1. NATIONAL HANSEN’S DISEASE PROGRAMS

2. DIAGNOSIS & TREATMENT OF HANSEN’S DISEASE DIAGNOSIS & TREATMENT OF HANSEN’S DISEASE

3. Hansen’s disease is an infectious disease of man primarily involving: Hansen’s disease is an infectious disease of man primarily involving: Skin Peripheral Nerves Eyes Mucous Membranes (Nose and Throat) Skin Peripheral Nerves Eyes Mucous Membranes (Nose and Throat)

4. HANSEN’S DISEASE IN THE UNITED STATES HANSEN’S DISEASE IN THE UNITED STATES Average number of new cases Reported annually is between 150 - 225 Average number of new cases Reported annually is between 150 - 225

5. ETIOLOGY - MYCOBACTERIUM LEPRAE Acid Fast Bacteria Discovered by Hansen in Norway in 1873 Never Been Cultured in Laboratory Found in Man, Armadillos, and Some Monkeys Acid Fast Bacteria Discovered by Hansen in Norway in 1873 Never Been Cultured in Laboratory Found in Man, Armadillos, and Some Monkeys

7. MODE OF TRANSMISSION Untreated Lepromatous Patients - Respiratory Route Armadillos? Soil or Vegetation? Incubation Period Average 3 - 5 years Untreated Lepromatous Patients - Respiratory Route Armadillos? Soil or Vegetation? Incubation Period Average 3 - 5 years

8. SUSCEPTIBILITYSUSCEPTIBILITY Only 3 - 5% of Populations are Susceptible Children or Contacts of Treated Patients Rarely Get the Disease Attack Rate of Spouses is 2 - 10% Genetic Factors Immune Factors Only 3 - 5% of Populations are Susceptible Children or Contacts of Treated Patients Rarely Get the Disease Attack Rate of Spouses is 2 - 10% Genetic Factors Immune Factors

9. TT BT BB BL LL CMI TUBERCULOID FEW BACTERIA LOW ANTIBODY LEVELS HIGH RESISTANCE TO M. LEPRAE TUBERCULOID FEW BACTERIA LOW ANTIBODY LEVELS HIGH RESISTANCE TO M. LEPRAE LEPROMATOUS MANY BACTERIA HIGH ANTIBODY LEVELS LOW RESISTANCE TO M.LEPRAE LEPROMATOUS MANY BACTERIA HIGH ANTIBODY LEVELS LOW RESISTANCE TO M.LEPRAE The Hansen’s Disease Spectrum BI ENL ANTIBODY LEVEL ANTIBODY LEVEL Reversal Reaction

10. CLASSIFICATION FOR TREATMENT I -Indeterminate TT -Tuberculoid BT -Borderline Tuberculoid I -Indeterminate TT -Tuberculoid BT -Borderline Tuberculoid BB -Midborderline BL -Borderline Lepromatous LL -Lepromatous BB -Midborderline BL -Borderline Lepromatous LL -Lepromatous PAUCIBACILLARY (PB) (No Bacilli in Skin Smears) PAUCIBACILLARY (PB) (No Bacilli in Skin Smears) MULTIBACILLARY (MB) (Skin Smears: 1+ to 6+ Bacilli) MULTIBACILLARY (MB) (Skin Smears: 1+ to 6+ Bacilli)

11. DIAGNOSIS OF HANSEN’S DISEASE Skin Nerves Eyes Hands & Feet Skin Nerves Eyes Hands & Feet Slit Skin Smears Skin Biopsies Slit Skin Smears Skin Biopsies Clinical Exam Procedures Lab Procedures

12. DIAGNOSTIC CRITERIA Anesthetic Skin Lesions Enlarged Peripheral Nerves Acid Fast Bacilli in Skin Smears Biopsy Evidence of Nerve Damage or Acid Fast Bacilli Anesthetic Skin Lesions Enlarged Peripheral Nerves Acid Fast Bacilli in Skin Smears Biopsy Evidence of Nerve Damage or Acid Fast Bacilli

14. Posterior Tibial Nerve Posterior Tibial Nerve Peroneal Nerve Radial Cutaneous Nerve Radial Cutaneous Nerve Ulnar Nerve Ulnar Nerve Great Auricular Nerve Great Auricular Nerve PERIPHERAL NERVES

23. BACTERIAL INDEX (BI) 0=None found in 100OIF 1+=1 - 10Per 100OIF 2+=1 - 10Per 10OIF 3+=1 - 10PerOIF 4+=10 - 100PerOIF 5+=100 - 1000PerOIF 6+=1000+PerOIF 0=None found in 100OIF 1+=1 - 10Per 100OIF 2+=1 - 10Per 10OIF 3+=1 - 10PerOIF 4+=10 - 100PerOIF 5+=100 - 1000PerOIF 6+=1000+PerOIF (OIF = Oil Immersion Field)

24. BIOPSIES Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm) Deep Enough to Include Subcutaneous Tissue and Fat Fix Promptly in at Least 10 Volumes of 10% Formalin Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm) Deep Enough to Include Subcutaneous Tissue and Fat Fix Promptly in at Least 10 Volumes of 10% Formalin

40. DRUGS FOR CHEMOTHERAPY DAPSONE (DDS) RIFAMPIN CLOFAZIMINE (B663 - LAMPRENE) DAPSONE (DDS) RIFAMPIN CLOFAZIMINE (B663 - LAMPRENE)

41. CHEMOTHERAPY OF HANSEN’S DISEASE U.S. Short Term World Health Organization U.S. Short Term World Health Organization

42. U. S. SHORT TERM THERAPY PAUCIBACILLARY - 1 Year Treatment Dapsone 100 mg Daily Rifampin 600 mg Daily Dapsone 100 mg Daily Rifampin 600 mg Daily MULTIBACILLARY - 2 Year Treatment Dapsone 100 mg Daily Rifampin 600 mg Daily Clofazimine 50 mg Daily Dapsone 100 mg Daily Rifampin 600 mg Daily Clofazimine 50 mg Daily

43. LABORATORY MONITORING Baseline Studies-CBC, Platelets, Liver Functions, and G-6-PD Rifampin-CBC and Liver Function Studies Every 2 to 3 Months Dapsone-CBC Every 6 Months Clofazimine-No Specific Studies Required Baseline Studies-CBC, Platelets, Liver Functions, and G-6-PD Rifampin-CBC and Liver Function Studies Every 2 to 3 Months Dapsone-CBC Every 6 Months Clofazimine-No Specific Studies Required

44. SIDE EFFECTS DAPSONE-Mild Anemia RIFAMPIN-Liver Toxicity Thrombocytopenia CLOFAZIMINE-Skin Pigmentation GI Disturbances DAPSONE-Mild Anemia RIFAMPIN-Liver Toxicity Thrombocytopenia CLOFAZIMINE-Skin Pigmentation GI Disturbances

46. MONITORING RESPONSE TO TREATMENT Regular Examination of Eyes, Hands and Feet Examination of Skin Lesions Repeat Skin Smears Annually Repeat Biopsies Regular Examination of Eyes, Hands and Feet Examination of Skin Lesions Repeat Skin Smears Annually Repeat Biopsies

47. NATIONAL HANSEN’S DISEASE PROGRAMS 1770 Physicians Park Drive Baton Rouge, Louisiana 70816 Phone: 1-800-642-2477 Fax: (225) 756-3760