Don’t Panic, Leprosy May Be Endemic in Florida Now

Leprosy is probably best known as the disease that made people “unclean” in biblical times, so it might come as a surprise that the CDC released a report this week that says the disease could be spreading unnoticed in Florida. But don’t run in terror, because we’re going to discuss what the report means, and dispel a lot of leprosy myths along the way.

What is leprosy?

Leprosy, better known in modern times as Hansen’s disease , is a bacterial infection caused by the microbe Mycobacterium leprae . Being bacterial, it can be treated with antibiotics – so this is not a death sentence and not a reason to exclude a person from society.

Bacteria grow slowly, and it can take decades before an infected person begins to show signs of illness. The bacteria infect the eyes, nose, skin and nerves. The resulting nerve damage means that people with Hansen’s disease can lose sensation, especially in their fingers and toes. Hence the myth that leprosy causes fingers or other appendages to “fall off”. What actually happens is that small injuries can build up and the body can absorb the damaged tissue. Over time, this can lead to the disappearance or shortening of the fingers ( CDC has a photo here ).

How contagious is leprosy?

Not much, it turns out. About 95% of people have natural immunity to this disease. Even for the 5% of unfortunate people, it can take years and sometimes decades of close contact with an infected person before someone becomes infected. The CDC says that transmission is thought to occur through droplets (such as coughs and sneezes of an untreated infected person) for “many months”.

In addition to humans, we also know that armadillos can get leprosy. So it’s possible to get Hansen’s disease from an armadillo, but again, that’s unlikely. “Most people who come into contact with armadillos are unlikely to contract Hansen’s disease,” the CDC assures us.

So why do we think of illness as something contagious and scary? Probably because of the biblical descriptions of skin diseases that make a person “unclean”. But the word that came to be translated as “leprosy” could not refer to Hansen’s illness; the symptoms do not match, writes dermatologist David Kaplan in an article comparing biblical descriptions with known symptoms of leprosy . (In the scriptures, leprosy is also described as a phenomenon that can be seen on clothes or on the walls of houses; here the word probably described something like mold or fungus.)

The Leprosy Foundation of Nepal notes that biblical and historical references, and the way we talk about them, contribute to the modern stigmatization of people with Hansen’s disease. The same thing happened in medieval Europe, and even in the modern US — Hawaiians with the disease were exiled to the Molokai leper colony as early as the 1960s , long after a cure was found.

Learn about the actual history of people with leprosy

• Colony: The Heartbreaking True Story of the Molokai Exiles by John Tyman
• Leprosy in Medieval England by Carol Rockliffe
• “The Carville Cure: Leprosy, Stigma, and the Fight for Justice ” by Pam Fessler (about another US facility for people with Hansen’s disease, this time in Louisiana)

What’s going on with leprosy in Florida?

The CDC’s report is to inform health officials that people in Florida are contracting Hansen’s disease, but it’s not clear exactly how they became infected. The report focuses on one case, a 54-year-old landscape designer. This person had no known close contact with people who were diagnosed with the disease, nor with people who traveled from areas where the disease is more common. He himself did not travel to any of these areas and did not spend time with the armadillos. So… he must have gotten it somewhere else .

This is the part that concerns public health officials: if you don’t know where someone got the disease, the disease probably circulated undetected for a while. It is, to use the technical term, endemic. Or, to put it another way: it might just be leprosy in Florida right now. The CDC suggests that in addition to asking patients if they have recently been to India, Brazil, Indonesia and other leprosy-endemic areas, doctors may need to start asking people if they have been to central Florida.

What happens if someone gets leprosy?

Fortunately, Hansen’s disease is treatable. It’s not as easy as taking pills out of a z-pack like a normal infection, but antibiotic treatment is available. This is usually a combination of two or three antibiotics that you will take for a year or more . You stop being contagious after the first few doses of the antibiotic.

Antibiotic treatment may prevent the progression of the disease, but does not reverse the damage already done. That’s why it’s worth getting tested if you have symptoms of Hansen’s disease, such as areas of skin that look different than your normal skin tone (lighter, darker, or thicker) that may feel numb. The CDC has a more detailed list of signs and symptoms here .

However, this disease is still very rare (even in Florida) and difficult to infect. In most years, fewer than 200 cases of Hansen’s disease have been reported in the entire US. In Florida, doctors are required to report cases so they can be counted and so people they have been in contact with can be notified and potentially cured.