Important information about the Florida Leprosy Outbreak

Central Florida is experiencing a leprosy outbreak, according to a new report from the Centers for Disease Control and Prevention (CDC).

While the infection may seem to have more biblical connotation than real-time relevance, Central Florida is experiencing a bit of a leprosy hotbed. The area now makes up nearly one in five leprosy cases detected in the US.

Historically, Florida has not been known as a leprosy hotspot. But the data surrounding this outbreak features a variety of patients who've come down with leprosy without leaving the state of Florida.

This suggests that the illness is now endemic in the state.

The letter also notes that other Florida residents have become infected with leprosy, which suggests that the illness is now endemic in the state. Endemic simply means a disease or infection is consistently present in a certain region.

The CDC has stressed that no travel warning has been issued for the state of Florida. While there are certain leprosy factors all individuals may want to be aware of, visiting the area does not imply contamination.

Below, experts break down how leprosy outbreaks occur, how they can be contained, and what you need to know if you believe you've been infected with leprosy.

While it may sound like an ancient disease, leprosy cases have been happening in the United States for years.

“In the 1980s, case numbers were in the 400s each year,” report co-author Rajiv Nathoo, MD, a dermatologist and complex clinic director for Advanced Dermatology and Cosmetic Surgery Clinics in Orlando, told Health. “Now, it’s about 150 a year.”

Case counts vary in the US each year, reaching 216 in 2019 and dropping to 159 in 2020.

Leprosy, also known as Hansen’s disease, can spread from person to person, but it requires prolonged contact with someone who is infected.

“This is not something you get from shaking hands,” said Anne W. Rimoin, PhD, MPH, a professor of epidemiology at the UCLA Jonathan and Karin Fielding School of Public Health.

Most leprosy cases in the US have been in people who recently traveled outside the country where leprosy cases are more common, or those who had direct contact with nine-banded armadillos, animals that are known carriers of the disease.

“But there’s a subset of folks—especially here in Florida—that haven’t left Florida,” Nathoo said. “That’s one of the reasons why we wanted to highlight our case and discuss the local cases.”

While it's not entirely clear why leprosy has become embedded in central Florida, there are some theories, report co-author and dermatologist Charles Dunn, MD, told Health.

“The most common method of transmission is person to person, but that typically requires prolonged, intense close contact,” said Dunn, who serves as the chief resident at Kansas City University–Graduate Medical Education/Advanced Dermatology and Cosmetic Surgery Consortium in Orlando.

He noted that about 75% of new cases of leprosy in Florida have no known cause.

“Some people have direct contact with armadillos and that makes sense,” he said. “For the others, the question is whether there are environmental sources of leprosy that we haven’t seen, like soil or plants from areas that armadillos have inhabited.”

Or, perhaps there's another animal that's spreading leprosy in the US that researchers just haven't identified yet, Dunn said.

As of now, there are no major concerns about leprosy spreading outside of central Florida, although experts say it can happen.

“We may have many more cases—you just don’t know,” Rimoin said. “If you don’t look for it, you don’t know it’s there.”

She noted the importance of public health surveillance and being aware of what’s happening in the community around you.

While, hypothetically, leprosy spreading outside the state could happen, it's unlikely to.

“The numbers of people infected are so, so small, even with the new cases in Florida,” Carrie Kovarik, MD, a professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, told Health.

“So far, we’re not seeing these in vacation travelers to central Florida and I don’t even think people in Florida need to panic,' she said.

Stanley H. Weiss, M.D., an epidemiologist and professor at Rutgers New Jersey Medical School and the Department of Biostatistics & Epidemiology at the Rutgers School of Public Health, told Health there's no need to avoid traveling to Central Florida over leprosy fears.

“People should not change their travel plans,” he said. “This is still very rare within the US.”

If left untreated, leprosy can lead to paralysis, chronic ulcers on the bottoms of the feet, blindness, and nose disfigurement.

Leprosy can be “difficult to diagnose,” particularly in its early stages, Kovarik said, pointing out that skin rashes are common.

Nathoo explained that the telltale sign of leprosy rashes is usually a lack of feeling on the affected patches or an unusual sensation over them.  

If you develop symptoms of leprosy, experts emphasize it’s important to see a doctor as soon as possible.

“People get worried when they hear about a disease that’s known from biblical times but, at that time, little was known about transmission and there was no way of treating it,” Weiss said. “Today, we have drugs that are usually very effective in treating leprosy.”

Leprosy is diagnosed via a skin biopsy, and treatment usually involves a combination of two or three antibiotics used at the same time—dapsone with rifampicin, and sometimes clofazimine.

If left untreated, leprosy can cause serious complications, including blindness, paralysis, and deformities, so it’s important to seek care if you suspect that you have it, Kovarik said.

But, again, leprosy diagnoses are very unusual in the US.

“This is a very rare disease,” Kovarik said. “There is good treatment if someone were to get this infection. It’s curable.”