Figure 6. Estimated Hansen disease cases per 100,000 population, Arkansas Marshallese and Republic of the Marshall Islands (RMI), 2000–2009. RMI rates from World Health Organization reports (1,2,13); Arkansas cases from National Hansen’s Disease Program records. Arkansas Marshallese population (denominator) derived from US Census estimates (15,17). migrants receive neither the health screening required for immigrants (which is not effective at preventing importation of HD because of its decades-long incubation period) nor targeted health services often available to large immigrant or refugee populations. Although legally residing in the United States, they remain citizens of their home nations and are thus ineligible for US health programs such as Medicare and Medicaid, although NHDP services such as biopsy interpretation, MDT, and direct outpatient care at the Baton Rouge facility are available. Many remain uninsured (>50% of the Arkansas Marshallese population) (17). Mainland state and local health departments are not typically resourced to serve either this population or this otherwise-rare condition. Hawaii receives more than $15 million annually in Compact impact funds to partially address the multiple health issues of the Marshallese and Micronesian migrant populations, but these additional US funds have not been available to the mainland states. (21). With the goal of decreasing health disparity and preventing disability, case-ﬁnding and case-management interventions are needed in US-resident Marshallese and Micronesian communities that are integrated into general health services and avoid the stigma of leprosy-labeled activities. Special efforts may be necessary to increase case detection among women and children. Large populations, such as the Arkansas Marshallese community, may be easier to reach with targeted but nonstigmatizing efforts, as has occurred in Hawaii. The small, widely distributed Hansen Disease, United States Micronesian communities, where the most severe, disabling cases have been identiﬁed, may be more difﬁcult to reach. Acknowledgment We thank the staff of the NHDP for assistance with data collection. We extend special thanks to Jerry Simmons and Kathleen Leonard for assistance in preparation of the ﬁgures. Dr Woodall worked as a US Public Health Service medical ofﬁcer in the Marshall Islands for several years and completed this work as a Master in Public Health and Tropical Medicine candidate at Tulane University. Her current interest is control of the neglected tropical diseases. References 1. World Health Organization. Epidemiological review of leprosy in the Western Paciﬁc Region 2007. Manila, Philippines: World Health Organization Regional Ofﬁce for the Western Paciﬁc; 2007 [cited 2010 Aug 10]. http://www.wpro.who.int/internet/resources.ashx/ leprosy/2007_Leprosy_Review.pdf 2. World Health Organization. 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