Thread: Leprosy outbreak causes concerns in Northwest Arkansas

This is bad news..
Leprosy epidemics will add $$$ to our health care costs...

And the likes of Janet Marguia have the unmitigated gall to call this type documented medical evidence "hate speech" and to try and have those who would warn the public silenced?

Send healthcare Hillary to SPRINGDALE

Either send them home or let Mike Huckabee pay for their treatment and make sure they take their meds.

I sent it to Neal Cavuto at Fox and Glenn Beck.

Everyone should send this to all your local schools, hospitals, restaurants, and day care facilities. Warn them of this problem and let them know the likely cause. Another good reason to home school.

UB

Springdale..Chicken Capital of the World
Tyson Foods..Cooked Chicken may be safe..but raw chicken..I think I will pass for now...

"The Marshallese are on the lower economic rungs of Springdale's work force. During the night shift at Tyson Foods' Randall Road plant, about half of the workers are islanders. They are also common on the factory floor of Rockline Industries, which makes baby wipes and scented tissues"

This has been going on since 2006, unbeknownst to much of the Arkansas population. This is an article from 2007 that tries to downplay the disease risk, and goes to great lengths to acquaint medical personnel with the cultural peculiarities which often prevent this population from seeking or continuing necessary medical treatment:

http://www.nwaonline.net/articles/2007/ ... ansens.txt




Leprosy has reared it ugly head in Northwest Arkansas. But it's not nearly as ugly as it used to be.

Health care providers learned the facts April 20 and April 21 in Fayetteville at a continuing education program presented by the National Hansen's Disease Research Center in Baton Rogue, La., and the University of Arkansas for Medical Sciences Arkansas Health Education Center Northwest in Fayetteville.

"It is easily diagnosable and easily treatable with antibiotics," said Dr. James Wharton, a Springdale dermatologist and speaker at the conference.

"It's not highly communicable," said Dr. Joe Bates, deputy state health director with the Department of Health and Human Services.

"Ninety-five to 97 percent of the people are naturally immune," Wharton added. "They couldn't get it if they took a bath with the stuff."

The disease affects Northwest Arkansas' immigrant populations, however -- especially the Marshallese.
*

"We have known for a long time of leprosy in the Marshall Islands," Bates said. "It's a substantial issue in the Marshall Islands. And they are bringing their health issues to this country with them.

"But we don't see much of it here," he continued. "Most nurses and doctors never see a single case."

Medical professionals know leprosy as Hansen's disease, named for G.H. Armaeur Hansen who discovered the bacteria in 1873 in Norway.

"This isn't the leprosy you read about in the Bible," said Dr. James Krahenbuhl, director of the National Hansen's Disease Program. "That was probably any number of different skin conditions.

"Leprosy is the most misunderstood of human diseases," Krahenbuhl continued. "Health care workers lack awareness. There's a stigma associated with the disease. It's not taught in med school. When you leave here today, you will know more than 99 percent of the physicians and nurses in the United States."

Hansen's Debilitating

Hansen's disease typically shows up with chronic skin lesions within a year of infection in people between the ages of 38 and 52, Krahenbuhl explained. These often occur on the arms, legs and "cooler" areas of the body.

"It can look like anything, but a blister -- ringworm, a common rash," said Dr. David Scollard, chief of pathology research for the National Hansen's Disease Program. "It has a wide range of appearances, depending on the patient's immune response to the bug."

Sensation in the lesions often disappear, and the untreated disease can lead to enlarged peripheral nerves and nerve damage, Scollard continued.

Without treatment, patients can lose toes or fingers from other injuries related to the disease, said Dr. Barbara Stryjewska, a medical officer with the Hansen's Center. "But it takes years to lose fingers."

Other consequences can include insensitivity to temperature, which can lead to injuries; dry skin, resulting in fissures; paralysis and loss of feeling, which can lead to fractures and other injuries; and dry eyes, maybe resulting in corneal scars and blindness, Stryjewska said.

The only diagnosis comes from a biopsy of a skin lesion, Scollard said. And the Hansen's center will perform the lab work for free, he told local health care workers.

Treatment comes from antibiotics, Scollard continued, and relapses are uncommon with treatment.

The bacteria also show no drug resistance, Krahenbuhl added.

But the daily drug regimen lasts for one to two years, depending on the type of the disease, because the bacteria divide and spread slowly, Scollard said. Patients also need followup once a year.

Treat wounds following normal wound care protocols, Stryjewska added.

