Floridians at Risk: The Alarming Potential of Endemic Leprosy

Leprosy could become endemic to Florida. Here is what to know.

Rising cases of leprosy in the Southeast U.S.

In recent years, there has been a concerning increase in leprosy cases in the Southeast United States, particularly in central Florida. The Centers for Disease Control and Prevention (CDC) have published a research letter highlighting this trend and warning that leprosy could become endemic to the region. This means that the disease could establish a constant presence in the population, leading to ongoing transmission and an increased burden of cases.

According to the CDC, the number of reported leprosy cases across the country has doubled over the past decade. In 2020 alone, there were 159 new cases reported, with nearly 70% of them occurring in Florida, California, Louisiana, Hawaii, New York, and Texas. While leprosy has historically been uncommon in the U.S., with most cases involving immigrants from leprosy-endemic areas, the new report reveals that around 34% of cases between 2015 and 2020 were locally acquired.

The Florida leprosy outbreak

The report suggests that Florida may represent an endemic location for leprosy. Central Florida in particular has seen a high concentration of cases, accounting for nearly 20% of the total number of cases reported nationally. Most cases in Florida were reported in central Florida, with 80% of them occurring in this area. What is particularly concerning is that several new-case patients in central Florida showed no clear evidence of zoonotic exposure or traditionally known risk factors for leprosy.

Understanding leprosy

Leprosy, scientifically known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin and peripheral nervous system and can sometimes infect other parts of the body, such as the lining in the airway passages of the nose. The disease has been around for thousands of years, with the earliest known records appearing in China and India around 600 B.C.

Contrary to its biblical description, leprosy is not easily spread, and about 95% of people have natural protective immunity. However, going without treatment can result in permanent nerve damage. The bacteria that causes leprosy is slow-growing, and it can take years for signs and symptoms to develop after exposure. Once the infection becomes evident, it can take anywhere between two weeks to months for it to progress.

Treatment and prevention

The good news is that leprosy is a curable disease. Patients with leprosy are typically prescribed antibiotics, which render them non-infectious after a few days of treatment. However, due to the slow growth of the bacteria, the treatment lasts between one to two years.

Early signs of leprosy include pale or slightly red areas or rash on the body, often accompanied by a loss of sensation in the affected area. Other symptoms may include a loss of feeling in the hands and feet, dry and stiff skin, thinning of the eyebrows and eyelashes, and sometimes nasal congestion. If left untreated, leprosy can result in weakness in the muscles of the hands and feet.

Transmission and precautions

Leprosy is contagious and can be transmitted by untreated individuals infected with the disease, although most people have natural protective immunity. It is advisable to avoid exposure to infected individuals, especially within families where protective immunity may be genetic. The exact mode of transmission is not fully understood due to the rarity of the disease, but it is not spread through casual contact, sexual transmission, or from mother to fetus.

Interestingly, a genetic study conducted at the National Hansen’s Disease Program found that armadillos in the southern U.S. carry a high number of M. leprae, the bacteria that causes leprosy. While transmission from animals to humans is low, it is still advisable to take proper precautions around armadillos.

Editorial and advice

The rising cases of leprosy, particularly in Florida, should serve as a wake-up call for public health officials and medical professionals. It is crucial to understand the factors contributing to the increase in cases and take proactive measures to prevent the disease from becoming endemic.

Local physicians play a vital role in identifying and reporting leprosy cases and should be more vigilant in considering the disease in the appropriate clinical context, even in the absence of traditional risk factors. Their efforts in contact tracing and reporting cases will be crucial in reducing the spread of the disease and informing further research on transmission routes.

The CDC and other relevant authorities should allocate adequate resources to study leprosy transmission more comprehensively, with a particular focus on understanding the dynamics of transmission within communities and regions. This research will help develop targeted interventions and prevention strategies to control the disease.

Public awareness campaigns should be conducted to educate the general population about leprosy, its signs and symptoms, and the importance of early detection and treatment. Disseminating accurate information about leprosy will help reduce stigma and ensure that individuals seek medical care promptly.

Efforts should also be made to address the underlying social determinants of leprosy, such as poverty and lack of access to healthcare. By improving socio-economic conditions and ensuring equitable access to healthcare services, we can reduce the overall burden of leprosy and enhance public health in affected communities.

In conclusion, the increasing cases of leprosy in Florida and other parts of the U.S. are a concerning development. However, with diligent surveillance, robust research, and comprehensive public health interventions, it is possible to control the spread of the disease and prevent it from becoming endemic. The time to act is now.