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Public Health: New leprosy case on Guam locally transmitted

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  Published in Health and Fitness on Tuesday, September 30th 2025 at 2:59 GMT by Pacific Daily News
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Guam Health Authorities Report First Locally‑Acquired Leprosy Case in Decades

In a development that has drawn the attention of both the local community and federal public‑health officials, the Guam Department of Health (GDH) confirmed on Monday that a new case of leprosy has been identified as locally transmitted. The patient, a resident of the island for more than a decade, was diagnosed with the disease after a dermatologist noted an unusual skin lesion during a routine check‑up. According to GDH, the case is the first instance of a locally acquired infection on the island in more than 30 years, raising questions about how the disease can still be present in a U.S. territory where leprosy is considered rare.

How the Case Came to Light

The patient first presented with a painless, skin‑colored patch on the dorsum of his left foot that had begun to enlarge over the previous month. The lesion eventually ulcerated and became discolored, prompting a referral to a local infectious‑disease specialist. After a skin biopsy and a battery of laboratory tests—including a PCR assay for Mycobacterium leprae—leprosy was confirmed. A review of the patient’s travel history revealed no recent trips to countries where leprosy is endemic, such as India, Brazil, or Indonesia, thereby establishing the case as locally transmitted.

Dr. Maria Sanchez, a dermatopathologist with the Guam Public Health Laboratory, explained the diagnostic process: “We look for classic histopathologic changes—such as a granulomatous infiltrate rich in macrophages—and confirm with molecular techniques. The key point here is that the bacterium has replicated locally, not imported.” She added that the laboratory’s capacity to conduct these advanced tests was a result of the CDC’s Leprosy Program partnership with Guam’s health department, a collaboration that began in the early 2000s.

Public‑Health Response

The GDH immediately launched a contact‑tracing protocol that is standard for any communicable disease of public health importance. Under the guidance of the Centers for Disease Control and Prevention (CDC), the department identified and examined approximately 35 close contacts, including household members, coworkers, and friends. All contacts underwent a skin examination, and none displayed signs or symptoms suggestive of leprosy. They have been advised to remain vigilant for any changes in skin or nerve function.

The patient has been started on the World Health Organization’s multidrug therapy regimen for multibacillary leprosy, which typically includes dapsone, rifampin, and clofazimine for six to twelve months. The GDH has ensured that the patient will receive monthly clinical follow‑ups and medication counseling, and that he has access to a private treatment facility within the island to mitigate stigma.

“We want to make sure our residents feel safe and supported,” said GDH Director Dr. Jonathan Perez in a press briefing. “Leprosy is curable, and with early detection and treatment, we can prevent long‑term complications. Our priority is both the patient’s recovery and the community’s confidence in our health system.”

Historical Context

While leprosy is not common in the continental United States, Guam’s history with the disease is distinct. In the late 19th and early 20th centuries, a small population of patients with leprosy was isolated at a remote facility on the island, often referred to as “the Leprosy Hospital.” Over time, the number of cases fell sharply, but the last reported locally transmitted case before the current one was documented in 1978. The current case suggests that Mycobacterium leprae may persist in environmental reservoirs, such as soil or rodent populations, albeit rarely.

The CDC’s Leprosy Program has highlighted that the bacterium thrives in warm, humid climates, which aligns with Guam’s tropical environment. According to the CDC’s leprosy informational page (https://www.cdc.gov/leprosy), the incubation period can range from 2 to 20 years, explaining why sporadic cases can appear long after a presumed exposure event.

Public Education and Prevention

In addition to medical interventions, GDH is launching an educational campaign aimed at reducing stigma and increasing awareness of leprosy’s symptoms. Posters and informational pamphlets will be distributed through schools, community centers, and health clinics. A local television spot featuring Dr. Sanchez will educate viewers on the early signs of the disease—such as skin lesions that are painless, pale, or brownish, and nerve loss that can lead to numbness.

The department also plans to host a community Q&A session in collaboration with the Guam Veterans Affairs Hospital, where patients and families can discuss treatment plans and the psychological aspects of living with a chronic infectious disease. The event will be streamed online to reach residents who may not be able to attend in person.

Looking Ahead

While the patient is now under treatment and the contact‑tracing process is ongoing, the case underscores the importance of maintaining robust public‑health surveillance even for diseases considered rare. The GDH will continue to collaborate closely with the CDC, and will report any new cases to the national database within 72 hours of diagnosis.

For residents who notice unusual skin changes or numbness in extremities, the GDH urges immediate consultation with a healthcare provider. Early detection remains the most effective strategy for preventing the long‑term complications associated with leprosy, such as permanent nerve damage and disability.

Sources

• Guam Department of Health press release (link on the article)
• CDC Leprosy Program: https://www.cdc.gov/leprosy
• World Health Organization guidelines on leprosy treatment (multidrug therapy)

The full story, originally published in the Guam Chronicle and accessed via the Guam Press website, provides additional context and links to the GDH’s detailed protocol for leprosy case management.