Leptospirosis in Animals and Humans in the Caribbean

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1 Leptospirosis in Animals and Humans in the Caribbean Dr. Saed Rahaman, Director Veterinary Public Health Ministry of Health, Trinidad and Tobago Dr. Sandra Vokaty, PAHO/WHO Subregional Advisor on Veterinary Public Health PAHO Office in Trinidad and Tobago Animal Disease Recogni9on and Response Workshop, Trinidad Tues 17 th & Wed 18 th November 2015 Arthur Lok Jack Graduate School of Business Mt. Hope, Trinidad Project Partners The One Health One Caribbean One Love project is implemented by University of the West Indies, School of Veterinary Medicine

2 Globally re- emerging infec1ous zoono1c disease, caused by leptospires. Common in the tropical and sub- tropical areas such as the Caribbean where there is significant rainfall. Main reservoir host is rodents. Disease affects humans and animals (cacle, pigs, horses, dogs, mongoose, bats and opossums).

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4 Humans can contract the disease by direct or indirect contact with infected urine from rodents or by consump1on of contaminated food or water. Individuals living in rural areas are at a greater risk. Occupa1onal ac1vi1es (rice workers, sewer workers, drain cleaners, contact with livestock and veterinary students) and recrea1onal ac1vi1es (water sports including swimming in contaminated water) are contribu1ng factors to transmission.

5 Clima1c condi1ons, high rainfall and floods escalate the dissemina1on of leptospirosis causing severe epidemics. Humans are more likely to contract leptospirosis when there are poor sanitary condi1ons and inadequate drainage.

6 Animal leptospirosis can be seen in a large propor1on of dogs as well as rodents, cats and livestock (cacle, pigs, sheep, goats, horses, and water buffalo). Canine leptospirosis has been isolated from healthy and acute dogs in Trinidad. Some of the most common serovars found in dogs, cats and livestock in the Caribbean are Icterohaemorrhagiae, Copenhageni, Canicola, Autumnalis.

7 Vary depending on serovar and host In maintenance host mild clinical signs and prolonged carrier state In incidental host severe disease, high 1ters, short renal carrier state. Chronic infec1ons abor1on, s1llbirth, birth of weak offspring Acute infec1on in calves (rare): high fever, hemoly1c anemia, hemoglobinuria, jaundice, pulmonary conges1on Acute infec1on in lacta1ng cows acute milk drop syndrome decreased produc1on of thick yellow milk, high SCC, sor udder.

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9 Can be subclinical Clinical signs can include anorexia, fever, arthralgia, myalgia, vomi1ng and diarrhea, and conjunc1vi1s. Severe infec1ons can cause jaundice and clotng problems (blood in stool or urine).

10 Serological tests: MAT & ELISA An1gen detec1on tests: - dark field microscopy: low sensi1vity and specificity - immunofluorescence: low sensi1vity and specificity - Culture of blood, urine, 1ssue: difficult & 1me consuming - Special stains on formalin fixed 1ssues: low sensi1vity - PCR

11 Serovars found in humans of the Caribbean are Autumnalis, Icterohaemorrhagiae, Ballum, Canicola, Grippotyphosa, Copenhageni and Australis. There are more cases of leptospirosis in the rainy season (June to December) than the dry season (January to May).

12 Leptospirosis is considered to be overlooked and neglected (difficult to diagnose and mimics the symptoms of other diseases.) Laboratory tes1ng such as Microscopic Agglu1na1on Test (MAT), ELISA (enzyme- linked immunosorbent assay), IFAT (immunofluorescent an1body test), and quick tests such as IHA (Indirect haemagglu1na1on) and MSAT (Macroscopic Slide Agglu1na1on Test).

13 Leptospirosis is underreported because of the shortage of diagnos1c centers and deficiency in clinical suspicion. Human clinical manifesta1on of leptospirosis is broad and can be misdiagnosed as dengue, Chikungunya, etc. Asymptoma1c infec1on can lead to underdiagnosis.

14 Economic and Social impact Source: Adapted from IOM (2009) World Bank (2012)

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16 Developed One Health guidelines for Leptospirosis surveillance, diagnosis, preven1on and control in 2013 Conducted literature review on Leptospirosis the Caribbean Preparing Leptospirosis fact sheets for: o Physicians o Livestock owners o Pet owners o General public Planning lab training on MAT in

17 Each par1cipant presented Leptospirosis informa1on from their countries. Informa1on was presented both for human and animal Leptospirosis. The Leptospirosis outbreak in Dominica in 2011 was discussed in detail. The data was used to do a root cause analysis on Leptospirosis in the Caribbean

18 Risk Factors for Human Leptospirosis Leptospirosis in humans Climate Change Flooding Recreational Exposure Men and Teenage boys Temperature and Humidity Seasonality Occupational exposure Urine Domestic animals (cattle, pigs and dogs) Mongoose and other wild life Rodents

19 Risk factor analysis was used to develop recommendations for each risk factor, addressing prevention, surveillance, clinical diagnosis, and treatment.

20 1. Improve diagnosis in humans Implement Modified Faine s criteria or WHO guidelines for all undifferen1ated fevers especially if rapid test for Dengue is nega1ve 2. Improve case management Implement WHO guidelines for case management of all possible & presump1ve cases. An1bio1c treatment as early as possible. Clinicians should never wait for results of lab tests before star1ng an1bio1c treatment (WHO) 3. Improve and integrate surveillance in humans and animals 4. Improve outbreak inves1ga1on by determining na1onal baseline data (humans & animals)and environmental source of infec1on 20

21 Determine which animal species are infec1on source and direct control measures to target local reservoir. Research on prevalent Lepto serovars in rodents, humans, dogs, domes1c animals, wildlife. 21

22 Biosecurity measures for farmers! Separate animal reservoirs from human dwellings through fences and screens! Control animal hygiene rat proofing, feeding regime! Rodent control! Immunise dogs and livestock with appropriate Lepto serovars! Remove licer around human dwellings.! Educate people not to leave animal feed or human food uncovered.

23 Improve work environment: o Provide Personal Protec1ve Equipment for high risk occupa1ons o Rodent proof abacoirs, food establishments, food storage, feed storage facili1es on farms o Provide washrooms, promote hand washing, first aid kits

24 Leptospirosis should be included in disaster planning and response, arer hurricanes and floods. Food safety and environmental legisla1on should include proper waste disposal and rodent proofing of abacoirs, food processing and storage facili1es, food service establishments. Food safety laws should empower competent authori1es to enter facili1es, inspect and audit records. Best prac1ces should include pest control, clean water sources & proper waste disposal. 24

25 Proper planning to consider loca1on, orienta1on of building and drainage. Effec1ve and efficient drainage systems Public awareness boil water in floods, stock up on bocled water, medica1on & medical supplies, danger of wading through flood waters, rat proof homes in floods. 25

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