harshness. A man with no forearms or legs, making his sleeve on the floor of a dusty street; a little girl smiling at the camera despite the spots that eat her face… Displayed in public transport or in the newspapers, these photos remind us that leprosy, one of the oldest diseases of humanity, continues to wreak havoc .
→ EXPLANATION. Hope for a leprosy vaccine
According to the World Health Organization (WHO), there are 2.8 million lepers in the world. Every two minutes, a new case arises, most often in India, Brazil, Indonesia, Nepal, the Democratic Republic of Congo or Mozambique, six countries which alone account for 83% of the global prevalence (1 ).
“If we sometimes tend to believe this disease has disappeared, it is partly due to a misunderstanding”, explains Professor Antoine Mahé, dermatologist and venereologist at the Pasteur hospital in Colmar.
→ ANALYSIS. Leprosy can be treated, but the stigmas remain
“At the end of the XXe century, a major effort to eliminate leprosy as a public health problem has been made by the WHO. The aim was not to eradicate it, but to reduce its prevalence to 1 in 10,000 worldwide. The objective achieved, this pathology has been relegated to the periphery, although there are still major foci in some countries ”, summarizes the doctor, editor-in-chief of Bulletin of the association of French-speaking leprologists.
An effective treatment in 99% of cases
Before that, many associations had already stopped their funding. “ Over the past thirty years, Western donors have tended to reorient their activities towards other diseases, such as AIDS ”, reports Professor Francis Chaise, director of the leprosy program at the Order of Malta, one of the historical players in the fight against this pathology.
While there is still no reliable test to diagnose it or a vaccine to prevent it, the therapeutic arsenal has grown. Since the early 1980s, multidrug therapy combining three antibiotics (dapsone, rifampicin and clofazimine) has made it possible to heal in six to twelve months. “It is effective in 99.9% of cases, says Professor Francis Chaise. You still have to have access to medicines and be able to take them correctly, which is not easy when you live in a village in Africa or Asia, without a dispensary nearby. “
Especially since the patients must be followed closely. “As with Covid, the severity of leprosy is not linked to the bacteria itself, but to the brutal immune reactions it elicits in 30% of cases, even under treatment, says Professor Chair. It is this reaction that will destroy the nerves. “ Unless you give him corticosteroids quickly and in high doses, which again requires access to care.
The most impressive progress in recent years is probably on the contagiousness front. “Contrary to popular belief, leprosy (which is transmitted by droplets from the nose or mouth, Editor’s note) is a disease not very contagious and often confined to the family circle ”, underlines Professor Mahé. But it presents a major difficulty: its very long incubation period, which can go up to twenty years in some people. So many years during which the patient infects his entourage …
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Well known to the general public since the Covid, the contact tracing makes it possible to limit these contaminations as soon as a case is identified. “We now know that 75% of cases will occur within a radius of 300 meters around the infected person. It is therefore a question of identifying, within this perimeter, all the people with whom it has been in contact, then examining them one by one ”, explains Professor Chair.
A painstaking job, concedes the doctor, “But it pays”. In particular when the contact cases receive rifampicin in prevention, which makes it possible to destroy almost all the germs present in their organism and therefore to reduce their contagiousness.
→ DEBATE. Is enough being done against neglected tropical diseases?
“In Asia, this protocol, which we have been implementing for five years, is showing very good results, with a very marked drop in the reporting of leprosy cases. We are finally in the process of better controlling this disease which has existed for thousands of years ”, rejoices Professor Chair.
” A punch in the stomach “
It remains to improve the daily lives of those already affected. “Five million people in the world have lost all autonomy. When they have no family to help them, death is guaranteed ”, indignant the doctor, who tries, in the countries where the Order of Malta is established, to give a job to these disabled persons or their children, often excluded from the society.
“To see these people who had their lives ahead of them lose their limbs in a few months, become blind, find themselves begging, it’s a punch in the stomach”, he testifies. Thirty years ago, this hand surgeon discovered the reality of this pathology at Saint-Louis hospital in Paris, where a ward was reserved for lepers, with thirty hospital beds.
→ MAINTENANCE. “Leprosy is not eradicated”
Even today, fifteen to twenty imported cases are recorded each year throughout the country. “But it’s probably a little more than that, because leprosy is not a notifiable disease”, specifies Antoine Mahé, who is campaigning for it to become one.
All the more so as to believe Francis Chaise, it is not excluded that leprosy will reappear one day in our latitudes. “The floods of migrants arriving in Europe without sanitary control raise fears of an efflorescence of all African diseases, and in particular leprosy. “ If that is the case, “We will know what to do”, reassures the professor.