EACH year, more than 200,000 new leprosy cases are reported worldwide. While the disease’s visibility has declined in many parts of the world, it continues to impact communities globally. Although it may not cross the minds of younger generations, leprosy still persists in Malaysia.
In 2023, the incidence rate (new cases) of leprosy in Malaysia was seven per million population, an increase from five in million in the preceding year. This rise can be attributed to the Health Ministry (MOH) targeted case screening and detection efforts.
What is leprosy?
Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by the bacteria Mycobacterium leprae (M. leprae). It primarily affects the skin, peripheral nerves (nerves outside the brain and spinal cord), the mucosal surfaces of the upper respiratory tract, and the eyes. As M. leprae multiply very slowly, the disease can have a long incubation period, with an average of five years or as long as 30 years.
Common signs of leprosy include the appearance of reddish or lighter-coloured skin patches or lesions, swelling on the face or earlobes, and loss or reduced sensation in skin patches. When nerve function is affected, patients may also experience numbness in the hands or feet and muscle weakness. If left untreated, leprosy can lead to physical disability, disfigurement, and deformities such as claw hand (where the fingers become weakened and curved inward), foot drop (inability to flex the foot due to weak muscles), or even blindness.
Contrary to popular belief, leprosy is not highly contagious. It is transmitted through respiratory droplets from untreated individuals. However, to become infected, an individual needs to be exposed continuously to the bacteria over several months. Even with exposure, an estimated 95 per cent of people do not develop leprosy because their immune systems are able to fight off the bacteria.
Leprosy is often reported among individuals who are close contacts of patients or have a low level of knowledge about the disease. In addition, living in crowded areas or having limited access to healthcare services can also increase the risk of leprosy transmission.
Treatment of leprosy
In the past, due to the lack of effective treatments, leprosy patients were isolated in places like the Sungai Buloh Leprosarium out of fear that the disease would spread. In contrast, with the advent of antibiotics, leprosy patients can now be treated effectively. Once treatment begins, patients become non-infectious within a few days and can continue to live and work as usual.
Leprosy patients are classified into either Paucibacillary (PB) or Multibacillary (MB) cases, with MB being the more severe form. This classification determines the duration of antibiotic treatment, with PB and MB cases requiring 6 months and 12 months of treatment, respectively.
The World Health Organisation (WHO) recommends a treatment regimen consisting of a combination of oral antibiotics known as multi-drug therapy (MDT). MDT is supplied in blister packs, with each pack containing a four-week supply of antibiotics. Patients will be guided on which tablets and capsules to take monthly on Day 1 and which ones to take daily from Day 2 to Day 28. MDT consists of three types of antibiotics, namely rifampicin, clofazimine, and dapsone.
Rifampicin
It is an antibiotic that kills the bacteria. It is taken once a month. Patients may notice their urine colour turning red or orange, along with possible discolouration of other body fluids (tears, sweat, saliva). This is a harmless reaction that occurs only while taking rifampicin.
Clofazimine
It is taken daily. Clofazimine may cause a change in skin colour (from orange-pink to brownish-black) and make the skin more sensitive to sunlight. The change in skin colour is reversible after treatment is completed, although it may take several months or even years. Therefore, patients are advised to avoid prolonged sun exposure and to use skin protection. Patients may also experience discolouration of stool and/or body fluids such as sweat, sputum, and urine. Additionally, other side effects of clofazimine include skin dryness and itching, as well as digestive system issues.
Dapsone
It is an antibiotic that inhibits bacterial growth and is taken daily. Dapsone carries the risk of causing hemolysis and anemia, but these side effects are usually mild.
Serious and life-threatening side effects of MDT are rare. However, patients should seek immediate medical attention if they develop jaundice or a severe allergic reaction to any of the antibiotics, which may present as severe skin rashes, difficulty breathing, or swollen lips.
Advice for patients and public
Leprosy is a curable disease. Therefore, patients should complete the full course of treatment by taking MDT at the correct dose and in the correct order. Additionally, strict adherence to the treatment regimen is crucial to ensure maximum effectiveness and to prevent M. leprae from developing resistance to the antibiotics.
To support adherence, patients can set a daily alarm as a reminder to take their medicines or maintain a medicine log to track the doses taken. For those who find it difficult to manage multiple medications due to other chronic conditions, they are recommended to seek guidance from a doctor or pharmacist at the nearest healthcare facilities.
At times, patients on treatment may continue to develop new skin lesions, swelling of existing lesions, worsening muscle weakness, or nerve pain. These inflammatory responses, known as leprosy reactions, occur due to the immune system’s response to M. leprae. If this happens, patients should consult a doctor promptly.
Leprosy reactions are natural parts of the disease’s progression and should not be mistaken for adverse effects of MDT or treatment failure. The reactions can occur before, during, or even after the completion of MDT. Therefore, patients who have successfully completed MDT will still be under clinical surveillance for the next 5 to 10 years.
The ministry is working toward the goal of achieving zero new local cases by 2030, in line with WHO’s recommendations. To support this effort, mobile healthcare teams have been deployed to remote areas to conduct case screening and provide treatment under the leprosy programme.
Additionally, the Ministry of Health Malaysia has implemented the administration of Single Dose Rifampicin prophylaxis to close contacts and at-risk communities, as recommended by the WHO, as an extra measure to reduce the risk of leprosy.
A comprehensive and systematic approach in managing leprosy cases including early detection, preventive measures, treatment, and continuous education has to be fully supported by all parties. Awareness of leprosy should be emphasised to prevent stigma.
If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.