Leptospirosis Outbreak following Severe Flooding: A Rapid Assessment and Mass Prophylaxis Campaign; Guyana, January–February 2005

Abstract

Background Leptospirosis is a zoonosis usually transmitted through contact with water or soil contaminated with urine from infected animals. Severe flooding can put individuals at greater risk for contracting leptospirosis in endemic areas. Rapid testing for the disease and large-scale interventions are necessary to identify and control infection. We describe a leptospirosis outbreak following severe flooding and a mass chemoprophylaxis campaign in Guyana. Methodology/Principal Findings From January–March 2005, we collected data on suspected leptospirosis hospitalizations and deaths. Laboratory testing included anti-leptospiral dot enzyme immunoassay (DST), immunohistochemistry (IHC) staining, and microscopic agglutination testing (MAT). DST testing was conducted for 105 (44%) of 236 patients; 52 (50%) tested positive. Four (57%) paired serum samples tested by MAT were confirmed leptospirosis. Of 34 total deaths attributed to leptospirosis, postmortem samples from 10 (83%) of 12 patients were positive by IHC. Of 201 patients interviewed, 89% reported direct contact with flood waters. A 3-week doxycycline chemoprophylaxis campaign reached over 280,000 people. Conclusions A confirmed leptospirosis outbreak in Guyana occurred after severe flooding, resulting in a massive chemoprophylaxis campaign to try to limit morbidity and mortality.

No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters

“…101 However, a time series analysis of diarrheal illness and flood water data from a health and demographic surveillance site found no support for a significant increase in diarrhea, including cholera, non-cholera, and rotavirus, in the three years following major flooding. 102 Two outbreaks of leptospirosis were confirmed within one month 103 and more than four weeks 104 after flooding, while approximately 27% of children presenting to a treatment facility with acute fever of unknown origin were diagnosed with leptospirosis within the first month after flooding. 105 Eye infections were seen in a significantly larger proportion of people living in flooded areas within four weeks of a flood compared to those living in non-flooded areas.…”

The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks

“…ReviewDoxycycline and penicillinThe role of antibiotics in chemoprophylaxis of leptospirosis is uncertain due to lack of large scale trials. More evidence based studies are required to generate evidence for antibiotics being used as chemoprophylaxis.Dechet [35]2012 PloS ONE Chemoprophylaxis campaign descriptionDoxycyclineThe effectiveness of the massive chemoprophylaxis campaign was inconclusive.McBride [57]2010 Pharmaceuticals ReviewDoxycyclineMay only act to reduce clinical illness rather than infection. May cause nausea and vomitingCruz [58]2009 Ethn.…”

Hydrology and public health: linking human leptospirosis and local hydrological dynamics in Trinidad, West Indies

“…Although previous studies have extensively reported the association of leptospirosis with heavy rainfall and consequent floods (Lau et al 2010b;Barcellos & Sabroza 2001;Gaynor et al 2007;Dechet et al 2012;Vanasco et al 2008;Mohan et al 2009), in this study we focused the analysis on not only rainfall but also other hydrological factors that might play an important role in the disease occurrence. For this, a total of five hydrologically-related covariates were developed to be tested within GWPR models.…”

“…Outbreaks have been reported from many regions around the world, including: Italy, 1994, (Beniamino et al 1987) Nicaragua, 1995(Zaki & Shieh 1996, Brazil, 1996(Barcellos & Sabroza 2001, Russian Federation, 1997 (Kalashnikov et al 2003), Honduras, 1998(Naranjo et al 2008, India, 1997(Vijayachari et al 2003Sehgal et al 2002;Jena et al 2004), Australia, 1999(Smythe et al 2002) Hawaii, 2004(Gaynor et al 2007, Guyana, 2005(Dechet et al 2012, the U.S., 2005 (Stern et al 2010) and the Philippines, 2009 (Amilasan et al 2009). Besides being associated to floods following heavy rains during the rainy season, or floods which occur in areas affected by either tropical cyclones or land use/ land cover changes Mahajan & Chlabra 2008), outbreaks have been reported after occupational or recreational activities related to water such as fishing, farming, canoeing, fresh water swimming or bathing (Keith 1996;Sanders et al 1999;Sejvar et al 2003;Segura et al 2005;Vanasco et al 2008).…”

“…Following previous research which has linked leptospirosis with hydrological events such as floods and heavy rainfall e.g. (Lau et al 2010b;Barcellos & Sabroza 2001;Gaynor et al 2007;Dechet et al 2012;Amilasan et al 2009), we present a multidisciplinary approach towards the quantitative analysis, assessment, modeling and mapping of the risk of leptospirosis in Trinidad at the community level, as it relates to hydrological factors. We explored the existence of spatial variation in human leptospirosis patterns and the existence of spatial heterogeneity in its relationship with local hydrological factors.…”