The U.S. Centers for Disease Control and Prevention (CDC) said in a report that cases of leprosy have increased in Florida and some health officials think the ancient disease may be endemic in the state.
The report, published in the CDC’s Emerging Infectious Diseases journal, states Florida has “witnessed an increased incidence of leprosy cases lacking traditional risk factors.”
“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,” the report reads.
“Leprosy, or Hansen disease, is a chronic infectious disease caused by the acid-fast rod Mycobacterium leprae. Leprosy primarily affects the skin and peripheral nervous system, and disease course is largely dependent on individual susceptibility to M. leprae,” the report states.
“It affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and the eyes,” The Epoch Times wrote.
The report noted that leprosy is “historically uncommon” in the United States.
“According to the National Hansen’s Disease Program, 159 new cases were reported in the United States in 2020; Florida was among the top reporting states,” the report states.
Cases of leprosy, ‘historically uncommon’ in US, surge in central Florida, CDC says https://t.co/OppGWXQYpC
— Fox News (@FoxNews) August 1, 2023
Leprosy “has appeared in literature and religious texts—notably the Bible—since ancient times,” The Epoch Times writes.
The CDC reports:
Central Florida, in particular, accounted for 81% of cases reported in Florida and almost one fifth of nationally reported cases (3). Whereas leprosy in the United States previously affected persons who had immigrated from leprosy-endemic areas, ≈34% of new case-patients during 2015–2020 appeared to have locally acquired the disease (4). Several cases in central Florida demonstrate no clear evidence of zoonotic exposure or traditionally known risk factors. We report a case of lepromatous leprosy in central Florida in a man without risk factors for known transmission routes. We also review the mounting epidemiologic evidence supporting leprosy as an endemic process in the southeastern United States.
A 54-year-old man sought treatment at a dermatology clinic for a painful and progressive erythematous rash (Figure). The lesions began on his distal extensor extremities and progressed to involve his trunk and face. He denied any domestic or foreign travel, exposure to armadillos, prolonged contact with immigrants from leprosy-endemic countries, or connections with someone known to have leprosy. He has resided in central Florida his entire life, works in landscaping, and spends long periods of time outdoors. Biopsies of multiple sites demonstrated a diffuse dermal infiltrate composed of disorganized aggregates of foamy histiocytes and lymphocytes. Fite stains revealed acid-fast bacilli within histiocytes and cutaneous nerve twigs, a pathognomonic finding of leprosy. He was referred to an infectious disease specialist who, under the direction of the National Hansen’s Disease Program, prescribed triple therapy with dapsone, rifampin, and clofazimine.
Transmission of leprosy has not been fully elucidated. Prolonged person-to-person contact through respiratory droplets is the most widely recognized route of transmission (1). A high percentage of unrelated leprosy cases in the southern United States were found to carry the same unique strain of M. leprae as nine-banded armadillos in the region, suggesting a strong likelihood of zoonotic transmission (4). A recent systematic review analyzing studies conducted during 1945–2019 supports an increasing role of anthroponotic and zoonotic transmission of leprosy (5). However, Rendini et al. demonstrated that many cases reported in eastern United States, including Georgia and central Florida, lacked zoonotic exposure or recent residence outside of the United States (6).
Given those reports, there is some support for the theory that international migration of persons with leprosy is a potential source of autochthonous transmission. Reports from Spain linked an increase in migration from other countries to an increase in autochthonous leprosy (7). The number of international migrants in North America increased from 27.6 million persons in 1990 to 58.7 million in 2020 (8), so a link to migration may account for the increase in incidence of leprosy in historically nonendemic areas. Further, reports from the Centers for Disease Control and Prevention show that, 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 (Appendix Figure) (9). This information suggests that leprosy has become an endemic disease process in Florida, warranting further research into other methods of autochthonous transmission.
— Grace Chong 🇺🇸 (@gc22gc) July 29, 2023
From The Epoch Times:
The CDC is warning doctors to investigate leprosy when examining individuals who have traveled to Florida or elsewhere in the Southeastern United States.
The Florida Department of Health requires medical practitioners to report leprosy in Florida by the next business day, according to the CDC. It noted that contact tracing is also critical so as to identify sources and reduce its transmission.
“In our case, contact tracing was done by the National Hansen’s Disease Program and revealed no associated risk factors, including travel, zoonotic exposure, occupational association, or personal contacts,” it stated. “The absence of traditional risk factors in many recent cases of leprosy in Florida … who spend a great deal of time outdoors, supports the investigation into environmental reservoirs as a potential source of transmission.”
The report comes weeks after the CDC issued an alert about locally transmitted malaria in Florida. Malaria is caused by the Plasmodium parasite and is spread via certain types of mosquitoes.
“It is not known exactly how Hansen’s disease spreads between people. Scientists currently think it may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria,” the agency stated. “Prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease.”