TM 12_Epidemiology of Leptospirosis.pptx

TM 12_Epidemiology of Leptospirosis.pptx

• 1.
  Epidemiology of Leptospirosis Divisionof Epidemiology, Faculty of Public Health, Universitas Airlangga, Indonesia
• 2.
  Introduction 🞆 Leptospirosis isan infectious disease caused by pathogenic bacteria called leptospires, that are transmitted directly or indirectly from animals to humans. 🞆 It is therefore a zoonosis. 🞆 Human-to-human transmission occurs only very rarely. 🞆 Leptospirosis occurs worldwide but is most common in tropical and subtropical areas with high rainfall. 🞆 The disease is found mainly wherever humans come into contact with the urine of infected animals or a urine-polluted environment.
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  History 🞆 Adolf Weildescribed leptospirosis as a disease entity in 1886. His name is still attached to a serious form of leptospirosis called Weil's disease, traditionally attributed to rat transmitted infection caused by the serovars icterohaemorrhagiae and copenhageni. 🞆 At present, it is preferable to refer to all leptospiral infections as leptospirosis regardless of clinical symptoms and signs 🞆 It was not until the second decade of the 20th century that leptospires were recognized by Inada and Ido in Japan and soon after, independently, in Germany by Uhlenhuth and Fromme as the cause of the disease that had been originally described by Weil.
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  Pathogenic 🞆 Leptospirosis isa bacterial disease that affects humans and animals. 🞆 It is caused by bacteria of the genus Leptospira 🞆 Leptospires are bacteria which can be either pathogenic (i.e. having the potential to cause disease in animals and humans) or saprophytic (i.e. free living and generally considered not to cause disease). 🞆 Pathogenic leptospires are maintained in nature in the renal tubules of certain animals. 🞆 Saprophytic leptospires are found in many types of wet or humid environments ranging from surface waters and moist soil to tap water. 🞆 Saprophytic halophilic (salt-loving) leptospires are found in seawater.
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  Morphology 🞆 Leptospires arecorkscrew-shaped bacteria, which differ from other spirochaetes by the presence of end hooks. 🞆 They belong to the order Spirochaetales, family Leptospiraceae, genus Leptospira. 🞆 They are too thin to be visible under the ordinary microscope. Dark-field microscopy (Annex 6) is most often used to observe leptospires. 🞆 All leptospires look alike with only minor differences so that morphology does not help to differentiate between pathogenic and saprophytic leptospires or between the various pathogenic leptospires.
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  Portal of Exit,Transmission, and Portal of Entry (1) 🞆 The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get into water or soil and can survive there for weeks to months. 🞆 Many different kinds of wild and domestic animals carry the bacterium. 🞆 These can include, but are not limited to: • Cattle • Pigs • Horses • Dogs • Rodents • Wild animals 🞆 When these animals are infected, they may have no symptoms of the disease. 🞆 Infected animals may continue to excrete the bacteria into the environment continuously or every once in a while for a few months up to several years.
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  Portal of Exit,Transmission, and Portal of Entry (2) 🞆 Humans can become infected through: • Contact with urine (or other body fluids, except saliva) from infected animals. • Contact with water, soil, or food contaminated with the urine of infected animals. 🞆 The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially if the skin is broken from a cut or scratch. 🞆 Drinking contaminated water can also cause infection. 🞆 Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. 🞆 Exposure to these risks are greater for workers, particularly those not wearing personal protective equipment, who conduct activities in paddy fields, collecting wood in the forest and clearing up garbage. 🞆 Person to person transmission is rare.
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  Susceptible Host (1) 🞆How do people get leptospirosis? • Encountering water or soil containing urine or bodily fluids from infected animal • Directly touching urine or bodily fluids from an infected animal • Eating food or drinking water contaminated by urine 🞆 Leptospirosis occurs worldwide, but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, such as: • Farmers • Mine workers • Sewer workers • Slaughterhouse workers • Veterinarians and animal caretakers • Fish workers • Dairy farmers • Military personnel
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  Susceptible Host (2) 🞆The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports. 🞆 The risk is likely greater for those who participate in these activities in tropical or temperate climates. 🞆 In addition, incidence of Leptospirosis infection among urban children appears to be increasing.
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  Epidemiology (1) 🞆 In2019, 920 leptospirosis cases were reported in Indonesia, with 122 deaths caused by the disease. The cases were reported from nine provinces (Banten, DKI Jakarta, West Java, Central Java, DI Yogyakarta, East Java, Maluku, South Sulawesi and North Kalimantan). 🞆 However, this reported case number is a severe underestimate of leptospirosis occurrence in Indonesia given that the annual morbidity of leptospirosis in the population was recently estimated at 39.2 per 100 000 people.
