Has the CDC issued a travel advisory for Florida?

Reports are circulating on the internet that there is a CDC travel warning for Florida due to leprosy.

The media reports that the Centers for Disease Control (CDC) has issued a travel advisory for Florida They are not, in short, true.

This is where the buzz started: a recent CDC Letter of Inquiry noted that Central Florida has reported an increase in cases of leprosy or Hansen’s disease in Central Florida. In the United States, where leprosy is rare, medical providers typically note that patients presenting with symptoms of the disease have traveled to places where leprosy is known to be endemic, have spent a significant amount of time with populations that have emigrated from places where leprosy is known to be endemic or who have come into contact with the small subset of animals known to carry and transmit the disease.

There is no travel warning in the letter of inquiry. There is a travel mention in summary, which reads: “Florida, USA, has witnessed a higher incidence of leprosy cases lacking traditional risk factors. These trends, in addition to declining diagnoses in foreign-born people, add to the evidence that leprosy has become endemic in the southeastern United States. Travel to Florida should be considered when conducting leprosy contact tracing in any state.”

The last sentence means that medical providers in other states should ask if their patients have recently visited Florida if they exhibit symptoms of leprosy, to help trace the source or point of transmission. The letter of inquiry indicates that there is mounting evidence that leprosy is endemic in Florida, but does not discourage travel to the state.

The CDC letter goes on to note that the absence of what are traditionally considered risk factors for leprosy transmission in Florida patients indicates that environmental factors may be contributing to transmissions in the state. In plain language, that means the disease can be transmitted in Florida:and the root cause of the transmission cannot be traced to another location.

The only other mention of travel in the letter reads: “Travel to this area, even in the absence of other risk factors, should lead to consideration of leprosy in the appropriate clinical context.” This means that medical providers can begin to consider travel to Central Florida as a risk factor for leprosy in a similar way to existing risk factors.

The letter also appears to question whether immigration to the United States continues to be a major factor in the transmission of the disease, noting that while immigration has increased significantly since 1990, the incidence of leprosy in immigrant populations from areas endemic rates of leprosy have actually decreased, suggesting that other risk factors may be more prominent.

Leprosy is one of the oldest known diseases to affect humans. A bacterial infection that is spread by prolonged exposure to contaminated droplets from coughs or sneezes, it can be a slow-growing disease, sometimes spread years or even decades before the patient begins to show symptoms.

The disease presents as skin lesions, nodules, or thick, dry skin in its early stages; in their most extreme form, they can give the skin the appearance of “melting”. In later stages, the bacteria cause nerve damage, loss of sensation in the extremities, muscle weakness, and bone resorption, leading to palpitations in the hands and feet.

There was no cure for leprosy until antibiotics were discovered in the mid-20th century. Because the disease was previously incurable, patients were often quarantined for the rest of their lives in dedicated “leper colonies”. One of the most famous was on the remote Kalaupapa Peninsula on the Hawaiian island of Molokai. A Belgian priest known as Father Damien lived in the colony, caring for his inmates until his own death from illness in 1889. He was canonized as Saint Damien of Molokai in 2009.

Today, infections are stopped with a cocktail of antibiotics.

Only 159 cases of leprosy were reported in the United States in 2020, the latest year for which data is available. Central Florida accounted for nearly a fifth of all cases of the disease reported nationally.