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close this book Combatting Hansen's disease
View the document Table of contents
View the document List of common abreviations
View the document I. Introduction
Open this folder and view contents II. Pertinent physiology and immunology
Open this folder and view contents III. Hansen's disease - Three perspectives
Open this folder and view contents IV. Health education
Open this folder and view contents V. Case finding
Open this folder and view contents VI. Diagnosis - Symptoms and testing in HD
Open this folder and view contents VII. Patient management
Open this folder and view contents VII. Co-operating institutions
Open this folder and view contents IX. Getting started
View the document Appendix I
View the document Appendix II
View the document Appendix III
View the document Appendix IV

Appendix III

Hansen's Disease in Korea: Statistics

Prepared by Dr. Kim, Do Il

Korean Leprosy Assoc.

Seoul

I Trends

A. General prevalence of HD per 1000

1. First epidemiological survey at Wolsung-gun, Kyeong buk

4.63 - 12.65.

Table 1

 

no.

prevalence

Registered cases before survey (1963)

113

0. 6/1,000 pop.

New cases after survey (1963-1965)

375

2.0/1,000 pop.

Total cases (1965)

488

2.6/1,000 pop.

*population of Wolsung-gun 189,995

*no. of people examined 181,084 (95.3%)

 

2. Second epidemiological survey at Wolsung gun, 9.73 - 10.73

Table 2

no. surveyed

no. of detected cases

detected rate

3 352

6*

1.8/1,000

*All six detected had not been examined in the first survey. There were no new cases among those examined the first time, thus indicating a significant reduction of in transmission or infectivity.

 

3. Reports on prevalence 1971-75

Table 3

year

population

registered cases

rate (1000)

no. of exam

new cases

detect. rate

prevl. rate

estimated no.

1971

31,927,000

33,822

1.5%

1,012,421

1,292

1.2%

2.7%

80,000

1972

32,544,000

33,856

1.4%

511,146

735

1.4%

2.8%

 

1973

33,169,000

33,819

1.0%

561,812

1,187

2.1%

3.1%

 

1974

33,771,000

33,116

1.0%

793,208

967

1.1%

2.1%

 

1975

34,688,000

32,152

0.9%

852,813

887

1.0%

1.9%

65,000

Based on the above date Dr. Kim calculates the estimated prevalence of HD in Korea at 1. 9 per 1000 which would mean a present population of approximately 65,000 patients.

 

B Type

1. Classification of registered out-patients yearly

Table 4

 

year

type

 

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

L

no.

774

1685

4878

5136

5272

5905

5895

13120

13101

13838

 

%

44.8

43.6

45.8

45.3

45.0

42.1

43.9

48.4

48.9

51.3

T

no.

830

1844

5029

5477

5685

6525

6492

12205

11906

11372

 

%

48.2

47.9

47.3

47.8

48.7

50.4

48.6

45.1

44.6

42.4

I

no.

121

332

738

731

745

1013

1011

1763

1761

1715

 

%

7.0

8.5

6.9

6.9

6.3

7.5

7.5

6.5

6.5

6.3

total no.

1725

3861

10645

11344

11702

13443

13398

27088

26768

26925

 

2. Classification of newly detected patients yearly

Table 5

year

1972

1973

1974

1975

pts.

No.

%.

no.

%

no.

%

no.

%

L

422

39.4

503

39.0

434

44.9

417

47.0

T

573

53.6

694

53.9

438

50.1

405

45.7

I

75

7.0

92

7.1

49

5.0

65

7.3

This data shows a gradual reduction of Tuberculoid discoveries and an increased percentage of Lepromatous discoveries in recent years.

 

C. Positivity rates

1. Positivity rates of all registered patients yearly (%)

Table 6

 

1973

1974

1975

Domiciliary pts.

12.0

12.0

12.3

RV pts.

1.1

2.2

2.7

In-patients

13.4

12, 6

12. 4

Total

8.1

8.7

9.0

 

2. Positivity rate of newly detected patients yearly (%)

Table 7

year

1973

1974

1975

rate

20.5

24.5

28.2

The main factor in the gradually rising positivity rate seems to be poor patient management especially regarding medicine defaulters leading to resistance or relapse.

 

D. Epidemiological considerations

Most of the villages where no cases were registered in 1966 are still free of patients in 1975 and the newly registered cases keep coming from the same the same villages as in the past, thus indicating no dramatic spread of the disease to previously non-infected communities. Among the 144 villages in the Wolsung-gun surveyed in 1963-1965, HD patients were found in 113 villages (78. 5%). In 1973 the situation was practically the same, 114 villages with HD, most of them the same villages as in 1965.