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  Epidemiology (2) 🞆 Leptospirosisrisk factors in Indonesia are vast, given the incidence of flooding and often subsequent presence of stagnant water or poor sewer and sanitation conditions in housing areas. 🞆 In Indonesia, an Early Warning Alert and Response System (EWARS) for leptospirosis is used by the Primary Health Care Centres to report suspected leptospirosis cases to the District Health Office, which will then verify the data and conduct field investigation and control activities. 🞆 Leptospirosis sentinel surveillance analyses epidemiology and virology data to better understand the disease and its distribution for the development of prevention and control programmes.
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  Symptoms (1) 🞆 Withouttreatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death. 🞆 In humans, Leptospirosis can cause a wide range of symptoms, including: • High fever • Headache • Chills • Muscle aches • Vomiting • Jaundice (yellow skin and eyes) • Red eyes • Abdominal pain • Diarrhea • Rash
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  Symptoms (2) 🞆 Manyof these symptoms can be mistaken for other diseases. In addition, some infected persons may have no symptoms at all. 🞆 The time between a person’s exposure to a contaminated source and becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases: • After the first phase (with fever, chills, headache, muscle aches, vomiting, or diarrhea) the patient may recover for a time but become ill again. • If a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis. 🞆 The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months.
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  https://www.physio-pedia.com/Leptospirosis
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  Diagnostic Tests/Lab Tests/LabValues 🞆 Laboratory studies used to screen for the diagnosis of leptospirosis include the following: • Leptospira immunoglobulin M (IgM) ELISA or IgM/immunoglobulin G (IgG) enzyme-linked immunoabsorbent assay (ELISA), including rapid diagnostic kits usable in the field • Real-time DNA polymerase chain reaction (PCR) of blood, urine, and cerebrospinal fluid (CSF)
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  🞆 Laboratory studiesused to confirm the diagnosis of leptospirosis include the following: • Microscopic agglutination testing (MAT; criterion standard for serologic identification of leptospires, available at reference laboratories) • Single titer ≥1:200 or 4-fold rise in serum drawn between the first and fourth week of illness is considered diagnostic • DNA PCR of blood, urine, CSF, tissue • Culture of leptospires from body fluids or tissue (criterion standard, but requires specific media and several weeks’ incubation, thus usually limited to reference laboratory) Diagnostic Tests/Lab Tests/Lab Values
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  Prevention (1) • Treatwater to make it safe to drink by boiling or using an appropriate chemical treatment. • Cover cuts or scratches with waterproof bandages or other coverings that seal out water. • Do not wade, swim, bathe, submerse your head in, or swallow floodwater or any fresh water source that may contain animal urine or be contaminated by floodwater runoff. • Wear waterproof protective clothing, shoes or boots near floodwater or other water or soil that may be contaminated with animal urine. • Prevent rodent infestation by keeping food, water and trash in closed containers, and trapping any rodents you see.
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  Prevention (2) 🞆 Therisk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine, or eliminating contact with potentially infected animals. 🞆 Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.
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  Strategies 🞆 Throughout Julyand August 2020, WHO collaborated with the Global Leptospirosis Environmental Action Network (GLEAN), Food and Agriculture Organization (FAO), Indonesia Epidemiology Association, Indonesia Entomology Association and Indonesia Parasitic Control Association to support the Ministry of Health host a series of four webinars on leptospirosis prevention and control in Indonesia. 🞆 Approximately 4 000 participants from across the country attended the sessions to discuss relevant strategies and the application of the one health approach to address leptospirosis during the COVID-19 pandemic.
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  Treatment 🞆 Leptospirosis istreated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. 🞆 Intravenous antibiotics may be required for persons with more severe symptoms. Persons with symptoms suggestive of leptospirosis should contact a health care provider.
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  🞆 Thank you
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  References 🞆 https://iris.who.int/bitstream/handle/10665/42667/WHO_CDS_CSR_EPH_2002.23.pdf?seque nce=1 🞆 https://www.who.int/indonesia/news/detail/24-08-2020-leptospirosis-prevention-and-contr ol-in-indonesia 🞆https://www.cdc.gov/leptospirosis/index.html 🞆 https://repository.badankebijakan.kemkes.go.id/id/eprint/3873/1/Buku_Leptospirosis.pdf