Leptospirosis:

Global situation
Principles of control

E. Bertherat
WHO Geneva

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Leptospirosis: both a human and animal disease

Incubation: 5-14 days Wild and domestic (pets

Asymptomatic forms and livestock).
Maintenance hosts
4 Categories:
 Mild, influenza-like illness
 Weil’s syndrome (jaundice, renal failure, Clinical disease
hemorrhage, myocarditis) Production loss
 Meningitis
 Pulmonary hemorrhage ± respiratory failure (abortions, reduced
growth, reduced milk
Case fatality rate: 5 to 30% production)

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Pathogenic leptospires live in the urogenital tract of host animals, and
are excreted with urine into environment

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Penetration through broken skin and mucous membranes

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 A complex and dynamic natural history
 Leptospires can survive for weeks to months in the
environment
 Bacteria hosted in animals’ kidneys for months/ years
 Leptospira must adapt to a wide variety of
environments
• High genome plasticity
• Wide variety of leptospires and wide variety of serovars:
25 serogroups divided in 250 serovars
• Host - serovar association: 1 serovar = +/- 1 reservoir

Ko A, Goarant C, Picardeau M. Nature Reviews Microbiology, 2009, 7: 736-747

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Leptospirosis: a global emerging public health problem

Human cases
• 1 M cases/year
• 60,000 deaths/year
• 2.9 million DALYs lost/year

Temperate countries: 0.1-1/100.000

Tropical countries: 10-100/100.000
Epidemic: >100/100.000

• Misdiagnosed, under reported

• Expected incidence rise
• Improvement of diagnosis and surveillance capacity Global burden of leptospirosis: distribution of Disability Adjusted Life Years.
• Uncontrolled urbanization (incl. urban gardening) Torgerson et al., PloS NTD 2015
• Mining activities
• Impact of climate change (natural disasters)

• Epidemic potential linked to climatic events

• Economic impact (human and animal)

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 Risk Factors for human infection
 Close and repeated contacts with rodents and domestic animals
 Contact with contaminated waters
 Poor living conditions
 Climate (humidity, heat)
 Occupational disease
 Recreational disease
 Disease of poverty, humanitarian
crisis, natural catastrophe
(cyclones, flooding)

Endemic + Epidemic

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Leptospirosis and natural catastrophes
Philippines 2009: 700 cases of leptospirosis /yr with seasonal peak during the rainy season

Typhoon
Pepeng:
3 October
Typhoon Ondoy:
26 September

In the 2 following weeks, 505 suspect

cases and 15 deaths in Manila alone

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PRINCIPLES OF CONTROL

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Reservoir

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 Reservoir
Endemic Outbreak
Water Hygiene and sanitation Decontamination
Provision of safe water
Rats Control Rat proofing
Domestic animals Vaccination N.A.
Treatment
Wild animals ? N.A.

Animal vaccination
•In developed countries to limit the effects of leptospirosis on production
•Does not completely prevent excretion of leptospires, but prevents infection by reducing the number of leptospires
•In few studies, decrease in human leptospirosis after livestock vaccination
•But circulating Leptospira serovars must be known

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 Rodents prevention and control

 Rodents impact far beyond human health

 Rodents population closely linked to agriculture practices (rural)
waste management and human behaviour (rural and urban)
 Need for an Integrated pest management strategy

Limited impact of rodenticides + side effects

Ecologically-based rodents management, incl. :
• Appropriate management of crops
• Rat proofing
• Improvement of the habitat
• Waste management
• Trapping campaigns at community level…

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Transmission
Endemic Outbreak
Health education +++ +
Barrier ++ +

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Human host
Endemic Outbreak
Chemoprophylaxis N.A Targeted on highest risk
groups
Vaccination ? High risk groups N.A
(occupation)
Case management Capacity building Early warning
Lab diagnostic Triage
Severe cases

Chemoprophylaxis
•Unclear benefit in reducing Leptospira seroconversion or clinical consequences.
•Seems more efficacious in non immune populations with short exposure (travelers, militaries..)
•Logistic issues
•How long ?

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 • Provide empiric treatment of all probable cases
• Provide population with treated water
Recommendations • Targeted chemoprophylaxis and protective equipment to very high risk population
(disaster relief workers, sewage and sanitation workers…)
for epidemic • Communication, Health Education and Social Mobilization

situation •
•
Rodent control and animal immunization are useless at this stage
No evidence that a mass chemoprophylaxis impacts the course of an outbreak (+
logistical issues)

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Practically, the choice of potential interventions depend on "local" conditions:

-Epidemiological situation
-Natural history (nature and respective role of the different reservoirs,
circulating serovars)
-Socioeconomic context (urban vs rural, poor vs rich..)
-Groups at risk
-Capacity of outbreak prediction (preparedness)

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Controling leptospirosis: An One Health strategy
Animal Human

Reducing infection source Rats and farming Water and sanitation

Treating infected animals Rodent control
Treating infected animals
Animal vaccination (pets
and livestock)
Interrupting transmission Good farming practices Protective clothing
Desinfecting at risk areas (occupational,
recreational)
Information
Protecting host Vaccination Chemoprophylaxis
(Vaccination)

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E. Bertherat
Health Emergencies Programme
WHO Geneva
bertherate@who.int

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