It's possible leprosy is endemic and the detected cases are a "tip of the iceberg", but I think an infectious disease doctor looked at a similar report recently and was confused why that would be assumed to be the case. Institutional knowledge on leprosy has probably been lost, and it's possible in the past that undetected infection and spread was commonly known about but not told to the public or new doctors and a current infectious disease doctor would not know about it, but I'm not sure about this situation in general.

Just fyi, "endemic" doesn't mean in humans specifically, it is being spread via zoonotic transmission, and it is endemic in certain animal populations in the southeast. The title is accurate.

The title is lifted verbatim from the abstract:

> Those trends, in addition to decreasing diagnoses in foreign-born persons, contribute to rising evidence that leprosy has become endemic in the southeastern United States.

and the paper itself says the same thing in the summary:

> In summary, our case adds to the growing body of literature suggesting that central Florida represents an endemic location for leprosy.

How is that misinformation?