Table 8: Proportion of infected villages by province

province

total villages

villages with cases

%

Kyeongsangbuk do

3,957

2,087

53

Kyeongsangnam do

2,225

1,472

66

Jeonlabuk do

2, 847

599

21

Jeonlanam do

5,242

1,264

24

Chungcheongbuk do

1,520

395

26

Chungcheongnam do

2,316

596

24

Kangwon do

1,279

133

10

Kyonggi do

4,167

96

2

Total

23,553

6,612

28

The proportion of infected villages in Korea is quite different from that of India, Burma and Ceylon, etc. While in the above mentioned countries the prevalence rate in the infected villages differs widely from one village to another, in Korea all over the country the range of the prevalence rate moves within very narrow limits. Among 113 villages with patients in Wolsung-gun, 108 infected villages have mostly low prevalence rates around 1%-2% with a few in the 3%-6% range.

 

2. Age

Table 9: Peak Age of Distribution among registered patients

Year

1960

1968

1973

Peak of age group (years)

30-34

45-49

50-54

 

E. Summary

The above statistics indicate the explosive spread of HD in Korea has been reduced and infection diminished. This may be due to one or a combination of the following:

a) sulphone treatment introduced in 1950

b) improvement of the country's socio-economic condition

c) successful detection by case workers

d) institutionalization

This is, however offset by the rising Lepromatous and positivity rates which may indicate a lessening of the general population's resistance to ML. So whereas the epidemiological picture in Korea may be improving the endemical situation is not so fair.

II. Present Status of HD in Korea

75.12. 31.

Number of registered patients by sex and residence

 

Table 10

patients

male

female

total

%

out -patients domiciliary

11,063

4,581

15,644

48.6

resettlement villages

6,043

5,238

11,281

35.0

in-patients

2,867

2,360

5,227

16.4

Total

19,973

12,179

32,152

 

%

62.1

37.9

   

male to female ratio is 1.6:1

 

B. Number of registered patients by classification

Table 11

type

out - patients

in -patients

total

%

lepromatous

13,283

4,137

17,420

54.2

tuberculoid

11,372

900

12,272

38.2

indeterminate

1,715

11

1,726

5.4

borderline

555

179

734

2.2

 

C. Number of registered patients by positivity - see Table 6

D. Number of registered patients by city-province

Table 12

City or province

Home

R. V.

Hosp.

Bact. Positive

total

%

Seoul

273

172

 

105(23.6)

445

1.4

Pusan

271

1034

 

252(19.3)

1305

4.1

Kyonggi

64

1550

76

72(4.3)

1690

5.2

Kangwon

306

382

 

62(9.0)

688

2.2

Chungbuk

681

74

 

100(13.2)

155

2.3

Chungnam

1264

232

 

161(10.7)

1496

4.6

Jeonbuk

1244

2525

 

166(4.4)

3769

11.7

Jeonnam

2677

789

3811

852(11.7)

7277

22.7

Kyeongpuk

5262

2191

975

724(8.6)

8428

26.3

Kyeongnam

3568

2332

365

374(6.0)

6265

19.4

Jaeju

34

   

17(50.0)

34

0.1

total

15644

11281

5227

2885

32152

100

 

III. HD Control Program Statistics Yearly

HD control activities in Korea have been carried out by 18 mobile teams (11 KLA and 7 voluntary teams) and 110 case workers at 197 local health centers which cover all counties and cities in the country.

A. Case-finding activities

Table 13

Year

1966

1961

1968

1969

1970

1971

1972

1973

1974

1975

New cases

4968

4680

3475

1891

1292

1394

1087

1289

967

887

The majority of newly detected cases tend to be quite advanced.

 

B. Methods of case-finding

Table 14

 

1913

1974

1975

 

No.

%

No.

%

No.

%

contact examination

146

11,3

78

8.0

84

9.4

notification

473

36.7

388

40.1

326

36.7

voluntary

308

23.8

255

26.2

274

30.9

intensive survey

295

22.8

205

21.2

134

15.1

others

67

5.4

41

4.5

69

7.9

 

C. Newly detected cases according to age at registration

Table 15

 

1973

1974

1975

age (years)

No. of pts.

%

No. of pts.

%

No. of pts.

%

Under 4

1

0.1

-

-

-

-

5-9

4

0.3

5

0.6

4

0.4

10-14

58

4.6

27

2.8

20

2.3

15-24

216

16.8

153

15. 8

143

16.1

25-34

260

20.3

161

16.6

141

15.9

35-44

242

18.9

198

20.5

211

23.8

over 45

500

39.0

423

43.7

368

41.5

There is an average 12.15 year lapse in Korea between onset and registration. The peak age of onset is 15-24 (46. 7%)

 

D. Newly detected cases according to sex

Table 16

 

1973

1974

1975

sex

no. of pts.

