On Tuesday, October 14, an inmate at Ohio’s Chillicothe Correctional Institution was diagnosed with Hansen’s disease, a disease also known as leprosy. According to local Ohio news [i], this is the first ever diagnosis of leprosy in an Ohio prison.
If true, it isn’t altogether surprising that this is the first time an Ohio prison has seen a case of Hansen’s disease. Hansen’s disease is pretty rare in the United States. According to the U.S. Department of Health and Human Services, there are currently about 6,500 cases of Hansen’s disease in the United States [ii]. Most adults, 95 percent according to the U.S. Centers for Disease Control and Prevention, are naturally immune to the disease [iii].
Hansen’s disease is caused by a slowly replicating bacterium called Mycobacterium leprae. Given the right conditions, some bacteria can multiply into thousands within a few hours [iv]. M. leprae, however, reproduces about every thirteen days [v]. Symptoms of Hansen’s disease include skin discoloration, skin lesions, enlarged nerves and loss of feeling [ii]. The severity of infection depends on the natural level of immunity, or resistance or defense, an individual has against the Hansen’s disease bacteria. If left untreated, permanent damage can occur in the skin, nerves, eyes, hands or feet [vi].
We are still not certain how Hansen’s disease is transmitted, but evidence suggests that human-to-human transmission can occur through air droplets and nasal secretions [vii]. Evidence also suggests that armadillos are reservoirs for Mycobacterium leprae and they can transmit the bacteria to humans [viii].
Hansen’s disease is treated with a multidrug therapy (MDT) consisting of rifampicin, dapsone and clofazimine [ix]. Since 1995, the World Health Organization has made MDT available for all Hansen’s disease patients free of charge, with support from drug manufacturers Novartis and Nippon [x].
Authorities believe that the Ohio patient became infected in Micronesia, where he is originally from and where Hansen’s disease is far more prevalent. Among the countries where, according to the WHO, Hansen’s disease is still endemic are: Angola, Bangladesh, Brazil, Democratic Republic of Congo, Nepal, Sri Lanka, and United Republic of Tanzania [xi]. In the last two decades, the WHO reports that more than 14 million Hansen’s disease patients have been cured and as of the end of 2012, there are approximately only 189 018 cases remaining worldwide [xi].
Jails and prisons typically hold a community’s more vulnerable members. In addition, the often-suboptimal conditions make increased disease transmission a serious concern. The Ohio patient has reportedly been incarcerated in three other prisons since 2011 [i]. So far, there are no signs of infection in other inmates but the Ohio Department of Rehabilitation and Correction continues to screen contacts and inmates. Wednesday, October 22, the patient was released from Franklin Medical Center [xii]. According to the DHHS, once a patient begins treatment, he or she is no longer infectious [ii].
For more on Hansen’s disease and its history, take a peek at the Disease Daily Spotlight on Hansen’s disease by Kat Schwan.
[i] http://www.cleveland.com/open/index.ssf/2014/10/ohio_inmate_has_leprosy_state.html
[ii] http://www.hrsa.gov/hansensdisease/index.html
[iii] http://www.cdc.gov/leprosy/exposure/index.html
[iv] http://www.microbeworld.org/interesting-facts/microbial-reproduction
[v] http://www.cdc.gov/leprosy/health-care-workers/index.html
[vi] http://www.niaid.nih.gov/topics/leprosy/Pages/Default.aspx
[vii] http://www.cdc.gov/leprosy/transmission/index.html
[viii] http://www.nejm.org/doi/full/10.1056/NEJMoa1010536?viewType=Print&
[ix] http://www.who.int/lep/mdt/en/
[x] http://www.who.int/lep/mdt/donation/en/
[xi] http://www.who.int/mediacentre/factsheets/fs101/en/
[xii] http://www.cleveland.com/open/index.ssf/2014/10/ohio_inmate_with_leprosy_relea.html
[xiii] http://healthmap.org/site/diseasedaily/article/spotlight-leprosy-two-thousand-years-solitude-8812
