Leprosy may become endemic in Florida as cases increase, CDC says

TAMPA, Fla. (WFLA) — Florida is experiencing an increase in leprosy cases that could mean the disease has become endemic in the Sunshine State, according to a letter released by the Centers for Disease Control and Prevention.

The letter, which was published in mid-July, said that while leprosy is historically uncommon in the United States, cases have more than doubled in the South over the past 10 years.

Leprosy, also known as Hansen’s disease, is caused by the bacterium Mycobacterium leprae and is characterized by discolored patches of skin, sores, lumps and damage to the nerves.

The CDC said that if left untreated, the disease can progress to paralysis, blindness, loss of one’s eyebrows, physical disfigurement and even “shortening of toes and fingers due to reabsorption.”

The Florida Department of Health said the disease first appeared in the state in 1921. The National Hansen’s Disease Programme found that 159 cases of leprosy were reported in 2020. Florida topped the list of states with the most new cases.

According to Florida Health Charts, the state had 26 reported cases in 2019, 27 in 2020 and 14 in 2021.

“Central Florida, in particular, accounted for 81% of cases reported in Florida and nearly one-fifth of nationally reported cases,” the letter said. “While leprosy in the United States previously affected people who immigrated from leprosy-endemic areas, (about) 34% of new patient cases in 2015-2020 appeared to have acquired the disease locally.”

A disease becomes endemic when it occurs regularly within a particular community or area.

The CDC letter said several cases showed no evidence of animal-to-human transmission or “traditionally known risk factors.”

One patient, a 54-year-old man in central Florida, was treated at a dermatology clinic for a progressive rash caused by leprosy.

When asked, the man said he had lived in Central Florida all his life, had not traveled domestically or internationally, had no exposure to armadillos (which can carry the disease), had no contact with immigrants with endemic leprosy, and had no connection to anyone with the disease.

Character. Leprosy found in 54-year-old man in central Florida (Photo and caption by CDC)

Experts said there was some support for the theory that an increase in migration from other countries to the United States may have pushed the disease into non-endemic areas. But while leprosy cases are increasing in the United States, the number of new cases in people born outside the United States had been declining since 2002.

“This information suggests that leprosy has become an endemic disease process in Florida, warranting further research into other methods of (local) transmission,” the letter said.

In the state of Florida, doctors must report leprosy by the next business day so contact tracing can be done and further infections reduced.

“In our case, contact tracing was performed by the National Hansen’s Disease Program and revealed no associated risk factors, including travel, zoonotic exposure, occupational association, or personal contacts,” the letter said. “The absence of traditional risk factors in many recent cases of leprosy in Florida, combined with the high proportion of residents like our patient who spend a lot of time outdoors, supports the investigation of environmental reservoirs as a potential source of transmission.”

The CDC said travel to Florida must now be considered when conducting contact tracing for leprosy in any state.

Leprosy, once contracted, can be treated with a combination of different antibiotics to prevent it from developing resistance to the medication, according to the CDC. Leprosy can be cured after one or two years of treatment.

But even when cured, any nerve damage and disfigurement caused by the disease will be permanent.

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