"Millions are cured bacteriologically, but one in three suffer permanent nerve damage," Krahenbuhl said.

Wharton warned the health professionals that everything they see is not Hansen's. Other conditions show similar symptoms, including atopic anemia, necrobiosis with diabetes, lupus, post-inflammatory pellagra, psoriasis, allergic reaction, drug reaction, rosacea and more.

"It can be mistaken," he said. "That's why we need the history, medical and physical exams."

Hansen's researchers think the disease spreads only through long-term exposure to aspirations from an infected person, Wharton said.

"It does spread from person to person," Bates added, but only with long-term exposure from the closest family members."

"Only 2 to 3 percent of the spouses get it," Stryjewska said. "Children and other contact rarely get it."

And once treatment starts, infectiousness goes away, Bates said.

Hansen's patients can remain in their homes, live with their families. But some might benefit from the rest hospitalization can provide, said Dr. Leo Yoder, a consultant leprologist.

"Leper colonies" have disappeared, although the National Hansen's Disease Program operates an inpatient program in Baton Rogue and 11 outpatient clinics across the United States.

Disease Worldwide

A map locating Hansen's patients showed heavier populations in warm areas, Krahenbuhl pointed out.

"It gives the impression that it's a tropical disease, but until 120 years ago, it was worldwide," he said. "There are always new cases."

The national Hansen's program reported just 500,000 cases worldwide in 2003, down from 3.5 million in 1993, Krahenbuhl said. But the number of new cases -- 166 for 2005 -- does not decline from year to year.

Of the nearly 12,000 U.S. cases registered with the center, only 6,600 are active. Seventeen physicians in Arkansas treat 27 cases, although there probably are more of both, Krahenbuhl said.

Armadillos might link the warm, moist Gulf Coastal areas with Hansen's disease, Krahenbuhl added. Some armadillos naturally carry the bacteria -- as many as 300,000 or 25 percent in Louisiana.

Wharton showed a slide of a UAMS patient in Little Rock with lesions on his arm. The man carried his pet armadillo under his arm, Wharton related.

Armadillos moving into Arkansas don't pose a threat "unless you handle them or have close contact -- and I wouldn't recommend that," Bates said. "Don't keep them as pets. They're not very pretty anyway."

Nearly 12,000 cases of Hansen's show up in port cities across the United States, Krahenbuhl pointed out, because immigrants often arrive with disease.

"They've got a passel of health problems, from cancer to diabetes to hepatitis," said Sandy Hainline, a registered nurse with the Washington County office of the state health department.

The disease can be difficult to diagnose outside of its endemic areas, Scollard said. Doctors often don't consider it.

Wharton urged school nurses, faculty nurses and those in office practices to be aware of the possibility. And Scollard encouraged consideration for immigrants, depending on their time in the country; travelers to areas of the world with high rates of Hansen's; and people living in Gulf Coastal areas, where armadillos live.

"What we are seeing is not a large number," Bates said. "It's a difficult disease to treat -- the medication is excellent, but it must be taken over a long period of time. Some people lose patience with that."

Treatment Barriers

"What do you do when a patient walks your door," Yoder asked. "What do you tell the patient? What are you going to do to help him understand the problem and that it's a treatable disease?"

The Marshallese culture often frustrates health care workers trying to serve them. The language difference makes it difficult for doctors to explain the disease and its treatment, said Wharton, who treated most of the severe cases of Hansen's in the region.

Also, the culture doesn't place importance on medical care, follow through and followup. Patients often don't appear for appointments, Wharton continued. He tries to contact them through phone, letters and even friends, and sees them when they appear without appointments, waiving fees, if necessary. He also dispenses their medications, which are free from the Hansen's program.

"Who are these people," asked Hainline, who spent many hours since a tuberculosis outbreak in the community with them in their homes and churches, building trust, explaining the disease and medications and finally treating them. She also traveled to the Marshall Islands getting a feel for the culture.

"It's been slow going, talking to them," Hainline said. "But finally they see people getting better all over the community, especially the children.

"They are the nicest, sweetest people you'll ever meet," she continued. "They share absolutely everything. Where this country stresses independence, to them, community is more important to the individual."

Hainline explained the Marshall Islands is a poor country, with the atolls on which people live isolated from others in distances greater than from Arkansas to Seattle.

"They are terrified of Western medicine," Hainline said. "The treatment for Hansen's disease can cause an exacerbation of symptoms. They are sure the medicine is wrong, too strong. Or when the symptoms go away, they think they're cured.

