Amidst a concerning rise in leprosy cases across Florida, the U.S. Centers for Disease Control and Prevention (CDC) issued a warning saying the disease may be on the path to becoming endemic in the region.
Travellers heading to the southeastern region of the United States, specifically central Florida, should be mindful of the potential risk of transmission, the CDC stated.
“Florida, USA, has witnessed an increased incidence of leprosy cases lacking traditional risk factors,” the CDC said in a report published on Monday. “Those trends, in addition to decreasing diagnoses in foreign-born persons, contribute to rising evidence that leprosy has become endemic in the southeastern United States.
“Travel to Florida should be considered when conducting leprosy contact tracing in any state.”
In 2020, 159 new cases of leprosy were reported in the U.S., according to the country’s National Hansen’s Disease Program. Florida was among the top reporting states. And Central Florida accounted for 81 per cent of cases in the state. That makes up one-fifth of reported cases in the entire country.
Leprosy, also known as Hansen’s disease, is an age-old infectious disease caused by the bacteria Mycobacterium leprae that affects the skin and nerves.
These bacteria are very slow growing and often may take up to 20 years to manifest after initial infection, according to the CDC. The bacteria attack the nerves, which can become swollen under the skin and cause the affected areas to lose the ability to sense touch and pain. If left untreated, it can also result in paralysis of the hands and feet.
Leprosy is not highly contagious and although it’s not exactly known how it transmits between people, the CDC said it may happen when an infected person coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. However, prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease, the health department added.
If detected early, leprosy can be cured with antibiotics.
Although very rare, cases of the disease have been reported in Canada.
For example, in Ontario, a very small number of imported cases occur per year, according to Public Health Ontario (PHO). The last data available shows that in 2021, there was one reported case. In 2016, there were six reported cases.
Global News reached out to Health Canada for comment about current leprosy rates in the country but did not hear back at the time of publication.
Why is leprosy on the rise in Florida?
Historically, leprosy has been rare in the U.S., with its peak occurrence happening around 1983, as reported by the CDC. Following that, there was a significant decline in the number of documented cases annually from the 1980s through 2000.
But since then, the CDC said, reports show a “gradual increase” in cases, with the number of reported cases more than doubling in the southeastern states over the last decade.
The notable difference is that previous cases primarily involved individuals who immigrated from leprosy-endemic regions around the world. However, according to the CDC’s report, during the period from 2015 to 2020, approximately 34 per cent of new cases seemed to have contracted the disease locally, raising concerns about potential transmission within the U.S.
For example, the department said in 2022 a 54-year-old man living in central Florida became sick with the disease without risk factors for known transmission routes. He went to a dermatology clinic looking for treatment for a painful and worsening red rash. The rash initially appeared on his hands and feet and then spread to his face. Biopsies taken from the affected area showed that he had leprosy.
Lepromatous leprosy in a 54-year-old man in central Florida, 2022.
CDC
He said he had not recently travelled, had prolonged contact with immigrants from leprosy-endemic regions, or associations with individuals known to have leprosy, the CDC said. He lived in central Florida his entire life, works in landscaping and spends extended periods outdoors, the department flagged.
The CDC then suggested “environmental reservoirs as a potential source of transmission” for this patient.
“Although the incidence of leprosy has been increasing, the rates of new diagnoses in persons born outside of the United States has been declining since 2002,” the CDC stated. “This information suggests that leprosy has become an endemic disease process in Florida.”
The CDC then warned that any travel to this area, “should prompt consideration of leprosy in the appropriate clinical context.”
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