Diseases We Thought We’d Wiped Out
Leprosy — yes, leprosy — might be back. And it's not the only illness. What's going on here?
Attendance may be back to near normal at Indian Hills Elementary School in Riverside County, California, but parents remain on edge knowing that two students are suspected of having leprosy, or Hansen’s disease. Their tests have not come back yet.
Officials from the school sent a note home to parents letting them know of the unconfirmed cases last week. It’s unsettling.
“Diseases that re-emerge can be tied back to our behavior — measles, staph infections, and tuberculosis,” said one expert.
About 40 percent of parents kept their kids home at the beginning of last week, district officials said. Superintendent Elliott Duchon believes that now parents better understand the disease is communicable only via prolonged contact with someone who is infected and is treatable with antibiotics.
“In my opinion, there is a lot about these cases that does not fit the epidemiological picture of leprosy,” said Dr. Meghan May, an associate professor of microbiology and infectious diseases at the University of New England College of Medicine.
“At this point, we do not know if the two children [suspected of having leprosy] are living in the same household, or if either have a history of travel to countries where leprosy cases are more common. If neither of these possibilities are true, the presumptive diagnosis of Hansen’s disease is quite remarkable, and it is very important that the diagnosis is confirmed before drawing many conclusions,” May told LifeZette.
Leprosy was largely believed to be eradicated globally as a public health problem (with a prevalence of less than 1 case per 10 000 persons) in 2000, so it’s rare that the issue arises.
It is estimated 95 percent of us are immune to the bacteria and not susceptible to the disease, according to the National Hansen’s (Leprosy) Disease Program. Still, there are 100 to 200 cases reported in the U.S. each year. More than 16 million leprosy patients have been treated worldwide over the past 20 years.
- 175 cases in U.S. in 2014
- Florida, California, New York, Louisiana, Texas, and Hawaii contributed largest number of cases
- Can last for years or be lifelong
- Presents with pale-colored, disfiguring skin sores, lumps, bumps
Leprosy is just one of a number of diseases that persist, however, despite ways to treat or eradicate them — so cases of emerging and re-emerging diseases in places like Riverside County are not necessarily surprising, May said. It has a very high population density and a high level of international travel relative to the rest of the country.
“Americans should be paying very, very close attention to those diseases whose re-emergence can be tied back to our behavior — the most glaring examples that jump to mind include measles, staph infections, and tuberculosis,” said May. And she added significantly, “The resurgence of many notorious diseases easily can be attributed to globalization, antibiotic resistance, and falling vaccination rates.”
Measles resurgence is specifically tied to lapsed vaccination rates. Drug-resistant tuberculosis is related to incomplete and unfinished treatment. Drug-resistant staph infections can be caused by the same — along with the over-prescription of antibiotics and hospitals, plus health care settings where people with compromised immune systems are especially at risk.
- Crimean-Congo haemorrhagic fever
- Lassa fever
- Rift Valley fever
“As a scientist and a mother of young children, I promise that the single best action you can take to maintain your children’s health and the health of the children in your community is to vaccinate them.”
Vaccines are the cornerstone of combating infectious diseases, said Dr. Amesh Adalja, a board-certified infectious disease physician at the University of Pittsburgh — they have literally added decades to human life. “Their incalculable benefit outweighs any fears, which are often arbitrary, that people may have regarding them.”
Chikungunya virus, May pointed out, is additionally something to watch for. In the past 18 months, it has gotten a foothold in Latin America and the Caribbean; and as is the case with Zika, the United States has the appropriate mosquito vectors to spread the disease locally. Chikungunya patients experience fever and pain during their illness, and can be left with ongoing pain after the illness ends.
"I suspect we will see more new or unexpected diseases. Different places around the world have wildly different regulations with regard to agricultural, open-air markets where animal slaughter may be happening in close proximity to large crowds of people, municipal insect vector control, and antibiotic use. All of these factors — human/animal contact, human/insect contact, and proper use of antibiotics — directly contribute to new and emerging diseases."
And if diseases emerge in one part of the world, she added — they can be rapidly transported back to the United States.