"The medicine might be free," she continued. "But the labs, office visits aren't. They might owe $150, but the money is not their own. It's shared with the household," and the care of one might not be the most important thing to the community.

Many reasons keep the Marshallese from appointments, Hainline said, from prioritizing school and work, to lack of transportation.

"Skin disease is seen as a curse," Hainline continued, "and parents are cursed through their children. It will go away whether you have medicine or not. No one can help remove the curse, but plenty of powerful people can put one on."

United States privacy laws -- the Health Insurance Portability and Accountability Act -- also clash with the Marshallese culture. "You don't talk directly to your client as required by HIPAA," Hainline told the health care providers. "Never give bad news directly, but to the people with the afflicted. Ask who speaks for the family.

"Ask permission to touch," Hainline urged. "Touching -- shaking hands, a pat on the back -- is cursing and insulting. Explain why you are touching them.

"They don't care if you're a doctor or a janitor, but 'Why do you care about me?'" she continued. "We rush in the room and spout info. They don't know who you are, what you care and don't care about. They want to know your personal life, too."

Grant money allowed for Hainline's daily visits to the family's homes for treatment of tuberculosis, but the same probably is not possible -- or even necessary -- with Hansen's disease.

"Hansen's disease is not nearly as contagious as TB," Scollard said. "The level of risk is greatly different. TB is of great interest to the medical community. There are great resources to mobilize. There are very few cases of leprosy."

"Only 5 percent are susceptible," Hainline said. "The risk of it spreading is almost zero."

"But it's important we work together to ID and care for these patients," Wharton concluded.

In the Middle Ages, leprosy was widespread. It was epidemic and contagious although some modern researchers claim 95% of the population are "naturally immune." This contradicts the facts of epidemics of leprosy in Ancient Israel, Medieval Europe, Modern India and now the fast spread of leprosy in South America. "Natural Immunity" is an unproven and speculative theory..not a fact.
It is more likely that leprosy is contagious and can become epidemic in *virgin* populations who do not have endemic exposure..That seemed to have occurred in the Middle Ages in Europe when leprosy spread rapidly..No one knows why leprosy subsided in Europe...although many theories including improved nutrition, hygiene, acquired evironmental immunity..even TB cross-immunization.. have been proposed...
Three antibiotics are used in treatment because leprosy acquires drug resistance easily..Little is known about transmission or incubation period..
It is contagious and very expensive to treat:

"Until the development of dapsone, rifampin, and clofazimine in the 1940s, there was no effective cure for leprosy. However, dapsone is only weakly bactericidal against M. leprae and it was considered necessary for patients to take the drug indefinitely. Moreover, when dapsone was used alone, the M. leprae population quickly evolved antibiotic resistance; by the 1960s, the world's only known anti-leprosy drug became virtually useless.

The search for more effective anti-leprosy drugs to dapsone led to the use of clofazimine and rifampicin in the 1960s and 1970s.[28] Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance.[29] Multidrug therapy (MDT) and combining all three drugs was first recommended by a WHO Expert Committee in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens. None of them are used alone because of the risk of developing resistance.

Because this treatment is quite expensive, it was not quickly adopted in most endemic countries

The entry route of M. leprae into the human body is also not definitely known. The two seriously considered are the skin and the upper respiratory tract. While older research dealt with the skin route, recent research has increasingly favored the respiratory route. Rees and McDougall succeeded in the experimental transmission of leprosy through aerosols containing M. leprae in immune-suppressed mice, suggesting a similar possibility in humans.[24] Successful results have also been reported on experiments with nude mice when M. leprae were introduced into the nasal cavity by topical application. [25] In summary, entry through the respiratory route appears the most probable route, although other routes, particularly broken skin, cannot be ruled out. The CDC notes the following assertion about the transmission of the disease: "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."[26]

In leprosy both the reference points for measuring the incubation period and the times of infection and onset of disease are difficult to define; the former because of the lack of adequate immunological tools and the latter because of the disease's slow onset. Even so, several investigators have attempted to measure the incubation period for leprosy. The minimum incubation period reported is as short as a few weeks and this is based on the very occasional occurrence of leprosy among young infants. [27] The maximum incubation period reported is as long as 30 years, or over, as observed among war veterans known to have been exposed for short periods in endemic areas but otherwise living in non-endemic areas. It is generally agreed that the average incubation period is between 3 to 5 years.