Chile has become the first country in the Americas to be recognised to have officially eliminated Leprosy, according to a press release issued by the World Health Organization on 4 March 2024. Chile is only the second country globally to reach this goal, following Jordan in September 2024. The conformation also makes Chile the sixth country in the Americas to have eliminated at least one Neglected Tropical Disease, joining Brazil, Colombia, Ecuador, Guatemala, and Mexico.
Leprosy was first recorded in Chile on Rapa Nui (Easter Island) in the late nineteenth century, with some subsequent cases reported on the mainland. The last reported case of a person becoming infected with the disease on Chilean territory occurred on Rapa Nui in 1993. However, the country has continued widespread monitoring for Leprosy, with 47 cases reported between 2012 and 2023, all of which were acquired outside of the country, and all of which were successfully treated.
Leprosy is caused by the Bacteria Mycobacterium leprae and Mycobacterium lepromatosis. It is essentially a skin disease, with the Bacteria infecting patches of skin, which can become dry and itchy, lose their pigmentation, suffer skin thickening, nerve damage, and local immune system failure, which can cause the patches vulnerable to secondary infections by other Bacteria, Fungi, and Viruses. It is these secondary infections which cause the ulceration and tissue loss associated with the disease, which can lead to shortening or loss of fingers and toes, or even facial features. The nerve damage associated with the disease can cause patients to fail to notice wounds, making them more vulnerable to infection.
Leprosy is thought to be spread by mucus droplets exposed by through the mouth or nose (which can enable it to spread among children rapidly) but not through most other forms of contact; it is not sexually transmitted, and patients with HIV do not appear to be any more vulnerable, although malnutrition may be a factor. Much of the Human population appear to be naturally immune to Leprosy, with vulnerability to the disease being genetic, and tending to run in families, which can be problematic, particularly in poorer communities where people are living in cramped conditions and have trouble accessing medicine.
Leprosy is a zoonotic disease, with wild reserves of the Bacteria found in a number of Animal species, including Primates such as the Chimpanzee, the Sooty Mangabey, and the Cynomolgus Macaque. In Europe is thought to have been spread by Red Squirrels, which are known to be vulnerable to the disease, and which were extensively hunted for their fur in the Middle Ages. The disease is thought to have been introduced to the Americas by European settlers, but has become established in there in Armadillos, which can act as a wild vector, spreading Leprosy back to Humans.
The first effective treatment for Leprosy was developed by Alice Augusta Ball, a young researcher at the College of Hawai'i (now the University of Hawai'i), in 1915 (Ball is also noted to have been the first African American woman to achieve a masters degree in chemistry, the first African American woman hired as a chemistry instructor at the College of Hawai'i, and possibly the first African American woman to publish an article in a major scientific journal). Today it is typically treated with a combination of antibiotics such as rifampicin, dapsone, and clofazimine, with other antibiotics available if resistance to these is encountered. Such treatments can typically eliminate the disease completely, although the courses of treatment are long (6-12 months) and involves taking multiple pills each day, which can be problematic, particularly in younger children.
Leprosy is still considered to be endemic to 132 countries, with around 200 000 new cases reported each year. The worst affected countries are Brazil, India, and Indonesia, each of which typically reports more than 10 000 new cases each year. Twelve other countries, Bangladesh, Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, Somalia, Sri Lanka and Tanzania, typically report between 1000 and 10 000 new cases per year, while another 117 countries typically report between 1 and 1000 cases per year. The World Health Organization is currently working towards the global elimination of Leprosy in partnership with the Swiss drug company Novartis, which provides multi-drug therapy for the disease to patients anywhere in the world at no cost, under the Partnership to Eliminate Leprosy scheme.
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