Leprosy is on the rise in Florida — are Canadian travellers at risk?

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Cases of leprosy are on the rise in Florida, according to a case report from the U.S. Centers for Disease Control and Prevention (CDC).

In a research letter published in the CDC and Prevention's Emerging Infectious Diseases (EID) journal on Monday, experts warn leprosy has become endemic in Central Florida.

"Florida, USA, has witnessed an increased incidence of leprosy cases lacking traditional risk factors," the CDC stated. While leprosy has been "historically uncommon" in the United States, the "number of reported cases has more than doubled in the southeastern states over the last decade."

There is "rising evidence that leprosy has become endemic in the southeastern United States," the report continues.

A disease outbreak is considered endemic when it is consistently present but limited to a particular region.

"Travel to Florida should be considered when conducting leprosy contact tracing in any state."

Although leprosy is rare in the U.S. — 159 new cases were reported in 2020 — Florida is among the country's top reporting states. Central Florida accounts for 81 per cent of cases in the Sunshine State and one-fifth of reported cases in the whole of the U.S.

Read on to learn about the potential risks to Canadians and Canadian travellers.

What is leprosy?

Leprosy, also known as Hansen's disease, is a chronic infectious disease that affects the skin and peripheral nervous system.

Leprosy is a bacterial infection caused by Mycobacterium leprae. According to the CDC, these bacteria grow very slowly and may take up to 20 years to show signs after the initial infection.

Hansen's disease can affect the nerves, skin, eyes and the nasal lining. The bacteria attack the nerves, which can become swollen under the skin, causing affected areas to lose sensations of touch and pain. If left untreated, the nerve damage can result in paralysis of the hands and feet.

If detected early, leprosy can be cured with antibiotics.

How does leprosy spread?

Despite the fear and stigma associated with leprosy, the disease is surprisingly hard to catch.

"It's extraordinarily uncommon," according to Dr. Isaac Bogoch, an associate professor at the University of Toronto and an infectious diseases specialist at the Toronto General Hospital.

"I think what people might not appreciate is that leprosy is endemic to the southern United States. It's found in a certain kind of armadillo," he explains.

In cases of person-to-person transmission, leprosy is transmitted through droplets from the nose and mouth. However, unlike the common cold, leprosy is not easily spread.

"Prolonged, close contact over months with someone with untreated leprosy is needed to catch the disease," according to the World Health Organization. It's not spread through casual contact like shaking hands or sitting beside each other.

According to the CDC, about 95 per cent of humans are immune to the bacteria that cause leprosy.

It's an "incredibly rare infection," says Bogoch. "And it's even more incredibly rare in the United States."

For Canadians, the odds of acquiring leprosy are "minuscule," he tells Yahoo Canada.

Should Canadian travellers be worried about leprosy?

Leprosy "should not even register as a [concern]" for Canadians travelling to Florida and the Southern United States, says Bogoch. "There are about a trillion other things to be mindful of if you're travelling to Florida."

The risk to a Canadian traveller is "bordering on zero per cent," he explains.

Despite increasing cases, the CDC has not issued a travel advisory for Florida or any other state. The CDC and the National Hansen's Disease Program are monitoring for exposures of all reported cases.

How is leprosy treated?

Leprosy is "not hard to diagnose and it's not hard to treat," Bogoch tells Yahoo Canada. "Those awful images that people might conjure up of disfigurement and loss of limbs are unacceptable in 2023."

Leprosy can be cured with antibiotic treatment, and once someone starts treatment, they can no longer spread the disease to other people.

In fact, the World Health Organization has "pre-made kits with leprosy therapeutics that are distributed to countries that have a higher burden of leprosy," Bogoch says.

In an era with widely available diagnostics and therapeutics, untreated cases of leprosy are "completely unnecessary," he says. "The key is you need access to care."

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