Leprosy, attributable to infection with Mycobacterium leprae, was once endemic over much of the world. Though now often considered a tropical disease, cases occurred north of the Arctic Circle just 100 years ago. The disease has gradually disappeared from higher latitudes in recent centuries.
The last case of leprosy attributable to continued transmission in the British Isles had onset around 1800 (1) and in Norway the last case had onset around 1950 (2). Mycobacterium leprae was carried repeatedly across the Atlantic from both Europe and Africa in the last few hundred years, becoming endemic throughout the Americas with the exception of Chile, Canada and the northern United States (cases still occur in Louisiana and Texas). The disease is found throughout Africa and Asia. Several hundred thousand cases are still diagnosed annually, worldwide, mainly in India and Brasil (2).
The leprosy situation in Europe is particularly interesting but poorly understood. The disease is still endemic in several parts of southern Europe. It may be slowly disappearing, but its current geographic extent is not known.
Because of its low frequency, the diagnosis is often not suspected, and thus delayed, and cases may suffer progressive disabilities which could have been prevented had appropriate treatment (available free through WHO) been initiated more promptly. Clarification of leprosy's current boundary would be useful for increasing suspicion of clinicians who may see cases, and for providing clues to the natural history of this ancient, but still poorly-understood, disease.
We are this interested in communicating with individuals who are aware of leprosy cases attributable to transmission within Europe.
If you are aware of any leprosy cases attributable to infection contracted in Europe and diagnosed recently (in the last 20 years), we would appreciate hearing from you.
Ideally we would hope to obtain the following information on cases:
Identifier (code maintain anonymity)
Year of birth,
Sex,
Year of onset (or diagnosis),
Classification (multibacillary or paucibacillary),
Location where case lives or where infection is likely to have taken place (with sufficient precision to allow it to be plotted on a map of Europe)
Whether case was known to have (eg household or family) contact with another known case
We will be pleased to correspond with interested scientists and physicians on this subject.
Prof Paul Fine
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT, UK
Tel: (44)[0]207-927-2219
paul.fine@lshtm.ac.uk
Mr Douglas Soutar
General Secretary
International Federation of Anti-leprosy Organisations (ILEP)
234 Blythe Road
London W14 OHJ
Tel: (44)[0]207-602-6925
Doug.soutar@ilep.org.uk
References:
1. Browne SG. Some aspects of the history of leprosy: the leprosy of yesteryear. Proc R Soc Med 1975. 68: 485-93.
2. Irgens LM. Leprosy in Norway an epidemiological study basedon a national patient registry. Lepr Rev 1980; 51 (suppl): 1 130.
3. WHO. Global leprosy situation: 2007. Wkly Epidemiol Rec 2007; 82: 225-32.
