The Department of Public Health has confirmed a locally acquired case of Hansen’s Disease—better known as leprosy. Though often thought of as a disease of the past, it still lingers today, occurring in more than 120 countries, with around 200,000 new cases reported each year, according to the World Health Organization. 

We spoke with a local health expert about how it spreads, whether it’s curable, and ongoing efforts to eliminate it altogether.

Leprosy is one of the oldest diseases known to man—with a history dating back thousands of years:. On Tuesday, the Department of Public Health and Social Services reporting one confirmed case of locally acquired Hansen’s Disease. The agency also confirming the TB/Hansen's Disease Program are continuing case investigation and coordinating with healthcare providers to ensure early detection of possible cases.

Despite common misconceptions, Chima Mbakwem, program manager for the Guam TB/Hansen’s Disease Control Program, says it is curable and not easily spread from person to person. “95% of people who get exposed to it actually do not get infected," he explained.

“One thing about leprosy cannot be transmitted through casual contact or insect bites. You have to be in prolonged contact with somebody who has the disease. Another good thing is that it is very curable–so, when there’s early detection, when you don’t have disabilities and you’re able to catch it early, treatment is easy and quick and we have the medication here at the TB/Hansen Disease Program.”

Hansen’s Disease is caused by slow-growing bacteria—mycobacterium leprae and mycobacterium lepromatosis—which can affect the nerves, skin, eyes, and the lining of the nose. "It's actually prolonged close contact with somebody who has untreated leprosy via respiratory droplets. So, when someone has untreated leprosy coughs or sneezes, bacteria leaves the body and then someone can inhale it and get infected," Mbakwem continued.

In some cases, the loss of sensation in affected areas can increase the risk of injury. “It is not highly contagious–it’s mildly infectious," he noted. "But, the challenge is between the time of exposure and the time of symptoms showing, takes a very long time. Because if that, a lot of people do not know they have the disease. So, that’s why most time when you see people with the disease, it’s almost at a stage where they would have big patches on their skin.”

Symptoms can include discolored or light patches on the skin, painless ulcers on the soles of the feet, or enlarged nerves—often around the elbows, knees, and side of the neck. Mbakwem emphasizes early detection is crucial.

Treatment, which is offered free at the island’s TB/Hansen’s Disease Program, uses a combination of antibiotics.  Once treatment begins—which usually lasts six months to two years—patients are no longer considered infectious.

“The earlier you identify the disease, the earlier you start treatment, then transmission is cut off and every other person is safe," said Mbakwem. And while leprosy is curable, he's calling on the community to remain vigilant, as an action plan to eliminate the disease is underway.

He said, “The director actually signed the leprosy elimination roadmap for Guam–the good thing about it is that plan was actually made to getting Guam to zero leprosy. So the plan is that by the end of 2030, Guam would be free of leprosy. So, now that we’re seeing this locally acquired case, is because we’re becoming more vigilant, making sure we ensure that people get tested and get adequate treatment. With that in mind, for everyone to be rest assured that there’s a plan–and that plan is to eliminate leprosy by 2030.”

As for testing and diagnosis, Public Health notes: “Trained healthcare worker can diagnose leprosy through a clinical evaluation that looks at skin lesions, sensory loss, and thickened peripheral nerves. To confirm the diagnosis, laboratory tests such as a skin biopsy or a slit-skin smear can be performed.”