Global Alert & Response (GAR) Leptospirosis. Global Alert & Response (GAR)
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1 Leptospirosis
2 Leptospirosis, a zoonotic and environmental disease a zoonotic and environmental disease Bacteria hosted in animals' kidneys for months/years Environment contaminated by urine (weeks/months) Transmission to human: contact with infected animals or contaminated water Entry points: Skin abrasions, mucous membranes, inhalation of droplets of urine, drinking water
3 Clinical presentation Incubation : 5-14 days 4 broad clinical categories: Mild, influenza-like illness Weil's syndrome (jaundice, renal failure, haemorrhage, myocarditis) Meningitis Pulmonary haemorrhage + respiratory failure Varied and non specific presentations +++ (dengue, yellow fever, malaria ) Asymptomatic forms? Case fatality : 5 to 30 %?
4 Laboratory confirmation Complexity of the pathogen 300 species, saprophyte or pathogenic 25 serogroups divided in 250 serovars 1 serovar = +/- 1 reservoir Complexity of the diagnostic Reference technique: 1917 Rapid tests
5 Control Treatment with common antibiotics but efficacy depends on early diagnosis and treatment Vaccine serovar specific (250 serovars!). Human / Animals. Limited availability. Does not prevent carriage and release Mass chemoprophylaxis not proven to be efficient. Logistic issues Decontamination of the environment? Improving living conditions
6 Risk Factors Close and repeated contacts with rodents and domestic animals Contact with contaminated waters Poor living conditions Climate (humidity, heat) Leptospirosis: Occupational disease (mainly developed countries) Recreational disease (developed countries) Disease of poverty, humanitarian crisis, natural catastrophe (cyclones, flooding): Endemic Epidemic
7 Global burden? Worldwide distribution, highly endemic in tropical countries + epidemic potential (Asia, Caribbean, South America, Pacific, Africa??) Estimation: More than annual cases with case fatality rate exceeding 10% Thailand: leptospirosis may represent up to 20% of febrile illness of unknown (undiagnosed/misdiagnosed) origin Seroprevalence: 44 % in some Philippines regions Veterinary health (+ economic) impact
8 Epidemic potential New Caledonia (2008): 135 cases /5 deaths following heavy rainfalls and floods Marked increase of outbreaks in Thailand Outbreaks in India, Australia, Malaysia, Indonesia, China, the Americas (Nicaragua, Brazil, Peru, Colombia, Ecuador) The Philipppines 2009
9 Philippines, 2009 Endemic with seasonal peak during the rainy season (July to October). 680 cases / yr In September typhoon Ondoy hit southern Luzon causing severe flooding in region 3 and 4 followed by a second typhoon a week later which caused flooding in region 1. Pepeng: 3 October, 2009 Ondoy: 26 September, 2009 Thousands of people displaced and housed in emergency evacuation centers In the 2 following weeks, 505 suspect cases and 15 deaths in NCR alone.
10 In summary Complex natural history (vast animal reservoir + environmental transmission) Complex pathogen agent ++ Non specific clinical presentation + possibility of lethal pneumonic form Endemic + epidemic potential Treatment available but public health control measures not well defined or difficult to implement Burden certainly underestimated but likely huge Epidemic potential linked to natural catastrophes. Probable impact of climate change
11 WHO plan of action Leptospirosis Burden Epidemiology Reference Group (LERG) 3 rd and final meeting planned in Sept. Clarify control strategy Lab confirmation issues Rapid test: development, field evaluation, where in the lab confirmation strategy? Specimens' management (from collection to reference lab) Vaccination? Mass chemoprophylaxis? Place of animal and environment control? Risk mapping?
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