Leprosy and Social Environment

Parliament yesterday passed a private member’s bill to repeal the Lepers Act 1898 that segregated leprosy patients from society and their families. This is the first time a private bill has got through the House during the tenure of the present Awami Leagueled government. Ruling party lawmaker Saber Hossain Chowdhury, who piloted the bill in parliament in June last year, proposed its passage yesterday. With the passage of the bill, all cases filed under this act will cease to have any effect. Leper asylums will be turned into hospitals where people suffering from leprosy will receive treatment, according to a provision of the bill. In a brief statement attached to copies of the bill, Saber said the Lepers Act goes against people’s fundamental rights guaranteed by the constitution. He said the law was enacted during the period of British rule in order to segregate leprosy patients from society. They were not allowed to take up any public job or profession. But leprosy is now curable......................... Dhaka, Bangladesh, 25-11-2011: The Daily Star This short article in newspaper “The Daily Star” of 25th November 2011 was very important news for leprosy patients in Bangladesh, who officially saw their rights restored. The article reveals something of the profound history of leprosy and makes clear that interference in the social environment of leprosy patients had enormous impact on patients’ lives. It also shows that for more than a century control measures have been applied in the Indian subcontinent

A Qualitative Exploration of Social Contact Patterns Relevant to Airborne Infectious Diseases in Northwest Bangladesh

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions

The combined effect of chemoprophylaxis with single dose rifampicin and immunoprophylaxis with BCG to prevent leprosy in contacts of newly diagnosed leprosy cases: A cluster randomized controlled trial (MALTALEP study)

Background: Despite almost 30 years of effective chemotherapy with MDT, the global new case detection rate of leprosy has remained quite constant over the past years. New tools and methodologies are necessary to interrupt the transmission of M. leprae. Single-dose rifampicin (SDR) has been shown to prevent 57% of incident cases of leprosy in the first two years, when given to contacts of newly diagnosed cases. Immunization of contacts with BCG has been less well documented, but appears to have a preventive effect lasting up to 9 years. However, one major disadvantage is the occurrence of excess cases within the first year after immunization. The objective of this study is to examine the effect of chemoprophylaxis with SDR and immunoprophylaxis with BCG on the clinical outcome as well as on host immune responses and gene expression profiles in contacts of newly diagnosed leprosy patients. We hypothesize that the effects of both interventions may be complementary, causing the combined preventive outcome to be significant and long-lasting.Methods/design: Through a cluster randomized controlled trial we compare immunization with BCG alone with BCG plus SDR in contacts of new leprosy cases. Contact groups of around 15 persons will be established for each of the 1300 leprosy patients included in the trial, resulting in approximately 20,000 contacts in total. BCG will be administered to the intervention group followed by SDR, 2 months later. The control group will receive BCG only. In total 10,000 contacts will be included in both intervention arms over a 2-year period. Follow-up will take place one year as well as two years after intake. The primary outcome is the occurrence of clinical leprosy within two years. Simultaneously with vaccination and SDR, blood samples for in vitro analyses will be obtained from 300 contacts participating in the trial to determine the effect of these chemo- and immunoprophylactic interventions on immune and genetic host parameters.Discussion: Combined chemoprophylaxis and immunoprophylaxis is potentially a very powerful and innovative tool aimed at contacts of leprosy patients that could reduce the transmission of M. leprae markedly. The trial intends to substantiate this potential preventive effect. Evaluation of immune and genetic biomarker profiles will allow identification of pathogenic versus (BCG-induced) protective host biomarkers and could lead to effective prophylactic interventions for leprosy using optimized tools for identification of individuals who are most at risk of developing disease.Trial registration: Netherlands Trial Register: NTR3087

Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study

Although intensive control programs reduced the prevalence of leprosy worldwide, new cases of this infectious disease are still detected in several of the poorest areas of the world. Therefore the disease is known as a disease of poverty. To be able to control the disease it is important to know which aspects of poverty play a role in transmission and acquiring clinical signs of disease. In this study socio-economic circumstances of recently diagnosed leprosy patients were compared with those of a control population in the poverty stricken northwest area of Bangladesh where leprosy is common. A recent period of food shortage was the only socio-economic factor that was found related to leprosy disease in this study and not poverty as such. Food shortage is seasonal and poverty related in northwest Bangladesh, while malnutrition is known to lower immunity and make people more vulnerable to infectious diseases. Therefore it was concluded that malnutrition as an aspect of poverty played an important role in the development of the clinical signs of leprosy. We therefore recommend that nutritional support for high risk groups should be included in leprosy control programmes to reduce risk of disease in areas where leprosy is common

A Qualitative Exploration of Social Contact Patterns Relevant to Airborne Infectious Diseases in Northwest Bangladesh

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions

A qualitative study examining the impact of multidrug-resistant organism (MDRO) carriage on the daily lives of carriers and parents of carriers with experiences of hospital precautionary measures.

BACKGROUND: Multidrug-resistant organism (MDRO) carriage may have an adverse impact on the quality of life of carriers, in particular those who have experienced hospital precautionary measures. This study aims to gain a deeper understanding of how MDRO carriage has affected the daily lives of carriers with these experiences. METHODS: This was a qualitative study based on 15 semi-structured interviews with MDRO carriers or parents of carriers, which were analysed by thematic analysis. RESULTS: Three main themes were identified: (1) Feeling dirty and unworthy portrays the feelings that MDRO carriers often expressed and how these were related to the language usage describing the MDRO, the perceived avoidance by staff and those in their personal networks, and the effects of the precautionary measures implemented in the hospital. (2) MDROs are invisible, but impact is visible covers how the microbe, despite its apparent invisibility, still impacted carriers in their physical and psychological health. MDRO carriage disrupted their lives, by affecting their other unrelated medical conditions at times and by causing varying levels of fear for their own and others’ health. (3) Carrying the burden on one’s own shoulders describes the lingering questions, uncertainties and confusion that carriers continued to live with and the perceived burden and responsibility that lay on their own shoulders with respect to carrying and preventing the transmission of the MDRO. CONCLUSIONS: MDRO carriage can negatively influence the quality of people’s lives in various ways. Improved support and sensitivity from health care providers (HCPs) are needed to address feelings of unworthiness among MDRO carriers and the fears that many experience. Clearer information and guidelines are also needed from HCPs to address the many questions and uncertainties that MDRO carriers face outside of the hospital in their daily lives

Perceptions of Dutch nurses carrying methicillin-resistant : a qualitative study.

Carriers of methicillin-resistant Staphylococcus aureus (MRSA) experience a variety of personal and social consequences, despite the asymptomatic nature of carriage. Some of these consequences are inherent to the application in practice of strict infection prevention guidelines. However, the experiences of nurses carrying MRSA have not been documented. This study aimed to describe the experiences of nurses carrying MRSA to get insight into the impact of MRSA carriage on nurses in a country with a "search-and-destroy" policy for MRSA