About the epidemiology of leprosy in Kazakhstan


January 23, 2023

Scientists who wrote about this disease (Abdirov C. A., Yushchenko A. A., Vdovina N. A. 1987) noted that leprosy (Hansen's disease, hanseniasis, hansenosis) is a chronic infectious human disease (anthroponosis), the causative agent of which is mycobacterium leprosy, affecting the skin, peripheral nervous system and internal organs. The duration of the incubation period of leprosy is on average 2-7 years and in some cases can last from several months to decades, depending on the body's resistance to the disease.

Judging by ancient books and archaeological research, leprosy has been known to mankind since very early times. In the ancient Indian monoscripts (1500-1000 BC) - "Kushta", in the five books of Moses (1500 BC) – "Zaraath", in the Egyptian papyri (1300-1000 BC) – "Uchedu" many authors wrote that leprosy spread all over the world from Central Africa, although there are also those who claim that the first focus was on the territory of Southeast Asia. B.C. according to the testimony of Herodotus, who lived in the V century, at that time in Iran leprosy was widespread under the name "pes (pis)".

Leprosy was brought to Europe from Egypt, Phoenicia and Asian countries through various migrations of peoples (trade relations, military campaigns, mass migrations). The mass spread of leprosy in Europe was facilitated by the Roman soldiers of Pompeii, who returned from a protracted campaign to the countries of Southeast Asia in the I century BC. At the beginning of the new era, leprosy began to be registered in Byzantium, Spain, France and other European countries. In the same period (II century) Galen wrote more detailed information about leprosy, highlighting 6 main signs of the disease: skin inflammation, ulcers, swelling of the legs, "lion-like appearance", hair loss on the skin and mutation (loss of peripheral joints). At first, leprosy was called "elephantiasis" (elephant – elephant leg). In the third century, the Christian theologian Origen replaced the disease with the biblical word "Zaraath", which translated into Greek became the term "lepra" (dry). Since that period, the name of the disease has been called "leprosy" in all countries.

The most active period of leprosy in European countries occurred in the X-XIII centuries. Since the XI century, leper colonies began to open in all European countries. In each country, leprosariums were called in their own way, in Italy - lazaretti – in honor of the biblical Saint Lazarus, who fell ill with leprosy–this name is still preserved in medical places of military and temporary restrictions, in England-lazar houses, in France-maladreri, etc. The number of leprosariums reached its peak in the XIII-XIV centuries when they appeared in almost every city. Isolation of patients was mandatory and lasted all their lives, depriving them of their civil rights. They were obliged to go out into the city only in unusual outfits and with bells that completely covered them, they were forbidden to enter houses and visit public places, to work, they were only allowed to earn a living by begging. In the absence of any approach to treatment, despite its severity, these measures were the only effective preventive measure that was used to prevent the widespread spread of the epidemic.

Subsequent social progress, an increase in material and cultural levels, and an improvement in occupational and household hygiene conditions gradually led to a decrease in the incidence of leprosy. Despite the fact that there is no special treatment yet, in the middle of the XVII century in many European countries there were only individual foci of leprosy. A sharp decrease in morbidity can also contribute to such particularly contagious diseases as plague, cholera, transferred during these periods.

In Norway, which later achieved economic and social progress, the leprosy epidemic continued until the end of the XIX century, and in countries such as Spain and Portugal, it is still registered.

Leprosy was brought to the territory of the former Russian Empire from heavily infected neighboring countries and preserved in the form of separate foci. Leprosy spread most widely in Russia in the XIX – XX centuries in the Astrakhan province, at the mouth of the confluence of the Volga River into the sea and in settlements on its left bank (V. R. Kogan. 1964). In the south of Russia, leprosy was called "leprosy", "Crimean disease or Crimean" (V. F. Shubin. 1957). The first leper colony in Russia was opened in 1769. N.A. Torsuev and S. M. Gitman (1956) write that in 1911 there were 21 leper colonies in the Russian Empire.

