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제목 |
Clinical Epidemiology of Ambulatory Leprosy Patients in Korea |
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저자 |
Young Soo Kim, and Joon Lew |
소속 |
World Vision Leprosy Treatment and Research Center, Dept. Microbiology, College of Medicine, Yonsei University Seoul, Korea |
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년도 |
1968 |
권 |
5 |
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호 |
1 |
번호 |
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시작페이지 |
79 |
끝페이지 |
94 |
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첨부 |
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요약 |
The introductions of various effective antileprosy drugs and of practical leprosy
control measures have greatly reduced the epidemic of leprosy in the world. There still
remains tremendous number of leprosy victims, particularly among the underdeveloped
nations in tropic and subtropic areas. The total number of leprosy patients in Korea has
been estimated around 80,000 to 100,000 at the present,
In Korea, leprosy had long been misunderstood as an incurable disease of God
punished and was feared and disliked by most of the public. The victims of leprosy in
this country have 1ong been segregated in leprosaria or lived in hide without any hope
of cure or rehabilitation to normal society. However, these dreadful situations have been
changed rather drastically in Korea following the introduction of modern concept of
leprosy, and the establishment of leprosy out-patients clinics such as the World Vision
Leprosy Center and leprosy mobile teams throughout the country. The main purposes of
those out-patient clinics arid mobile teams are to take care of the patients on
home-living basis, not segregated in hospitals or similar institutes, thus economically
more efficient and will have no problem of social rehabilitation.
It is well known that data of epidemiological surveys play a great role in the control
of the infectious diseases, particularly in leprosy. Previously several reports have been
made on the epidemiology of leprosy in this country. However, all of these surveys
were made with the leprosy patients who were usually rather far-advanced, deformed
and institutionalized under the compulsory segregation Taw that was effective until 1963
in Korea.
The World Vision Leprosy Center, established in May 1959 as the first leprosy out-
patient clinic in Korea, had took care of total of 3,657 of which 2,313 cases were
diagnosed as leprosy and have been treated continuously, and the rest, 1,344 cases were
diagnosed as patients of other skin ailment or leprophobia..
The out-patients, diagnosed, registered and treated at the World Vision Leprosy
Center, have the following two characteristics. In the first place the distribution of the
registered patients are quite evenly nationwide, and in the second, their visits to the
Center are completely voluntary, usually in early stages of the disease and with the
motive of the disease cured.
With those 2,313 out-patient leprosy case, authors attempted to carry out a series of
epidemiological survey in this study and hoped to clarify the recent trends in the
epidemiology and to reevaluate the previous reports and to uncover some of hitherto
unknown aspects in epidemics of leprosy in Korea. The results are summerized and
concluded as follow:
1. It was found that present residence of more than a half of Leprosy cases(50.8%
)who have registered at the World Vision Leprosy Center are concentrated in Seoul and
Kyunggi Province, but the birth place of most of them were both Kyungsang and Cholla
Provinces which are well-known heavily endemic area of leprosy in Korea. This
apparent tendency of concentration of leprosy cases of the Center in or near Seoul
appeared to be caused by the social prejudice against leprosy.
2. During the past 8 years since from 1959 to 1965, the yearly average number of
new out-patient at the Center was around 300. However, in 1966 the number of new
cases decreased to 227. It is presumed that the general decrease in the number of new
leprosy cases throughout the country and the increased services at other out-patient
clinics and mobile teams have brought the decrease in the of number yearly new
out-patients in 1966.
3. The classification of the disease types revealed that the lepromatous type occupied
50.6%; tuberculoid, 40.3%; indeterminate group, 7.0% and borderline group, 2.1%. There
observed no sex difference among the patients in the types of the disease. Since 1950
the number of patients of lepromatous type leprosy has become greater than that of
tuberculoid type of leprosy. This fact is interpreted as that the epidemicity of leprosy in
Korea has been decreasing, and that the general immunity in community against leprosy
has been lowered.
4. Survey on the age of the onset of the disease established that about a half of total
2,313 patients examined had the onset at between 15 and 24 years of ages. Among the
greater portion of the patients, the ages at the time of registration at this Center were
in the twenties. These data indicated that there were about 5 years delay from the
onset of the disease to the time of registration at the Center. The shortening of this
delay (theoretically to zero) will certainly provide a significant progress in the control
of leprosy in Korea.
5. Survey of prevalence of leperomatous or tubrculoid type of leprosy in regard to the
birth place of the patients revealed significant epidemiological finding that among the
leprosy patients whose birth places were in Seoul, Kyunggi, Chungchoung Province and
North Korea where leprosy has not been considered endemic, the number of leproulatous
type leprosy were greater than that of tuberculoid type cases. But, to the contrary,
among the patients whose birth places were in Kyungsang and Cholla Provinces where
leprosy has long been known endemic, the number of tuberculoid type leprosy Ivere
greater than that of lepromatous type cases. This finding showed that eprosy is quite
endemic in both Kyungsang and Cholla Provinces and these Provinces are the endemic
areas of leprosy in Korea as being generally considered.
6. Bacteriological examination of tre out-patients showed that 47.5% of the total
patients registered at the Canter, and 87% of lepromatous cases were bacteriologically
positive.
7. Since 1960, the gradual and significant increases in the number of leprosy patients
who made the first visit to the Center within a year after the onset of the disease were
observed. In 1959 such cases occupied only 12.6% , but in 1966 the figure increased to
33.1%. This increase in the number of cases who made the visit within a year after the
onset of the disease indicated that the public understanding on leprosy itself has been
greatly promoted year after year.
8. Among the bacteriologically positive cases, lepromatous type leprosy and borderline
group cases required longer time of treatment to become bacteriologically negative, and
85% of them became bacteriologically negative within 5 years, but in cases it took 7
years for the negative conversion, after the initiation of adequate antileprosy treatment
at the Center. However, in tuberculoid and indeterminate group patients, it took shorter
period of active treatment to become bacteriologically negative, usualy within 2 years.
9. The degree of education of the patients, in general, were higher than that reported
previously by other workers. This higher degree of education seemed to be partially due
to the facts that the registration and medical treatment of the out-patient cases at the
Center were not on the compulsory but on the voluntary basis, and therefore higher
standard of cooperation has been achieved between doctors and patients.
10. Throughout the study it became more evident that early diagnosis and treatment
of early cases at the out-patient clinic are distinctly effective in the control of leprosy
in Korea. For the early case finding of leprosy patients, more practical training of
practicing physicians and medical personnels introducing them the modern concept of
leprosy and their supports in this activity appeared to be very important. |
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