Abstract
Leptospirosis has been recognized as a major public health concern in Thailand following dramatic outbreaks. We analyzed human leptospirosis incidence between 2004 and 2014 in Mahasarakham province, Northeastern Thailand, in order to identify the agronomical and environmental factors likely to explain incidence at the level of 133 sub-districts and 1982 villages of the province. We performed general additive modeling (GAM) in order to take the spatial-temporal epidemiological dynamics into account. The results of GAM analyses showed that the average slope, population size, pig density, cow density and flood cover were significantly associated with leptospirosis occurrence in a district. Our results stress the importance of livestock favoring leptospirosis transmission to humans and suggest that prevention and control of leptospirosis need strong intersectoral collaboration between the public health, the livestock department and local communities. More specifically, such collaboration should integrate leptospirosis surveillance in both public and animal health for a better control of diseases in livestock while promoting public health prevention as encouraged by the One Health approach.
Highlights
Human leptospirosis is a neglected infectious disease [1] with high incidence in 34 countries [2]
The aim of the present study is to investigate the factors, including human population size, livestock, rainfall, flood cover and physical geography, i.e. average slope, that can explain the spatiotemporal distribution of human leptospirosis cases in Mahasarakham, Thailand from 2004 to 2014
We conducted our analyses following the following workflow: first (1), we investigated the spatial autocorrelation of leptospirosis cases and performed spatial interpolation; second (2), we analyzed the temporal pattern of leptospirosis cases; third (3), we described the spatiotemporal distribution of cases and tested for correlation between leptospirosis cases, rainfall and flood cover; fourth (4), we tested the effect of health policy and surveillance system change in 2012 on the temporal dynamics; and (5), we used general additive modeling (GAM) to investigate the effects of rainfall, flood cover and livestock on leptospirosis cases taking into account the results obtained from (1), (2), (3) and (4)
Summary
Human leptospirosis is a neglected infectious disease [1] with high incidence in 34 countries [2]. High prevalence of human leptospirosis occurs in tropical environments where conditions may favor the survival of Leptospira in the environment [3,4]. Leptospirosis is a zoonotic bacterial disease caused by spirochete species of the genus Leptospira [5], which includes nine pathogenic species and at least five intermediate pathogenic ones [6]. Many animal species shed leptospires [6] with an important role as reservoir for livestock [9]. Wild rodents have usually been considered as one of the main reservoirs for human leptospirosis [10], several studies have recently challenged their importance in rural environments compared to urban environments [11,12,13]
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