Abstract
BackgroundHuman leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM.MethodsA four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10–30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT).ResultsOf 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1–30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9–161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT.ConclusionsThis study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.
Highlights
Human leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific
Some enrolled patients were not tested by microscopic agglutination test (MAT) if they left the hospital prior to serum collection and could not be contacted by the researcher
The 11 confirmed cases were associated with serovars Copenhageni, Ballum, and LT751-Pohnpei based on a 20 serovar MAT panel (Table 2)
Summary
Human leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM. Human leptospirosis is a widespread zoonotic disease caused by bacteria of the genus Leptospira [1]. Human transmission occurs from direct contact with carrier animals or via indirect contact with pathogenic leptospires present in the environment [5]. Leptospirosis is considered an emerging infectious disease of significant concern in tropical developing regions including Pacific Island populations [8]
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