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Hansen's Disease Control Programme

HANSEN’S DISEASE

Hansen’s disease, commonly called Leprosy is a slightly infectious chronic disease of humans caused by Mycobacterium Leprae. This germ was discovered in Norway, Bergen in 1873 by Dr. Gerhard Armauer Hansen. The bacillus germ attacks mainly the skin and nerve tissue. Hansen’s disease can be cured with the modern multiple drug therapy without causing damage to the nerves, but only when recognized and properly treated early. If left untreated, it may cause severe disabilities secondary to nerve damage, which result in the distressing and stigmatizing manifestations such as loss of muscle control, crippling of hands and feet, damage to the eyes which may lead to blindness, collapse of the nose etc. Treating the patient early will not only prevent nerve damage but breaks the cycle of the spread of the disease.


TRANSMISSION

Man is the only source of infection, although Hansen’s disease had been reported in 9 - banded armadillos in the Southern States in America.

No one knows the exact way the disease spreads, but it is believed that it spreads through the respiratory tract as in coughing and sneezing or by skin to skin contact with entry through a broken skin. Hansen’s disease is not hereditary and is not transmitted sexually.

Hansen’s disease is considered chronic because it starts slowly and lasts for a long time. The Mycobacterium Leprae multiplies every 12 days, unlike other bacteria or virus that divides within hours. The incubation period of the disease is usually 2-5 years, although there have been reports of from 3 months to 40 years. Incubation period means from the time one is exposed to the disease to the time signs and symptoms appears.


SKIN SIGNS

A. Rash on the skin is chronic and persists. It does not respond to anti-fungals, anti-eczemas which are applied locally to the skin or given orally.

  • Earliest sign is the reduction in the shininess of the skin
  • There is slight disturbance in the colour of the skin, so it might the light or bright coloured
  • The growth of fine hair is impaired (decreased hair growth or no growth at all on the spot)
  • sweating is impaired on the skin spot
  • Loss of feeling to light touch or pin prick on the surface of the skin

B. Nodules (lumps) on nose, ears, face and limbs, but can be seen at any site.

C. Infiltration (skin feels thickened and raised) on skin of limbs and body with sparing of armpits and groin.


NERVE SIGNS

A. Deformity due to paralysis of the affected nerve as in foot-drop, wrist-drop and paralysis of the face.

B. Nerve involvement causing wasting of muscles of the palms, hands, feet, fingertips and curling of the fingers, loss of feeling on hands and/or feet.

C. Dryness of the hands, and/ or feet due to loss of sweating.

D. Corneal anaesthesia (loss of feeling on the transparent cover of the eye) which may lead to eye ulcer and eventually blindness


CARDINAL (POSITIVE) SIGNS OF HANSEN’S DISEASE

  1. Light coloured spot on the skin with some loss of feeling to touch and pinprick
  2. Enlarged or painful peripheral nerve
  3. Presence of Acid Fast Bacilli (Mycobacterium Leprae) on skin scrapping.


TYPE AND TREATMENT OF HANSEN’S DISEEASE

The length of treatment and number of drugs given depends on the different type of Hansen’s disease.

There is only one type of Mycobacterium Leprae that causes Hansen’s disease. The reason for the different type is because of each individual’s body resistance specific to Mycobacterium Leprae.

  • If the individual has complete body resistance to the germ Mycobacterium Leprae, the person will kill all the germs, so there is no Hansen’s disease.
  • If the individual has a strong body resistance to Mycobacterium Leprae, majority of the germs are killed and some are not. If the individual get the disease it will be the Tuberculoid type.
  • If the individual has a moderate body resistance to Mycobacterium Leprae, some germs are killed and some are not. If the individual do get Hansen’s disease, the type is called

Borderline type (in-between). This type is not stable.

  • Finally if the individual has no resistance or poor resistance to Mycobacterium Leprae, the germs multiply unchecked. If the person gets Hansen’s disease it will be the Lepromatous type. Each type of Hansen’s disease has their distinct features.

Once the patient is diagnosed and treated early, the person is considered non-infectious. The germs that are coughed out sneezed out or passed through a broken skin are dead. If all the people with Hansen’s disease in any county could be found and treated early, then no one could catch the disease. This is the aim of every Hansen’s Disease Control Programme.


MULTIPLE DRUG THERAPY

The World Health Organization introduced the Multiple Drug Therapy (MDT) in Trinidad and Tobago in 1982.

For treatment purpose Hansen’s disease is grouped into two, the Paucibacillary (PB) and Multibacillary (MB).

Paucibacillary are patients with less than five skin/nerve lesions and are AFB (Acid Fast Bacilli) negative on skin scrapings but maybe lodged in the nerve tissue. We do not do nerve biopsy, due to chronic post surgical (biopsy) pain. Hansen’s disease is one of those illnesses that can be recognized by the trained eye of a clinician.

This group is given 2 types of drugs once a month for 6 months and one type of drug to be taken once a day for 6 months.

Multibacillary are patients with more than five skin/nerve lesions and/or are AFB Positive for Acid Fast Bacilli on skin scrapings.

This group is given 3 types of drugs, once a month for 24 months and daily dose of 2 other drugs for 24 months.

At the end of the prescribed 6-24 months of treatment, the patients are released from treatment. However, they are advised to visit the clinic every 6 months for 3 years for the PB type and for 5 years for the MB type. This is called the surveillance period. At the end of 3 and 5 years of surveillance, they are discharged from the clinic it they are well. During surveillance the patients’ skin and nerves are examined. Skin scrapings are done for the MB type. Patients are advised to visit the clinics if they have any skin or nerve problem. Other than that, they are to visit their health office for non skin problem.


Schedule of the Joint Hansen’s Disease and Dermatology clinic:

Arima - 1st and 3rd Wednesday

Chaguanas - 2nd and 4th Friday

George Street - 2nd and 4th Thursday

San Fernando - 1st and 3rd Tuesday (Ward 17)

Sangre Grande - 2nd and 4th Tuesday

St. Joseph - 2nd and 4th Monday

Tobago is held once a month at the Scarborough Hospital. It is run by Dr. Marilyn Suite who is on contract with the Tobago House of Assembly.

All clinics start at 8:00 a.m. with the exception of St. Joseph which begin at 11:00 a.m.

Head Office:
Hansen’s Disease Control Unit
182 Western Main Road,
Cocorite
Tel. #: (868)-622-3904






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