Hawaii still records new cases of Hansen’s disease every year, but the numbers have remained steady, according to health officials.
The state has been tracking new cases since 1982, according to Lori Anne Ching, program manager of the state Hansen’s Disease Community Program, with anywhere from 10 to 25 per year. So far, 12 new cases have been reported this year.
“Our program is part of the Department of Health, so we are the ones that track the cases and coordinate care to make sure everybody who has Hansen’s disease has access to care,” said Ching, a registered nurse. “It’s treatable and curable, so it’s mainstreamed in the health care system.”
Only eight new cases were added to the Hawaii Hansen’s Disease Registry in 2022, seven in 2021 and 15 in 2020, with dips likely due to lower referrals during the pandemic. In 2018 there were 17 new cases added to the registry.
Hansen’s disease — also known as leprosy — was feared in the past, but remains very rare in the United States, according to the Centers for Disease Control and Prevention, with fewer than 200 cases reported per year.
Transmission is usually through prolonged, close contact with someone with untreated leprosy or possibly, armadillos.
A new study published in CDC’s “Emerging Infectious Diseases” noted a rise in leprosy cases in Florida without traditional risk factors.
A 54-year-old man with no history of travel outside Florida or other known risk factors was diagnosed with leprosy, researchers said, presenting evidence it might become endemic in the southeastern United States.
He did not have connections with anyone known to have leprosy or prolonged contact with others from countries where leprosy is endemic, nor any exposure to armadillos. He worked in landscaping.
“Travel to Florida should be considered when conducting leprosy contact tracing in any state,” the authors say in the study’s abstract.
Hansen’s disease is caused by slow-growing bacteria called Mycobacterium leprae, which can affect the nerves, skin, eyes and lining of the nose. Symptoms include discolored patches of skin that may be numb, skin growths or painless ulcers on the soles of feet.
It does not spread easily from person to person or through casual contact such as talking or shaking hands. With early diagnosis and treatment, it can be cured.
Ching recommends anyone, particularly someone who has lived outside of the United States for six months or more, to see a dermatologist for a skin rash that does not go away, especially if there is a lack of sensation.
The program will assist those who seek screening for Hansen’s disease, and help cover costs to ease any fear of stigma.
The program currently is managing about 260 active cases, with about a third on medication and others being monitored. Getting timely treatment is important, she said.
“Sometimes if they were late to get diagnosed — because it does mimic a lot of skin conditions, then they might sustain some permanent nerve damage which is what we’re trying to prevent,” she said.
Baron Chan, chief of the Hansen’s Disease Branch at DOH, said the latest development in Florida is not a major cause for concern.
About 95% of the general population has immunity to Hansen’s disease, he noted, so most will not get it even if exposed.
For those susceptible, contracting the disease is usually the result of prolonged, close contact with someone with untreated Hansen’s disease. Even then, it might be 10 to 20 years before symptoms develop, one of the disease’s challenges.
“You take a course of antibiotics — it is for two years at minimum, usually — but it’s very slow developing,” he said. “So it’s not like COVID. It won’t just spread like wildfire, and you won’t know who on the street has it.”
The National Hansen’s Disease Program said 159 new cases were reported in the United States in 2020, based on the most recent data available. Most new cases were reported in Florida, California, Louisiana, Hawaii, New York, Oregon and Texas.
Hawaii is likely among these states, said Ching, because it is a port city with a diverse population and many travelers.
In the 1800s in Hawaii, the introduction of Hansen’s disease was deadly to Native Hawaiians never exposed to it, prompting King Kamehameha V to banish all afflicted to Kalaupapa on Molokai’s north shore.
More than 8,000 patients died at Kalaupapa, now a national historical park.
When the law exiling patients in 1969 was repealed, roughly half of the settlement opted to stay. Eight registered patients remain today under the care of the state, according to Chan. They range in ages from 82 to 99 years old.
