Rising leprosy cases in Central Florida put Puerto Rico's doctors on alert

An unusual rise in leprosy cases in Central Florida has infectious disease doctors in Puerto Rico watching their patients closely, especially those who travel to or spend part of the year in that state. Dr. Miguel Colón, an infectious disease physician, warned this week that the pattern seen in Central Florida is an unusual event, because that region had never historically been associated with Hansen’s disease, and that the constant back and forth of Puerto Ricans between the island and that state calls for heightened vigilance, though he clarified that in Puerto Rico the situation remains stable, with only one or two active cases under treatment at any given time¹.

Leprosy, also known as Hansen’s disease, is an infection caused by the bacterium Mycobacterium leprae that mainly attacks the skin and peripheral nerves. Contrary to popular myth, it is not spread by a handshake or sharing a meal, but through respiratory droplets after close, prolonged contact with an untreated person; once treatment begins, the patient is no longer contagious³.

In Puerto Rico the disease has a particular history. Colón recalled that decades ago, northwestern municipalities such as Arecibo, Camuy, Quebradillas, Hatillo and Florida accounted for a good share of the cases diagnosed on the island, and that today the Río Piedras Medical Center still runs a clinic dedicated exclusively to managing these patients. What worries doctors now is that Florida had never been linked to leprosy before, and the fact that the central part of that state is reporting an increase is an atypical signal the scientific community is following closely¹. With hundreds of thousands of Puerto Ricans living in Central Florida or traveling between both territories for work, family or vacation, any epidemiological shift there can eventually knock on a doctor’s door on the island.

Globally, the World Health Organization reports about 200,000 new leprosy cases a year across more than 120 countries, with Brazil, India and Indonesia leading the count³. In the Americas, the Pan American Health Organization tallied 24,773 new cases in 2023, of which Brazil accounted for more than 90 percent; Venezuela, Colombia, Paraguay and the Dominican Republic also reported dozens of cases that year⁴. The region has set an elimination goal for 2030, and this year Chile became the first country certified by the WHO for eliminating leprosy as a public health problem⁴.

On the clinical presentation, Colón explained that the most common way the disease shows up today is through whitish skin patches that lose all sensation, resembling vitiligo at first glance, but that do not react to pain or temperature¹. A clinical case documented recently by the journal Medicina y Salud Pública describes a 45-year-old farmer who developed hypopigmented patches on his arms and back over 18 months, with tingling and progressive weakness in his hands, until a biopsy confirmed multibacillary leprosy; after twelve months of treatment, he recovered well².

What it means for you

If you travel to Florida frequently, have family there, or spend part of the year in that state, this is not a reason to panic, but it is a reason to pay attention. Leprosy remains a rare, slow-progressing disease with an incubation period that can span years, so there is no risk of a sudden outbreak on the island. What matters is that if you notice a skin patch that will not go away, that loses sensation to touch, heat or pain, and that does not respond to common treatments for fungus or allergies, do not ignore it or treat it as a cosmetic issue. Tell your doctor if you have traveled to or lived in Florida, because that detail can speed up the right diagnosis¹.

How to do it / Checklist

1. Check your skin periodically, especially arms, back, legs and face, looking for whitish or reddish patches that do not itch or hurt.
2. Do a sensitivity test at home: touch the patch with cotton or warm and cold water; if you feel no difference, write it down.
3. Tell your primary doctor if you have a history of travel to or residence in Florida, especially the central part of the state.
4. Ask for a referral to infectious disease or dermatology if the lesion lasts more than a few weeks without a clear explanation.
5. If you are diagnosed with leprosy, complete the treatment: the combination of dapsone, rifampin and clofazimine cures the disease, but it takes six to twelve months depending on severity³.
6. Tell your doctor if a close family member has had leprosy, since prolonged household contact is the main known risk factor.

What’s next

Colón and other infectious disease doctors on the island will keep a close eye on the data coming out of Florida in the coming weeks, since there is still no clear explanation for why that region, with no prior history, began reporting more diagnoses. Meanwhile, the clinic at Río Piedras Medical Center remains the island’s reference point for any suspected case, and the Department of Health is expected to keep epidemiological surveillance active given the volume of air and family traffic between both territories. The regional goal of eliminating leprosy as a public health problem by 2030 still stands, and Chile already proved this year that it is achievable; Puerto Rico, with its specialized clinic and its low number of active cases, is already ahead on that path⁴.

Sources: ¹ Medicina y Salud Pública — https://medicinaysaludpublica.com/noticias/infectologia/impacto-en-puerto-rico-de-los-casos-diagnosticados-de-lepra-en-florida/30674 ² Medicina y Salud Pública — https://medicinaysaludpublica.com/noticias/casos-clinicos/manchas-con-perdida-de-sensibilidad-y-debilidad-en-las-manos-asi-se-presento-un-caso-de-lepra/30661 ³ World Health Organization — https://www.who.int/news-room/fact-sheets/detail/leprosy ⁴ Pan American Health Organization — https://www.paho.org/en/topics/leprosy-hansen-disease