Hansen's Disease in a Healthcare Worker—New York, 2013

BACKGROUND: Hansen’s disease (HD), also known as leprosy, occurs at a constant low level in the United States with approximately 150–200 new cases diagnosed annually. Mycobacterium leprae, the bacillus that causes HD, produces a chronic infection of the nerve, skin, and mucosal cells. Suspected to be transmitted via respiratory droplets, HD is one of the least contagious of all the communicable diseases. Greater than 95% of the human population has a natural immunity to the disease. HD is curable with a multidrug regimen, which reduces transmissibility to zero after two days of treatment. In November 2013, the New York State Department of Health (NYSDOH) investigated a single case of HD in a healthcare worker in order to determine an appropriate infection control response.

METHODS: The patient’s medical records, laboratory results, and travel history were reviewed. To assess risk of exposure, interviews were conducted with the patient’s wife and other family members. Close contacts were referred for evaluation and NYSDOH consulted with subject-matter experts regarding infection control recommendations.

RESULTS: The 28-year-old healthcare worker immigrated to the United States from an HD endemic area. Several years later, the patient presented with a single, small lesion on his extremity that was clinically and epidemiologically consistent with leprosy. Skin biopsy of the lesion was strongly suggestive of multibacillary HD. The patient was excluded from work until he completed two days of antibiotics, initially rifampin and clarithromycin. The patient’s wife, also a healthcare worker, was excluded from work until further evaluation determined that she had no signs of disease. No patient notification was conducted, as the risk of transmission was felt to be negligible within the healthcare setting.

CONCLUSIONS: Although rare, cases of HD do occur within the United States. This case illustrates that while HD is infectious, the risk of transmission with the transient interactions that occur in a hospital setting is very low. Moreover, the multidrug regimen to cure HD is highly effective and rapidly renders a patient non-infectious allowing for a quick return to work.