Abstract
Futuna is a small Polynesian island in the South Pacific with a population of 3,612 in 2013. The first human leptospirosis case was confirmed in 1997. Active surveillance started in 2004. Cases were confirmed by PCR or real time PCR, or by serology using MAT or a combination of IgM-ELISA and MAT. A retrospective analysis of surveillance data shows that the disease was endemic with a mean annual incidence of 844 cases per 100,000 over an 11-year period from 2004 to 2014. An epidemic peak as high as 1,945 cases per 100,000 occurred in 2008. Serogroup Australis was predominant until 2007, Icterohaemorrhagiae was dominant afterwards. Cluster analysis revealed different hot spots over time. Lifestyle habits, such as walking barefoot in irrigated taro fields or pig pens probably contributed to contamination from the swine and rodent reservoirs to humans. Severe forms were rare, and the case fatality rate was 0.5%. The medical community and general population were aware of leptospirosis and rapid treatment with amoxycillin was the main treatment, probably contributing to this low fatality rate.
Highlights
Leptospirosis is a bacterial zoonosis of worldwide significance
The annual incidence was on average 844 cases per 100,000 for the period 2004–2014 (Fig 3). This increase illustrates that active surveillance and improved awareness resulted in better identification of leptospirosis cases, as already shown in other settings [11, 12] and already recognized in the Asia-Pacific region [13]
High incidence of leptospirosis has already been reported from French Polynesia with 180 and 150 cases per 100,000 in Raiatea and Marquesas islands respectively [14], from the Seychelles with 101 cases per 100,000 [15] or up to 500 cases per 100,000 in particular hot spots in New Caledonia [16]
Summary
Leptospirosis is a bacterial zoonosis of worldwide significance. Rodents are the main animal reservoir, but other mammals may maintain other co-adapted pathogenic Leptospira strains. Transmission to humans occurs through contact of abraded skin or mucous membranes with urine of infected animals, mostly chronic asymptomatic reservoirs, either directly or via surface waters or wet soils [1]. After an incubation time of 2 to 21 days, the acute phase is usually sudden and characterized by fever, headache and myalgia. Later symptoms may include conjunctival injection, abdominal pain, vomiting, prostration, icterus, anuria or oliguria, cardiac arrhythmia or deficiency, meningeal syndrome and a skin rash.
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