Hansen Disease, United States | CDC EID

EID Journal Home > Volume 17, Number 7–July 2011
Volume 17, Number 7–July 2011
Research
Hansen Disease among Micronesian and Marshallese Persons Living in the United States
Patricia Woodall, David Scollard, and Latha RajanAuthor affiliations: Tulane University, New Orleans, Lousiana, USA (P. Woodall, L. Rajan); and National Hansen's Disease Program, Baton Rouge, Louisiana, USA (D. Scollard)

Suggested citation for this article

Abstract
An increasing proportion of Hansen disease cases in the United States occurs among migrants from the Micronesian region, where leprosy prevalence is high. We abstracted surveillance and clinical records of the National Hansen's Disease Program to determine geographic, demographic, and clinical patterns. Since 2004, 13% of US cases have occurred in this migrant population. Although Hawaii reported the most cases, reports have increased in the central and southern states. Multibacillary disease in men predominates on the US mainland. Of 49 patients for whom clinical data were available, 37 (75%) had leprosy reaction, neuropathy, or other complications; 17 (37%) of 46 completed treatment. Comparison of data from the US mainland with Hawaii and country-of-origin suggests under-detection of cases in pediatric and female patients and with paucibacillary disease in the United States. Increased case finding and management, and avoidance of leprosy-labeled stigma, is needed for this population.

At 11 cases per 10,000 population and 8 per 10,000, respectively, in 2007, the small Pacific Island nations of the Republic of the Marshall Islands and the Federated States of Micronesia have the highest prevalence of Hansen disease (HD), i.e., leprosy, in the world and have made little progress in the past decade toward the World Health Organization (WHO) leprosy elimination target of <1 per 10,000 (1,2). During the first quarter of 2010, 33 new cases were detected among the 54,000 residents of the Marshall Islands (3).

HD has been present in the United States for more than a century; the number of patients has remained relatively constant at 150–200 per year (4).The US National Hansen's Disease Program (NHDP) has noted an increasing number of cases among US-resident Marshall Islanders and Micronesians, including several persons with advanced disease. In 1996, the Hawaii HD program reported a cluster involving 16 (5%) of 321 persons screened from a Marshallese migrant community (5,6). In 2002, the US Army noted 3 cases in 1 month in soldiers from this region (7). The recent reporting of multiple cases among the Marshallese community in northwestern Arkansas (Centers for Disease Control and Prevention, unpub. data, 2006) has drawn attention in a region unaccustomed to leprosy, with its stigmatizing historical connotations (8,9).

Under the terms of the Compacts of Free Association (the legal documents governing the relationships between the United States, Federated States of Micronesia, and the Republic of the Marshall Islands), citizens of this former US Trust Territory of the Pacific Islands are not subject to usual immigration requirements but may freely enter, reside, and work in the United States for as long as they wish. They hold a unique legal status, are not classified as immigrants, and maintain their country-of-origin citizenship. Transportation data indicate net emigration of an average of 952 Marshallese and 1,443 Micronesians annually, with a total of 38,325 emigrants for 1991–2006; almost all of these persons are thought to have immigrated to the United States and its territories (10). The actual distribution of this population within the United States is unknown; a specific category included in the 2010 US Census should provide this information. As economic and climatologic pressure drive increasing emigration from this HD-endemic former US Trust Territory, the US HD case load is expected to continue to increase, worsening health disparities and requiring increased program and local resources, although this increased case load is unlikely to create a public health threat of transmission to the general population. Cultural and socioeconomic issues may affect case detection and long-term disease management in this population, including adherence to and completion of therapy.

The objective of this report is to describe, on the basis of secondary analysis of existing program data, the epidemiology of HD among Marshallese and Micronesian persons residing in the United States. The intent is to assist in providing resources to address a health disparity that disproportionately affects a group of a particular national origin, while at the same time avoiding worsening of ethnic and disease-related stigma.

full-text:
Hansen Disease, United States CDC EID


Suggested Citation for this Article

Woodall P, Scollard D, Rajan L. Hansen disease among Micronesian and Marshallese persons living in the United States. Emerg Infect Dis [serial on the Internet] 2011 Jul [date cited]. http://www.cdc.gov/EID/content/17/7/1202.htm

DOI: 10.3201/eid1707.102036

Comments to the Authors


Please use the form below to submit correspondence to the authors or contact them at the following address: David Scollard, National Hansen's Disease Programs, Clinical Branch, 1770 Physician Park Dr, Baton Rouge, LA 70816, USA; email: dscollard@hrsa.gov