Lifting the Stigma of Leprosy

A new vaccine offers hope against an ancient disease

"He is a leprous man, he is unclean," says Chapter 13 of Leviticus.

Throughout the ages, leprosy has been looked upon with contempt and horror. The Bible enjoins lepers to "dwell alone," wear torn clothing and cry out "Unclean, unclean." In the Middle Ages lepers were barred from public buildings, forbidden to speak with children and required to sound a bell or clapper. The very word leper came to mean outcast.

Yet the stigma of leprosy is based largely on misunderstanding. The use of the term leprosy in the Bible was the result of translation errors; eczema or psoriasis would be more accurate. Furthermore, leprosy, also known as Hansen's disease after the doctor who discovered the bacterium that causes it, is not very contagious. About 95% of the world's population seems to be immune, and even those who are susceptible are at risk only after long-term exposure to an active case.

Another misunderstanding lingers: that leprosy is a thing of the past. "The fact is, leprosy is not disappearing," says Dr. Charles Shepard, chief of the leprosy lab at Atlanta's Centers for Disease Control. There are now at least 11 million cases in the world. Most are in the tropical regions of Africa, Latin America and southern Asia. But there are about 4,200 cases in the U.S., with the number of new cases up 500% since 1960.

The main reason for the increase is changes in the traditional pattern of immigration. Revision of the federal immigration law in 1965 allowed people from Third World countries, such as Mexico and the Philippines, where leprosy is endemic, to enter the U.S. in increased numbers. Refugees from Viet Nam and Cuba have helped create sizable pockets of the disease in California (1,038 reported cases), Hawaii (759), Texas (509), New York (401) and Florida (115). Though health authorities routinely screen immigrants and refugees, leprosy often escapes notice. Explains Dr. Thomas Rea, who treats 320 leprosy patients in Los Angeles: "It can take up to 20 years after infection before symptoms appear."

There are two principal forms of the disease. In tuberculoid leprosy, few bacilli are present, and the symptoms are pale, patchy spots on the face, hands and feet. In the more contagious, lepromatous form, many microorganisms are present in the skin and in nasal secretions; patches and lumps can occur all over the body, and the facial lines tend to deepen. Leprosy does not usually cause gross mutilations. But it can cause a numbness of the hands and feet that leads to accidental burning or mutilation of extremities. This is a source of the myth that leprosy causes parts of the body to drop off.

Since the 1940s, leprosy has been treated effectively with a sulfone drug called dapsone. Recently, however, doctors have noticed an alarming increase in the number of cases resistant to dapsone. The most promising therapy would use several drugs in combination so that patients would not develop a resistance to any one medication. The antibiotic rifampin, a leading antituberculosis drug, has proved effective, healing leprous skin lesions four times as fast as dapsone. Unfortunately, it can cause flulike side effects, and a year's supply may cost $600. The annual bill for dapsone is about $2.

The best treatment, most doctors agree, would be a vaccine. Researchers have been working with armadillos, which are among the few animals susceptible to leprosy. Leprosy bacteria taken from infected armadillos are killed and used in an experimental vaccine. Results of tests in animals are encouraging. Tests of the vaccine in humans will probably begin in two or three years, but because of leprosy's long incubation period, it will be more than a decade before results are known.

A successful vaccine would finally put an end to the age-old taint that lepers bear. Even today, patients, though treated and no longer contagious, carry the onus. "I feel ashamed," says Leni Ignosta, 20, a Los Angeles welder who contracted leprosy five years ago in Samoa before moving to the U.S. "I don't want anybody to know I have it, not even my family. I wanted to stay in the U.S., but I think I'll go back to Samoa and live by myself." qed

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