Rare Case of Leprosy in Ireland Highlights Public Health Challenges
Science/Medical/Technology
Monday 27th, January 2025
4 minute read.
A rare case of leprosy in the south-west of Ireland has presented significant challenges to healthcare authorities, with calls for specific public health guidelines for managing the disease. The case, recorded by the Health Service Executive (HSE) South-West in 2024, is one of only five cases reported in Ireland over the last decade and the first in this region.
Leprosy, a chronic infectious disease caused by bacteria that damage nerve endings and impair the body’s ability to feel pain, remains curable. However, the associated stigma often deters individuals from seeking diagnosis and treatment, increasing transmission risks.
The infected individual, a person in their 30s, was living with eight others in Ireland. Born and raised in a Caribbean country where leprosy is endemic, they had moved to Ireland in 2022 from southern Brazil, another region with a high prevalence of the disease. They first sought medical help in late 2023 for symptoms including numbness and pain in the right arm and hand, as well as light-coloured lesions on their face, chest, arms, and legs.
The patient was diagnosed in mid-2024 and successfully treated with multi-drug therapy.
The report, published in the journal Eurosurveillance, noted the absence of specific guidelines for managing close contacts of leprosy cases. In response, HSE staff reviewed international guidelines to determine an appropriate contact tracing strategy.
Defining close contact as someone who had been in contact with the patient for at least 20 hours per week over three months in the previous year, they identified three close contacts: one housemate, the patient’s partner, and a work colleague.
“No credible source of infection was identified among their Irish contacts,” the report stated.
Another 10 adults, including two who had since left Ireland, were considered potential contacts. However, public health staff decided not to conduct extensive contact tracing among all household members due to concerns it could jeopardise the patient’s precarious housing and employment situation.
Based on guidance from the World Health Organisation and authorities in the UK and Western Australia, preventative medication was offered to the three close contacts. They were also scheduled for annual skin and neurological examinations for at least five years. This decision accounted for the fact that the close contacts were migrants from leprosy-endemic regions.
Dr Rebecca Marshall, a specialist registrar in public health medicine with HSE South-West and one of the report’s authors, highlighted the difficulties of managing leprosy in countries like Ireland.
“While it is a curable bacterial infection, diagnosis in low-prevalence settings is often delayed due to healthcare professionals' unfamiliarity with signs and symptoms of the disease, as observed in this case", she explained.
The delay can increase the risk of irreversible nerve damage, leading to lifelong disability and care needs.
The report emphasised the need for robust strategies to address stigma and ensure access to mental health support for those affected by leprosy. It also noted the absence of consistent international guidelines for managing the disease in high-income, non-endemic countries.
Most guidelines are tailored for endemic regions and show significant variation in approaches to prevention and contact tracing in other settings. The report recommended better education for healthcare workers in recognising tropical diseases and improved strategies for public health response.
Leprosy is not considered highly infectious, but its exact mode of transmission remains poorly understood. It is believed to spread primarily through respiratory droplets and requires prolonged close contact for transmission. Genetic factors may also play a role.
Although 97% of the global population is naturally immune, 182,815 new cases were reported worldwide in 2023. Young people are at higher risk, with infection rates also linked to extreme poverty and poor nutrition.
This case has underlined the importance of developing specific guidelines and fostering greater awareness among healthcare professionals to manage rare diseases effectively.
Leprosy, a chronic infectious disease caused by bacteria that damage nerve endings and impair the body’s ability to feel pain, remains curable. However, the associated stigma often deters individuals from seeking diagnosis and treatment, increasing transmission risks.
The infected individual, a person in their 30s, was living with eight others in Ireland. Born and raised in a Caribbean country where leprosy is endemic, they had moved to Ireland in 2022 from southern Brazil, another region with a high prevalence of the disease. They first sought medical help in late 2023 for symptoms including numbness and pain in the right arm and hand, as well as light-coloured lesions on their face, chest, arms, and legs.
The patient was diagnosed in mid-2024 and successfully treated with multi-drug therapy.
The report, published in the journal Eurosurveillance, noted the absence of specific guidelines for managing close contacts of leprosy cases. In response, HSE staff reviewed international guidelines to determine an appropriate contact tracing strategy.
Defining close contact as someone who had been in contact with the patient for at least 20 hours per week over three months in the previous year, they identified three close contacts: one housemate, the patient’s partner, and a work colleague.
“No credible source of infection was identified among their Irish contacts,” the report stated.
Another 10 adults, including two who had since left Ireland, were considered potential contacts. However, public health staff decided not to conduct extensive contact tracing among all household members due to concerns it could jeopardise the patient’s precarious housing and employment situation.
Based on guidance from the World Health Organisation and authorities in the UK and Western Australia, preventative medication was offered to the three close contacts. They were also scheduled for annual skin and neurological examinations for at least five years. This decision accounted for the fact that the close contacts were migrants from leprosy-endemic regions.
Dr Rebecca Marshall, a specialist registrar in public health medicine with HSE South-West and one of the report’s authors, highlighted the difficulties of managing leprosy in countries like Ireland.
“While it is a curable bacterial infection, diagnosis in low-prevalence settings is often delayed due to healthcare professionals' unfamiliarity with signs and symptoms of the disease, as observed in this case", she explained.
The delay can increase the risk of irreversible nerve damage, leading to lifelong disability and care needs.
The report emphasised the need for robust strategies to address stigma and ensure access to mental health support for those affected by leprosy. It also noted the absence of consistent international guidelines for managing the disease in high-income, non-endemic countries.
Most guidelines are tailored for endemic regions and show significant variation in approaches to prevention and contact tracing in other settings. The report recommended better education for healthcare workers in recognising tropical diseases and improved strategies for public health response.
Leprosy is not considered highly infectious, but its exact mode of transmission remains poorly understood. It is believed to spread primarily through respiratory droplets and requires prolonged close contact for transmission. Genetic factors may also play a role.
Although 97% of the global population is naturally immune, 182,815 new cases were reported worldwide in 2023. Young people are at higher risk, with infection rates also linked to extreme poverty and poor nutrition.
This case has underlined the importance of developing specific guidelines and fostering greater awareness among healthcare professionals to manage rare diseases effectively.
