Cases of leprosy lacking traditional risk factors have escalated in Florida in recent years and health officials have expressed concern that the infectious disease may be endemic to the state.
From 2015 to 2020, about 20% of the reported U.S. cases were in Florida, and 81% of those cases in Central Florida, according to a research letter released by the Centers for Disease Control and Prevention.
"Leprosy has been historically uncommon in the United States; incidence peaked around 1983, and a drastic reduction in the annual number of documented cases occurred from the 1980s through 2000," the letter's authors wrote. "However, since then, reports demonstrate a gradual increase in the incidence of leprosy in the United States. The number of reported cases has more than doubled in the Southeastern states over the last decade."
The chronic infectious disease, also known as Hansen's disease, is caused by the bacterium Mycobacterium leprae and primarily affects the skin and peripheral nervous system, according to the Florida Department of Health website.
The CDC said 159 cases were reported in the U.S. in 2020, with about 70% in Florida, California, Louisiana, Hawaii, New York and Texas. Approximately 34% of the U.S. cases from 2015 and 2020 were locally acquired, as opposed to travel-related, the researchers said.
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Health officials said several cases in Central Florida demonstrated no clear evidence of zoonotic exposure or traditionally known risk factors.
The report cited a case of the more serious lepromatous leprosy in a 54-year-old landscaper without risk factors for known transmission routes.
The man, a lifelong Central Florida resident, sought treatment at a dermatology clinic for a painful and progressively worsening rash. The rash initially appeared on his hands and feet and later spread to his trunk and face. He denied any travel or exposure to known leprosy sources.
After biopsies confirmed he had Hansen disease, he was prescribed a triple therapy treatment plan under the direction of the National Hansen’s Disease Program by an infectious disease specialist.
Most people infected do not develop leprosy, experts said. Prolonged person-to-person contact through respiratory droplets is the most widely recognized route of transmission. Also, the handling of certain infected armadillos has been linked to some leprosy cases in the country.
Collaborations between the CDC and local health departments have been initiated to improve surveillance and promptly identify cases. Public awareness campaigns are also underway to educate residents about symptoms, transmission routes and available treatment options.
Leprosy affects the skin, eyes, mucous membranes and nerves and causes disfiguring sores, skin lesions with loss of sensation and other nerve damage.
The disease is treatable and even curable, according to the state health department. Early diagnosis and treatment remain the most effective strategies in curtailing the disease's spread and improving patient outcomes, officials said.
The CDC is informing doctors to consider leprosy when examining patients who have traveled to Florida or the Southeast. The agency is also recommending that travel to Florida be considered when conducting leprosy contact tracing in any state.
Hansen’s disease has been reported in Florida since 1921, according to the state health department. Up until 1975, an average of four cases were reported each year. Another 82 cases were reported from 1976 to 1995.
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