Two children at the Indian Hills Elementary School in Riverside, California may have leprosy, according to reports from the Jurupa Unified School District (JUSD) Superintendent and the Riverside County Health Department.
Last Friday, parents received a letter from JUSD Superintendent Elliott Duchon, informing them of an “unconfirmed report that two students…have been diagnosed with Hansen’s disease (leprosy).” The letter included information from the U.S. Department of Health and Human Services regarding the symptoms, treatment, and contractibility of the infection.
The chronic bacterial disease, which primarily affects the eyes, skin, upper airway, and sensory and motor nerves, is not highly infectious, nor does it cause disability or disfigurement if diagnosed and treated early. Caused by the slowly multiplying bacteria M. leprae, the transmission rate is relatively low. The National Hansen’s (Leprosy) Disease Program estimates that 95 percent of people have immunity to the bacteria and are not susceptible to the disease.
Superintendent Duchon told The Daily Beast that close to 90 students were absent from school Tuesday morning. “Normally we have about 30 kids out on any given day at that particular school, and we had about 90 out,” he said. “The school has over 600 kids, so to our best estimation, an additional 10 percent of students were out of school.”
Parents and caregivers also noticed these absences. Adolph Flores, a grandparent of an Indian Hills student, told ABC News, “Normally this place would be packed with kids. We walk around and the sidewalk [is] full of kids, [but there are] hardly any [today].” He said he was worried about the suspected leprosy cases but was willing to follow the school’s recommendations. “We’re concerned, but what can we do? They say it’s okay, so it’s okay.”
Other parents were not as pacified by the school’s reassurances. “I don’t know exactly what [leprosy] is,” Karen Sunderland, an Indian Hills parent told ABC News reporters. “I just know it’s scary.”
Shortly after the letter was sent to parents Friday, it was posted to JUSD’s Facebook page. Parents from Indian Hills Elementary and other district schools quickly began posting comments and reactions. Many were concerned that the letter had only been given to Indian Hills’ parents and that a more public announcement had not been made. Some asked why the letter wasn’t sent to staff and parents throughout the district.
According to Barbara Cole, a registered nurse and branch chief of the Riverside County Health Department, notifying other parents or teachers wasn’t necessary because “transmission or spread to others is very unlikely.”
Cole told The Daily Beast that she doesn’t consider it to be a public health risk—even if cases are confirmed. “Even if confirmed, Hansen’s disease is difficult to transfer to other children,” she said. “The school setting does not hold considerable risk.”
Although Duchon told The Daily Beast that the children who have suspected cases of leprosy are “out of school and will not be admitted without a doctor’s note that they are not contagious,” Cole said that her team “did not exclude the children from attending school.”
The Centers for Disease Control and Prevention (CDC) backed Cole’s assertion that the children need not be removed from the school. “If the case is not confirmed,” Tom Skinner, Senior Press Officer for the CDC, told The Daily Beast, “[there is] no reason for the child to stay away from school.”
The label of “‘no risk’ is always tricky,” Skinner said, but “if a child is a confirmed case, school contact is still very low risk…a few days of antibiotics and the child is not contagious and could go to school.”
Skinner added that the Indian Hills Elementary school case had not been reported to the CDC. He also said that “there is no test for asymptomatic people,” and that without a “full risk assessment, travel [history], family history, clinical history,” and a biopsy of a lesion to confirm, the CDC would not recommend taking the child out of the school.
Superintendent Duchon said that in addition to removing the children from the school, the classrooms “involved” were disinfected—adding that it was a precautionary measure, not recommended by the Riverside County Health Department.
“We did it to make sure people knew we were doing everything we could. We were not sure whether it was necessary, but we felt like it certainly couldn’t hurt,” he told The Daily Beast.
In his letter to parents, Duchon expressed that most of the measures taken were contingencies, conducted with “an abundance of caution.” By emphasizing the treatable nature of leprosy and dispelling information as soon as possible, Duchon hoped that the letter would “reduce rumors and misinformation being spread.”
“While we occasionally have incidents of students with either active or inactive TB [tuberculosis] and or staph, I don’t think it’s got the [same] stigma,” he told The Daily Beast. “It’s not as catchy as when people hear the term ‘leprosy.’”
He has a point: most of the hullabaloo about the case comes from lack of education about leprosy and the treatments that have made progress since the Middle Ages, when it was highly prevalent in Europe.
As a result of the skin lesions that can appear on the skin of afflicted patients, leprosy was a highly feared and stigmatized illness for much of human history. Individuals suffering from Hansen’s disease were often ostracized and forced to live in leper colonies due to false beliefs about the infectious nature of the disease.
But now we know that leprosy is transmitted “via droplets from the nose and mouth, during close and frequent contact with untreated cases,” according to the World Health Organization (WHO). It is fairly difficult to become infected by those outside of one’s direct household.
The infection is also easily “curable with multidrug therapy (MDT),” according to the World Health Organization (WHO). According to The National Hansen’s Disease (Leprosy) Program, “patients become noninfectious after taking only a few doses of the medication and need not be isolated from family and friends.”
Dr. David Scollard, Director of the National Hansen’s Disease Program, told The Daily Beast that he agrees with the Riverside County Health Department’s recommendations “one hundred percent.”
“We see people react with hysterical, uninformed responses because they’re shocked. They think that the disease doesn’t exist, that it’s only in the Bible,” Dr. Scollard said. “The uniformed responses [are] detrimental to everybody.”
According to the U.S. Department of Health and Human Services, Hansen’s disease is considered little more than “a minor skin disease,” since permanent nerve damage is extremely rare. Compiled statistics indicate that there are currently around 6,500 cases of leprosy in the United States, with only about half requiring “active medical management.” Only 175 new cases were reported in the U.S. in 2014; 73 percent of those were reported in Arkansas, California, Florida, Hawaii, Louisiana, New York, and Texas.
The link between Hansen’s disease and the southern U.S. is due to wild armadillos to and their ability to transmit M. leprae to humans. According to a study published in The New England Journal of Medicine, “native-born Americans with no history of foreign exposure” may be infected thanks to armadillos, which serve as “a large natural reservoir” for the bacteria.
Neither Cole nor Duchon would release information regarding whether the children with suspected Hansen’s disease had traveled to another country or had contact with individuals with leprosy, citing HIPAA and student privacy rights. Cole did mention, however, that she had been conferring with the Indian Hills Elementary School nurse.
Duchon said that there would be a “joint meeting” between the Riverside County Health Department and the school district Wednesday night for parents and teachers to attend.
When asked if the school had any additional plans or policies it would implement going forward, Duchon deferred to the recommendations of Cole and her team of public health specialists. “We’ve relied 100 percent on the county health department,” he said. “They’re the experts.