Armadillo meat consumption and Hansen’s disease (leprosy): a case–control study in Brazil

BACKGROUND: Hansen's disease (HD, leprosy) had a global incidence of approximately 200 000 new cases per annum over the last decade. Armadillos are recognized reservoirs of Mycobacterium leprae in the Americas and HD is considered a zoonosis in the USA. Our aim was to evaluate the association between armadillo meat consumption and HD in Brazil. METHODS: We conducted a case-control study (n=59 patients with HD, n=59 controls) in the state of Espírito Santo, Brazil, between February and December 2025. Data collected included clinical and sociodemographic, armadillo meat consumption and known (human) case contacts (KCCs). RESULTS: Armadillo meat consumption was much more frequent among cases (59.3%) than controls (8.5%). Consumption was the strongest independent predictor of HD, with 15-fold higher odds of exposure (adjusted odds ratio [aOR] 16.5 [95% confidence interval {CI} 5.2 to 52.5], p<0.001) among cases. Odds of KCCs were five-fold higher among cases (aOR 6.0 [95% CI 2.2 to 16.8], p=0.001). CONCLUSIONS: This study provides evidence that armadillo meat consumption is an independent transmission pathway for human M. leprae infection in Brazil. Zoonotic transmission likely accounts for some of the HD 'contact gap' in this setting, supporting the need for a paradigm shift towards One Health surveillance of HD in the Americas.