RESEARCH Table 1. Hansen disease in residents of Micronesian and Marshallese origin, United States* No. (%) patients Median time from Age US entry to report, MDT,† <15 y y (range) no. (%) ENL 3 (10) 1.5 (0–13) Population group Total MB F RR Hawaii-residing 29 22 (76) 5 (17) Micronesians, 2000–2009§ Hawaii-residing 43 31 (72) 17 (39) 1 (2) 1 (0–14) Marshallese, 2000–2009§ US Mainland 55 42 (76) 10 (18) 6 (10) 3 (0–10) 10 (42) 15 3 8 6 3¶ Micronesians, 1990–2009 US Mainland 33 25 (76) 11 (33) 3 (10) 2 (0–12) 7 (32) 6 3 5 1 1# Marshallese, 1990–2009 Arkansas-residing 17 15 (88) 5 (30) 0 (0) 2 (0–5) 3 (20) 4 2 2 0 0 Marshallese, 1990–2009 *Data from National Hansen’s Disease Program surveillance and clinical records, January 1990–October 2009. MB, multibacillary; MDT, multidrug therapy; ENL, erythema nodosum leprosum; RR, reversal reaction; NA, data not available. †MDT completed, excluding patients currently under active treatment. ‡Patients for whom clinical data were available. §Pre-2000 data were not reported to National Hansen’s Disease Program. ¶1 renal, 1 testicular, 1 palatal. #1 renal. Complications, no. cases Hand/foot Any neuropathy Eye Other (%)‡ 25 (77) 12 (75) 12 (70) Of the 33 US mainland Marshallese patients since 1990 (25 of these since 2000), single cases were reported in 9 states, 2 in California, 5 in Washington, and 17 in Arkansas. All but 1 patient were <40 years of age, 25 (76%) had multibacillary disease, 11 (33%) were female, and 3 (10%) were children. Three patients reported that their HD had been diagnosed in the Marshall Islands; none had completed MDT there. Nine patients had resided in other mainland states before moving to the reporting state; 5 had ﬁrst lived in Hawaii. Of the 16 patients for whom clinical data were available, 12 had >1 complication, including 6 patients with ENL. Two patients were pregnant at the time of diagnosis. Of the 22 patients for whom pharmacy data were available (excluding 3 currently being treated), the complete US-recommended MDT course had been dispensed to 7 (32%) (Table 1). Beginning in 1996, 17 HD cases have been reported among the ≈8,000–10,000 Marshallese living in northwestern Arkansas, 10 of these since 2004. All patients were <40 years of age, 15 (88%) had multibacillary disease, 5 (30%) were female, and none were children. (Two 25-year-old men with multibacillary disease, reported in November 2009 after completion of data collection for this study, are not included in this analysis.) Four patients had previously lived in other states, none in Hawaii. Speciﬁc island origin within the Marshall Islands was not reported; however, the general Arkansas Marshallese population is known to come from several different atolls. Of the 10 patients for whom clinical data were available, 7 had >1 complication, including 4 patients with ENL. Excluding the 2 patients currently being treated, the US-recommended MDT course had been dispensed to 3 (20%) (Table 1). HD prevalence reported in the countries of origin is summarized in Figures 4 and 5. Because of the epidemiologic characteristics of HD (e.g., lack of biomarker, prolonged latency), surveillance is generally based on program records rather than population surveys; prevalence and case-detection rate (an approximation of incidence) are highly dependent on operational factors (Figure 5). Active case-detection programs were done in the Federated States of Micronesia in 1996 and 2005 and in the Marshall Islands in 1996 and 1998–1999 (18–20). Patterns of age/ sex/classiﬁcation distribution differed markedly during these years, with more children and paucibacillary disease Table 2. Hansen disease patient data for multibacillary disease status, female sex, and age <15 y, as reported by sources other than the US National Hansen’s Disease Program* Data source Multibacillary disease, % Female sex, % Age <15 y Federated States of Micronesia national data, 2000–2007† 44 35 34 Federated States of Micronesia Leprosy Elimination Campaign, 2005‡ 30 36 32 Republic of the Marshall Islands national data, 2000–2007† 55 42 23 Republic of the Marshall Islands Leprosy Elimination Campaign, 1999‡ 31 35 Hawaii Marshallese cluster, 1998‡ 28 39 *NA, data not available. †World Health Organization annual reports (national surveillance). ‡Published reports from active case-finding campaigns (5,13,18–20). 1204 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 7, July 2011