%

no. of pts.

%

no. of pts.

%

male

885

68.7

655

67.7

617

69.5

female

404

31.3

312

32.3

270

30.5

male to female ratio is 2.2:1

 

E. Newly detected cases according to type

Table 17

type

               

L

422

39.4

503

39.0

434

44.9

417

47.0

T

573

53.6

694

53.9

438

50.1

405

45.7

I

75

7 0

92

7.1

49

5.0

65

7.3

 

F. Bacteriological examination of newly detected cases

Table 18

   

1973

1974

1975

type

Bacilli

no.

%

no.

%

no.

%

L

+

257

51.1

230

53.0

245

58.8

 

-

246

48.9

204

47.0

172

41.2

 

total

503

100

434

100

417

100

Non-L

+

7

0.9

7

1.3

6

1.3

 

-

779

99.1

526

98.7

464

98.7

 

total

786

100

533

100

470

100

total

+

264

20.5

237

24.5

251

28.2

 

-

1025

79.5

730

75.5

636

71.8

The number of (-) lepromatous patients being discovered indicates they have to be treating themselves for a number of years before being "discovered" by control workers.

 

G. Percentage of patients on, and duration of self-treatment prior to registration

Table 19

 

1972

1973

1974

1975

% with previous treatment

43.9

47.1

46.1

48.5

duration of previous treatment (in years)

3.6

3.6

3.7

4.1

 

H. Patients infected by known family contact

Table 20

 

1973

1974

1975

L

59

44

53

non-L

117

79

74

total

176

123

127

%

13.6

12.7

14.3

According to investigation of family source of infection of detected patients, 12-15% of patients had family source of infection Compared with detection of 8-12% of patients by family contact examination majority of patients with the family source of infection were detected by contact examination.

 

I. Follow up treatment of out-patients as indicated by positivity rates

Table 24: Number and positivity rates among domiciliary patients

year

positive rate (%)

1967

16.6

1968

15.2

1969

13.7

1970

14.7

1971

13.6

1972

14.6

1973

12.0

1974

12.0

1975

12.3

Since the policy of leprosy control changed from asylum treatment to out-patient treatment, the number of out-patients has been increasing year after year and the positivity rate had decreased year by year. However the positivity rate increased slightly in 1975 as compared with previous years. This suggested that the relapse cases have increased either because of irregular anti-leprosy treatment or treatment stoppage.

 

2. Number and positivity rate among RV patients

Table 25

year

no. of pts.

positive cases

positive rate (%)

1973

12,156

142

1.1

1974

11,560

260

2.2

1975

11,281

305(395)*

2.7(4.1)*

*() indicates Emma survey results

 

J. Summary and Recommendations

Number of leprosy patients in Korea is estimated at about 65,000 of which 32,152 cases were already detected registered patients while about 33, 000 cases are still hidden patients.

Bacilli positive cases which are the source of infection numbered about 3,000 among registered patients in the country. If calculated on the base of positivity rate of newly detected patients in 1975, about 8,460 cases might be positive among 30, 000 hidden cases. Then 11,460 positive cases may be the source of infection.

On the transmission of leprosy in Korea, about 6,600 villages (28%) out of about 23,500 villages in the country are leprosy contaminated villages and those leprosy contaminated villages did not increase as compared with the past 10 years. Therefore it seems to be that the transmission of leprosy between villages have not spread.

The ratio of lepromatous leprosy to tuberculoid leprosy increased recently. This means that while The explosive epidemiological transmission of leprosy in Korea became stationary or declining the public resistance against leprosy has weakened. Endemically tuberculoid patients are more than lepromatous patients in leprosy dense are as such as Kyungsang-do and Cholla-do, but lepromatous patients are more in leprosy sparse area such as Kangwon-do and Kyungki-do.

Comparing domiciliary patients and patients of resettlement villages, follow-up treatment was given to former patients and rehabilitation for self-reliance was given to latter patients such that the number of bacilli positive cases were less among domiciliary patients than patients of resettlement villages.

Of WHO suggested HD control activities case finding has been carried cut actively but patient management (including regular -chemotherapy, PT, OT, regular examinations and social welfare measures) has been much ignored.

Relapse, resistant, or sulphone sensitive patients should be treated with Rifamicin or Lampcene. But as this is quite expensive all efforts should be made to guard against relapse and resistance by full patient management.

Self administration makes proper epidemiological studies impossible but more, predisposes patients to relapse, reaction or resistance. The author feels however that though controls on anti-ML drugs may be needed in the future at present he does not support bons on their over the counter sale.