Indonesia still ranked third with leprosy, UNAIR expert: We are all responsible for leprosy elimination

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Professor of Dermatology Venereology Universitas Airlangga, Prof. Dr. Cita Rosita Sigit Prakoeswa, dr., Sp. KK (K), FINSDV, FAADV. is a specialist in dermatology venereology with active involvement in campaigns for the care of people with leprosy. (Photo: By courtesy)

UNAIR NEWS – More than six decades ago, a French journalist named Raoul Follereau encouraged the public vigorously to be more concerned about lepers. The invitation stems from his experience when visiting Sahara region. During his stay, he was presented with the reality of a sufferer’s discrimination.

Since then, Follereau has actively traveled embracing lepers in order to change the longstanding negative stigma. In 1953, he proposed the last week in January as International Leprosy Day because it coincides with the third week after the Enlightenment or Epiphany in the Catholic Calendar System.

Follereau effort was supported by 150 radio stations from 60 countries participating in the campaign for leprosy awareness. Furthermore, the timing was also a form of appreciation to Mahatma Gandhi who died on January 30, 1948. In his life, Gandhi paid great attention to lepers because he was inspired by Jesus.

Prof. Dr. Cita Rosita Sigit Prakoeswa, dr., Sp. KK (K), FINSDV, FAADV, conducts an examination on one of the leprosy patients. (Photo: By courtesy)

One form of discrimination to lepers is the obligation to lepers to use certain clothing or special attributes to distinguish them from those who are not infected. In fact, there was a time when the community develop special exile areas for lepers and it happened in some countries. The situation is exacerbated by the absence of drugs and the lack of effort in dealing with sufferers.

Professor of Dermatology Venereology, Faculty of Medicine, Universitas Airlangga, Prof. Dr. Cita Rosita Sigit Prakoeswa, dr., Sp. KK (K), FINSDV, FAADV, explained that leprosy is a type of infectious disease whose development is determined by three factors, the host (human immunity), agents (germs / bacteria), and the environment.

“Before someone gets sick, the body will experience immunity dysregulation, which is a poor regulation of the immune system. When the body is in good condition, the immunity dysregulation only occurs temporarily, and the person will not become ill. On the other hand, when the body’s condition is not good, the immunity dysregulation can continue (irreversible). Finally, people can get diseases, from infections such as leprosy, “explained Prof. Cita.

She continued, transmission of leprosy generally occurs due to interactions with patients who have not been treated. The interaction can be in the form of direct contact with the skin and breathing. However, this process must take place continuously and in a long time, as it has long incubation period (2-5 years or more).

“Leprosy attacks the skin, peripheral nerves and eyes. After the incubation period, symptoms will appear on the skin such as white spots, reddish spots, tingling, and numbness. If you have this, you should immediately see a doctor because it can cause permanent disabilities in the skin, nerves, eyes, until the limbs. That long-term effect then leads to stigma and discrimination, “explained Prof. Cita.

Asked about the issue of hereditary diseases circulating in the community, he firmly answered that leprosy is not a hereditary disease or even a curse. Humans inherit susceptibility (sensitivity) to a particular disease from the parents.

“Regarding the object of transmission, so far it is believed that leprosy is only transmitted between humans. However, it is also known if there are animals known to be Mycobacterium leprae carriers, such as armadillos (not found in Indonesia). So, it is also possible that there are non-human resources. They are currently in our research on the presence of these germs in the environment, “said a member of the Ministry of Health leprosy team.

Leprosy is a disease throughout human civilization. Data from the World Health Organization (WHO), recorded a prevalence of 0.2 per 10,000 population, with new 208,619 cases occurring during 2018. Until now, there are three countries with heavy tasks in fighting leprosy, India, Brazil, and Indonesia.

“Elimination of leprosy in Indonesia was achieved in 2000 while East Java Province achieved elimination in 2016. Then, in 2018, the number of new leprosy cases in Indonesia was 14,397 with a case detection rate of 5.43 per 100,000 population with a total number of leprosy cases of 19,033 with a prevalence rate of 0.72 per 10,000 residents, but there are still endemic areas, especially in Eastern Indonesia, “said the Global Partnership for Zero Leprosy advisor who is also a member of the WHO Guideline of Leprosy team.

She emphasized that leprosy is not just a clinical problem, but also a social problem. Discrimination and stigma that have not completely disappeared will complicate the process of total elimination, because these two things can make patients and their families reluctant to seek treatment, so the disease transmission cannot be stopped.

“Moreover, discrimination and stigma that develop can also limit all activities, including the economic activities of leprosy patients and result in poverty. We must break this vicious circle immediately, “said Prof. Cita.

Prof. Dr. Cita Rosita Sigit Prakoeswa, dr., Sp. KK (K), FINSDV, FAADV, during counseling and discussion with some leprosy patients. (Photo: By courtesy)

All this time, both global and national authorities have tried their best to eradicate leprosy. Various studies have also been conducted, especially on aspects of diagnosis and therapy. Also, efforts to break the chain of leprosy are pursued through treatments and vaccinations.

“The current treatment for leprosy patients is Multi Drug Treatment of Leprosy (MDTL). There are two regiments, the cure for Pausi bacillary (PB) leprosy-type consisting of rifampicin and dapsone. Then the drug for Multi Bacillary type leprosy (MB) is in the form of rifampicin, clofazimin, and dapsone, “said Prof. Cita.

She added that other preventive efforts would be carried out through Post Exposure Prophylaxis (PEP). However, Prof. Cita said, PEP is still in the research stage for the next five years. This research was funded by Netherland Leprosy Relief involving India, Brazil, Indonesia, the Netherlands, Britain, America and France.

“Our task is to improve coordination between academics, researchers, clinicians, and health agencies, including the distribution of research results, promotion and prevention. Then, the community must be able to maintain the health of themselves, their families and the environment to avoid prolonged dysregulation of immunity and fall ill. In other words, germs may be present but our body remains healthy. See the doctor if there are early signs of spots and numbness. Most importantly, eliminate negative attitudes towards patients, because eliminating leprosy is our responsibility, ” she concluded. (*)

Author: Nabila Amelia

Editor: Khefti Al Mawalia

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