Cases of leprosy are on the rise in Florida, particularly in Central Florida, according to a recent research letter shared by the Centers for Disease Control and Prevention (CDC). The authors of the letter warn that leprosy has become endemic in the southeastern United States, with an increased incidence of cases lacking traditional risk factors. The number of reported leprosy cases in southeastern states has more than doubled in the last decade.

The letter highlights the need to consider travel to Florida when conducting leprosy contact tracing in any state. It also notes that leprosy cases in the United States previously affected individuals who had immigrated from leprosy-endemic areas, but now a significant percentage of new cases appear to have locally acquired the disease. Many cases in central Florida show no clear evidence of zoonotic exposure or traditionally known risk factors.

In one case, a 54-year-old man in central Florida was diagnosed with lepromatous leprosy in 2022. The man, a lifelong resident of the area and a landscaper, sought treatment for a painful and progressive rash. He denied any recent travel, exposure to armadillos, contact with immigrants from leprosy-endemic countries, or connections with known leprosy patients.

While some cases in the South have been linked to zoonotic transmission from nine-banded armadillos, many cases in eastern United States, including Georgia and central Florida, lack zoonotic exposure. The authors suggest a potential link to international migration as a source of autochthonous transmission, although rates of new diagnoses in people born outside the U.S. have been declining since 2002.

The authors of the letter call for further research into other methods of autochthonous transmission and the investigation of environmental reservoirs as potential sources of leprosy transmission in Florida. They emphasize that travel to the area, even without other risk factors, should prompt consideration of leprosy in the appropriate clinical context.

Leprosy, also known as Hansen's disease, is a chronic infectious disease that primarily affects the skin and peripheral nervous system. It has been historically uncommon in the United States, but the incidence has been gradually increasing in recent years. The disease is curable with antibiotics and is primarily spread through prolonged person-to-person contact or respiratory droplets.