Hansen disease among Micronesian and Marshallese persons living in the United States

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.

Figure 1

New patients of Marshallese or Micronesian origin with Hansen disease, compared with total new US patients with Hansen disease, 2000–2008. White bars, total US patients; black bars, total patients of Marshallese or Micronesian origin; red line, patients of Marshallese or Micronesian origin as percentage of total US patients.

Figure 2

Hansen disease in patients of Marshallese or Micronesian origin, US mainland, by year reported, January 1990–October 2009.

Figure 3

States reporting Hansen disease in patients of Marshallese or Micronesian origin, US mainland, January 1990–October 2009. The number of cases reported from each state is indicated.

Figure 4

Hansen disease prevalence as cases per 10,000 population, Federated States of Micronesia (FSM) and Republic of the Marshall Islands (RMI) 1991–2005 (1,2,13).

Figure 5

Hansen disease cases per 100,000 population, Federated States of Micronesia (FSM) and Republic of the Marshall Islands (RMI) (1,2,13), 1990–2008.

Figure 6

Estimated Hansen disease cases per 100,000 population, Arkansas Marshallese and Republic of the Marshall Islands (RMI), 2000–2009. RMI rates from World Health Organization reports (1,2,13); Arkansas cases from National Hansen’s Disease Program records. Arkansas Marshallese population (denominator) derived from US Census estimates (15,17).