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Hansen's disease, also known as leprosy, is an infectious disease caused by
infection by Mycobacterium leprae, named after its discoverer G. A. Hansen.
Sufferers from Hansen's disease have generally been called lepers, although
term is falling into disuse both from the diminishing number of leprosy
patients and from pressure to avoid the demeaning connotations of the term.
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.
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
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.
In 1999, the world incidence of Hansen's disease was estimated to be
640,000; and in 2000, 738,284 cases were identified. In 1999, 108 cases
occurred in the United States. In 2000, the World Health Organization (WHO)
listed 91 countries in which Hansen's disease is endemic, with India,
Myanmar, and Nepal having 70% of cases.
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
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
There are a few 'leper colonies' around the world. In the United States on
the tiny island of Molokai in the Hawaiian chain is the oldest leper colony
in America. Government run leper colonies in Japan in 2001 came under
judicial scrutiny ruling the Japanese government had mistreated the
patients. Leper colonies are located in India and the Philippines, with high
likelihood there are many more in many more countries.