Mentioned 68 times in the Bible, according to some reports, the disease that scientists now say has become endemic in Florida was once viewed in those times as more than just a condition disfiguring the body, but one representing divine retribution. Those who had the disease were excluded from society—kicked out of their homes and forced to live with others suffering the same.
Thankfully, no one is treated that way in modern times, but to hear of this biblical disease not only present in the U.S. but so widespread in a southern state is shocking.
According to a new research letter from the Centers for Disease Control and Prevention, Central Florida accounted for 81 percent of reported cases of Hansen’s disease, or leprosy, and nearly a fifth of all cases reported across the country.
"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 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."
In 2020, 159 new cases were reported in the U.S., according to the National Hansen’s Disease Program, with Florida being among the top reporting states.
“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,” the letter continues. “Several cases in central Florida demonstrate no clear evidence of zoonotic exposure or traditionally known risk factors.”
While armadillos are known to carry the disease and have been blamed for spreading infections in the past, the authors also point to other theories like international migration while emphasizing that in certain parts of the country, it has become an endemic disease, which means it is “something that is circulating and is present at all times," Dr. Nicole Iovine, chief hospital epidemiologist and an infectious disease physician at the University of Florida, told WESH 2.
Transmission of leprosy has not been fully elucidated. Prolonged person-to-person contact through respiratory droplets is the most widely recognized route of transmission. 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. A recent systematic review analyzing studies conducted during 1945–2019 supports an increasing role of anthroponotic and zoonotic transmission of leprosy. 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.
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. The number of international migrants in North America increased from 27.6 million persons in 1990 to 58.7 million in 2020, 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). This information suggests that leprosy has become an endemic disease process in Florida, warranting further research into other methods of autochthonous transmission. (CDC)
About 200,000 new cases are reported worldwide each year, the World Health Organization says, with the highest concentration in Brazil, India, and Indonesia.