The earliest written document on the existence of leprosy on the territory of Kazakhstan can be found in the works of P. S. Pallas (1889). In 1769, while in Yaik (now the Ural city), he saw leprosy among the Ural Cossacks and left the following inscription: "... when Yaik began to show a special and little-known disease, from which bad consequences can be produced if there is no precaution. The Yaitsky Cossacks say that she stuck to them from a Koman from Astrakhan who was in the Persian campaign and is called a "black mute" because her face is starting to turn blue." There is written evidence that several authors P. Simontovsky (1796), N.Minkh (1888), L. Rutenberg (1897), F. Gorbatsevich (1898) and others encountered leprosy on the territory of modern Western Kazakhstan, Atyrau region. It is noteworthy that the data were about the Russian population living in these regions, nothing was written about the indigenous inhabitants of Kazakhstan – Kazakhs.

In their works on the epidemiology of leprosy in Kazakhstan, many authors note the importance of the Great Silk Road through the Kazakh land, the campaigns of Arab invaders, Genghis Khan, Temirlan, conclude that leprosy spread during these periods.

However, until the 50s of the last century, when the incidence of leprosy reached its apogee, the disease was not detected in all places on the territory of the Kazakh SSR, out of 16 regions that make up it, only in 8: these are Kyzylorda, Guryev, West Kazakhstan, Aktobe, South Kazakhstan, Zhambyl, Almaty and Semipalatinsk regions. Of these, 95% of all detected cases were detected in Kyzylorda and Guryev regions, and 5% in the remaining 6 regions.

Considering that the cases in the last 6 regions have long remained sporadic, which led to the epidemic nature of the situation in the Aral-Kazalin focus of Guryev, especially Kyzylorda region. In 1885, the famous Russian doctor G. N. Minkh, having studied the Perovsky and Kazalinsky districts, said that he had not met leprosy diseases there. Reshetillo, who was conducting research at the time, also agreed with this opinion. This fact is confirmed by Mamonov in the survey of the Syrdarya region for 1885. The documents mention the existence of leprosy in this area during the period when its territory also included the lands of neighboring republics. It is known that among the foci that he indicated, there was not a single settlement included in the territory of the later Kazakh SSR.

Leprosy is mainly a common disease among sedentary peoples. In his scientific work "Leprosy in the Kazakh SSR" K. A. Kolesov noted that among the Kazakhs there was a concept of "pes (PES, leprosy)", but this word itself is borrowed from the Persian language, the translation of which means "ala", which may be based on vitiligo disease. There is a version that this word was called leprosy in neighboring Khiva, Khorezm countries, where "mahauhona", "mahaukishlaks" already existed. That is, leprosy, along with their names, was allegedly imported to the territory of Kazakhstan from neighboring countries. Considering that at these stages many chronic skin diseases do not differ from each other, we can also notice that these names can be applied to various skin diseases.

Thanks to effective national measures carried out for almost a century, the leprosy epidemic was localized in the country. No State in the world has achieved such success in such a short time against the leprosy epidemic. Currently, there are only sporadic cases in our country. The only special institution in the country is located in the Kyzylorda region. The specialists of the leprosarium were previously mainly engaged in extinguishing the foci of leprosy, and we can say that they won in this struggle.  The fight against leprosy has its own problems:

  1. internal and external migration of the population of the country: as a result of the ecological catastrophe that arose in connection with the drainage of the Aral Sea over the past 30-40 years, together with the population of the endemic focus, sick people were forced to relocate to other regions of the country. Currently, patients and those who are in close contact with them live in almost all regions of the country. This, in turn, can also lead to the risk of spreading infection in regions whose residents have nothing to do with leprosy at all. Moreover, our country has gained sovereignty and established trade, economic and tourist relations with almost all countries of the world, including unstable states on leprosy. This circumstance, in turn, increases the risk of penetration from the outside of various infections, as well as leprosy. So, in 2012-2016 alone, 32 patients moved from the territory of the neighboring Republic of Karakalpakstan to the country. They are registered at the dispensary.
  2. ignorance of leprosy by medical workers of the country, in turn, creates the risk of untimely detection of the disease and long-term environmental impact.

Given the above-mentioned problems, it is still too early to stop the fight against leprosy because of the current situation. Now our goal is the radical destruction of leprosy (elimination). Not only specialists of this industry, but also all medical workers of the country should be involved in the eradication of leprosy.

 М. Seitaliev,

Kazakh Republican Leprosarium

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