Abstract
Leptospirosis is a globally disseminated zoonotic disease with no national surveillance systems. On the other hand, surveillance is crucial for improving population health, and surveillance systems produce data that motivates action. Unfortunately, like many other countries, Ecuador put in place a monitoring system that has never been tested. The goal of this study was to use scenario tree modeling to assess the sensitivity of Ecuador's current national surveillance system to human leptospirosis as the basis for an economic assessment of the system. We created a decision-tree model to analyze the current system's sensitivity. The inputs were described as probabilities distributions, and the model assessed the program's sensitivity as an output. The model also considers the geographical and weather variations across Ecuador's three continental regions: Andean, Amazonia, and the Coast. Several data sources were used to create the model, including leptospirosis records from Ecuador's Ministry of Public Health, national and international literature, and expert elicitation, all of which were incorporated in a Bayesian framework. We were able to determine the most critical parameters influencing each scenario's output (CSU) sensitivity through sensitivity analysis. The Coast region had the best sensitivity scenario, with a median of 0.85% (IC 95% 0.41–0.99), followed by the Amazonia with a median of 0.54% (CI 95% 0.18–0.99) and the Andes with a median of 0.29% (CI 95% 0.02–0.89). As per the sensitivity study, the most influential criteria on the system's sensitivity were “Attendance or probability of going to a health center” and “probability of having symptoms,” notably for the Coast and Amazonia Regions.
Highlights
Leptospirosis is a disease caused by infection with at least 64 species of spirochetes from the genus Leptospira [1–4]
In Ecuador, leptospirosis is a notifiable disease, and the government has set up a passive surveillance system that is coordinated by the Ministry of Public Health across the country
Based on reports from official health statistics, we established the geographic risk scenarios for these characteristics (Table 2). We identified these geographical regions as zones with low (1–10%), medium (11–20%), and high (21–30%) prevalence levels, based on the information from cases reported by health authorities as well as the environmental conditions in each region, which play a key role in Leptospira transmission dynamics
Summary
Leptospirosis is a disease caused by infection with at least 64 species of spirochetes from the genus Leptospira [1–4]. These pathogenic Leptospira spp. can infect and cause disease in humans and animals and can be divided into four subgroups (I–IV) [4, 5]. It is a worldwide zoonotic disease; it is endemic in Central and South America, where some of the world’s highest rates of leptospirosis can be found [6]. Despite the fact that it is a prevalent zoonotic disease, it is underreported, and many nations lack surveillance infrastructure [7].
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