Leprosy is still a scourge in Argentina

By Orlando Jenkinson
Herald Staff
(This article and its content were first published in the Buenos Aires Herald—print edition— October 2, 2015)

Hundreds of cases diagnosed anually despite major medical advances

Despite its virtual eradication from some developed corners of the world and association with ancient and pre-industrial societies, leprosy remains a significant health problem in Argentina, with hundreds of new cases reported every year.

Senior dermatologist at Buenos Aires City’s Ramos Mejía and leprosy expert Dr Jorge Tiscornia said that though the progress made against the disease had been remarkable during the second half of the twentieth century, the myths and dangers posed by the disease continued to be a serious problem in the country and across Latin America.

Tiscornia spoke to the Herald at the start of the National Campaign for Education and Prevention of Leprosy that runs in the first week of October.

“This was a disease that touched all corners of the globe historically, and in the past those suffering from leprosy were needlessly put away in colonies. It’s been a huge leap forward in last 70 years,” he said, adding that despite such progress, the problem remained.

“One problem with leprosy is that it’s a disease that can be hard to recognise straight away. There have been approximately 300 cases in Argentina since the new year. We are also treating patients from Paraguay that itself has a serious leprosy problem,” he added.

Part of the difficulty in seeking to curtail and eventually eradicate leprosy — as the World Health Organization (WHO) had hoped to achieve by the year 2000 — is the nature of its early development.

Early symptoms include faint blemishes on the skin and a numbness, rather than pain, in the affected areas. Consequently, many people suffering in the early stages of the disease when it is most treatable miss or dismiss the symptoms as unimportant.

“A common symptom is losing sensation in the skin on your hands, arms or elsewhere, and often people do not think much of it and may have contracted the disease without realizing,” Tiscornia said.

Further, according to the WHO leprosy disproportionately affects communities blighted by poverty with limited access to basic health necessities like sanitation or regular check-ups.

“Under-served and marginalized communities (are) most at risk from leprosy, often the poorest of the poor,” the WHO said.

This is true globally, where the three heavily populated countries with the most leprosy cases — India, Indonesia and Brazil — are all affected by endemic and widespread poverty.

It is also reflected in Argentina, where according to the Argentine Dermatology Society (SAD), the highest occurrence of new leprosy cases were in the Northern provinces of Formosa and Chaco, two of the poorest regions in the country.

Stigma and discrimination

One of the biggest obstacles in tackling the disease concerns the widespread misinformation about the causes, risks and of leprosy. Contrary to popular myths surrounding the disease, influenced by its historically taboo reputation, it is in fact extremely difficult to contract leprosy via contagion.

According to the SAD, in the majority of cases over three years of regular close contact with the disease is necessary before one is at risk of contracting it directly from someone already suffering, and the antibiotic drugs used to combat the disease today can cure anyone who contracts it within a year. However, popular misconceptions and discrimination remain.

“There’s a lot of damaging stigma and prejudice surrounding the disease,” Tiscornia told the Herald. “People still believe falsely that it’s incredibly contagious and shun it. And those suffering from leprosy are affected badly by the stigma.”

The aim of the awareness week it has run for 16 years is to challenge the stigma and make sure people do not ignore the early symptoms.




Report: Chagas disease a scourge for 1.5 million Argentines

By Orlando Jenkinson, Herald Staff

(This article and its content were first published in the Buenos Aires Herald, print edition, August 28, 2015)


One of the most wide-spread but little-known infectious diseases in Argentina will be thrust into the spotlight today as the National Day For Argentina Without Chagas is marked.

The government-backed campaign, which has been underway all week and officially takes place throughout the month of August each year since 2011, saw special awareness-raising events take place alongside extra public diagnosis and treatment measures in the northern provinces of Chaco, Formosa and Misiones among others that are most severely affected by the disease.

“The idea is that we’re letting people with the disease know that we have not forgotten them,” Marcelo Abril, the projects director of Healthy World (Mundo Sano) told the Herald. “The hope is that we can show people infected that they have a right to treatment and to raise awareness about the disease,” he added.

Despite infecting an estimated 1.5 million Argentines (around four percent of the population) according to Healthy World, Chagas is officially classified as a neglected disease by the NGO, which staged the 17th International Symposium on Neglected Diseases at the National Academy of Medicine in Buenos Aires City earlier this week.

One speaker at the event, neglected diseases expert and Children Without Worms director Dr. David Addiss, said that neglected tropical diseases like Chagas or Soil-Transmitted Worms lacked the dramatic nature of other serious diseases and so had been sidelined.

“Other tropical diseases that caused death and are in some ways more dramatic were very interesting from a research perspective: HIV, malaria and so on. Professors were in some ways attracted to studying these diseases more,” he said.

Chagas symptoms are often latent within the body and so can be significantly prolonged. While someone who contracts other tropical diseases like yellow fever, for example, is at risk of death without treatment within weeks but may also recover relatively quickly, Chagas stays present in an infected person’s system for years, even decades.

Slow motion disease

The virus is contracted by coming into contact with kissing bugs that live in humid sub tropical climates such as the Greater Chaco region, and can be transmitted through blood transfusions and from mother to child during pregnancy.

It works slowly, attacking vital muscle tissue such as the heart, which can deteriorate slowly over many years as a result.

Unlike yellow fever, which has a widely enforced vaccine, or malaria, for which preventative drugs like Doxycycline and Malarone have existed for decades, there is no current vaccine or cure for Chagas.

On the other hand the treatment that is available, mostly taking the form of antiparisitic drugs, works well in nullifying the worst effects.

“Treatment effectiveness is higher than 80 percent in the acute phase and, in congenital cases treated during the first year of life, it exceeds 90 percent; hence the importance of early detection and treatment,” Healthy World said.

Consequently, raising awareness about the disease is of paramount importance. The government’s Program Against Chagas, of which today’s national spotlight is a part, has helped launch awareness raising events like this weekend’s National Walk For Infancy Without Chagas — aimed at highlighting the risks of mother to child transmission — across 15 provinces.

Special treatment and diagnosis stations were also launched in the most at-risk provinces recently following government and NGO efforts. The disease affects the northern provinces acutely due to their subtropical climate, but is exacerbated by generally lower levels of basic sanitation among poorer rural populations in northern Argentina.

As such, targeted action is what the government and NGOs working against Chagas disease have tried to achieve.

“The government’s Program Against Chagas including tomorrow’s National Day Without Chagas, works alongside targeted provincial programmes too. It has helped promote diagnosis and provides free treatment for infected people,” Abril said.

The Healthy World programmes director said that in recent years there had been a slight tendency of falling infection rates among some populations since the government effort was launched in 2011, although due to the stealth-like nature of the disease and lack of public awareness about its symptoms there are no precise data for Chagas infection rates.

While the positive efforts of the government and NGOs like Healthy World have helped launch initiatives to combat the disease, though, the problems of diagnosis and treatment coverage—despite it’s high effectiveness—remain obstacles in the fight against the disease.

Rick L. Tarleton, the president of the international Chagas Foundation, said that despite renewed government efforts, the majority of the estimated 1.5 million Argentines already infected nationwide were not receiving medical help.

“Unfortunately I don’t think National Day Without Chagas had much impact. Few of those already infected are being treated. We have a long way to go,” he said.