Transmission of the disease is by direct human-to-human contact. The source of the organisms is mainly nasal secretions of a lepromatous case, which transport M. leprae to mucous membranes or skin abrasions of another individual. Although leprosy bacilli readily infect people exposed to a case of lepromatous leprosy, the disease develops in only a tiny minority, being controlled by body defenses in the rest. Hansen's disease is no longer a much feared contagious disease, and the morbid days when lepers were forced to carry a bell or horn to warn others of their presence are fortunately past.
Natural infections with M. leprae occur in wild nine-banded armadillos and in mangabey monkeys. An epidemiological study appears to exclude armadillos as an important source of human leprosy, but occasional transmissions to humans have not been ruled out.
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