Endemic Leprosy Areas Globally
Leprosy remains endemic primarily in tropical and subtropical regions of Asia, Africa, and Latin America, with India, Brazil, and Indonesia accounting for the majority of global cases. 1, 2
Primary Endemic Regions
Asia
- India represents the highest burden globally and is considered a major endemic area 3, 4
- Nepal maintains endemic transmission with a prevalence rate of 0.89/10,000 population as of 2015 3
- Indonesia is one of the three countries with the highest global case burden 3
- Parts of Asia broadly show prevalence frequently exceeding 10 per 1,000 population in certain areas 4
Latin America
- Brazil is one of the three countries accounting for the majority of global leprosy cases 1, 2, 3
- South and Central America broadly remain endemic regions, with 18% of migrant cases in Italy originating from these areas 2
Africa
- Multiple regions across Africa show prevalence rates frequently exceeding 10 per 1,000 population 4
- 42% of migrant leprosy cases diagnosed in Italy between 2009-2018 originated from African countries 2
China
- Wenshan region in China demonstrated historical endemicity with a peak prevalence rate of 4.9/10,000 population in 1986, though rates have declined with multidrug therapy implementation 3
Geographic and Environmental Risk Factors
Geographic latitude and tropical/subtropical climate are primary determinants of leprosy endemicity 1, 3
- Endemic areas share similarities in socio-cultural features, geographical distribution, environmental factors, and economic situations 3
- The disease is now endemic only in tropical and subtropical regions, having disappeared from temperate climates where it was historically present 1
Incidence Patterns in Endemic Areas
- In highly endemic areas, incidence may reach 4-6 cases per 1,000 population 4
- Prevalence frequently exceeds 10 per 1,000 population in parts of Africa and Asia 4
- Over 200,000 new cases are detected globally each year, with more than 4 million people living with leprosy-related disabilities 2
Important Clinical Context
Socioeconomic conditions and healthcare access are critical factors determining disease burden in endemic regions 3
- Poor healthcare infrastructure contributes to delayed diagnosis and higher rates of visible deformity at presentation 3
- In Wenshan, China, visible deformity increased to 34.8% among new cases by 2015, reflecting delayed detection 3
- The disease thrives in environments of poverty and limited education 5
Implications for Non-Endemic Countries
Europe and other developed regions continue to diagnose leprosy cases primarily among refugees and migrants from endemic countries 2, 5
- Between 2009-2018, 280 migrant patients with leprosy were reported across Europe 2
- Clinical suspicion remains difficult in non-endemic settings due to clinician unfamiliarity with the disease's varied presentations 2, 5
- The long incubation period (often years) means migrants may develop symptoms long after arrival in non-endemic countries 1