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KMID : 0386319680050010079
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Korean Leprosy Bulletin
1968 Volume.5 No. 1 p.79 ~ p.94
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Clinical Epidemiology of Ambulatory Leprosy Patients in Korea
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金英洙/Kim, Young Soo
柳駿/Lew Joon
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Abstract
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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 long 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 outpatient clinics and 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 law that was effective until 1963 in Korea.
The World Vision Leprosy Center, established in May 1959 as the first leprosy outpatient 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 summarized 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 221´. 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
1960 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 beween 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 lepromatous 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 were greater than that of lepromatous type cases. This finding showed that leprosy 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 the out-patients showed that 47.5 % of the total patients registered at the Center, and 87% of lepromatous cases were bacteriologically positive.
7. Since 1960; thegradual 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. Howerver, in tuberculoid and indeterminate group patients, it took shorter period´ of active treatment to become bacteriologically negative, usually 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 of t-patietit 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 acid medical personnels introducing them. the modern concept of leprosy and their supports in this activity appeared to be very important.
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