Leptospirosis Outbreaks
in Nicaragua: Identifying
Critical Areas and
Exploring Drivers for
Evidence-Based Planning
M C Sch...
Background – Leptospirosis in Americas
An emerging disease of epidemic-prone
Global alerts of leptospirosis, January 2010 ...
Top infectious diseases in the Emergency Management
System/International Health Regulations
June 2007 to February 2013
Glo...
Background – Leptospirosis in Nicaragua
• Nicaragua is located in one of the subregions most vulnerable to natural
disaste...
Objective of the Study
Document the analysis of drivers in Nicaragua in order to identify areas at
risk for outbreaks of l...
Methodology
Type of study, period and data source
• Ecological-type study by second subnational level (153
municipalities ...
Methodology
Steps
•

Description of the actions for prevention/response for leptospirosis in the
country
Definitions and c...
Results
Cases of leptospirosis, Nicaragua, 2004-2010

Source: Ministry of Health of Nicaragua
|
Results
Cases of leptospirosis, by department, Nicaragua, 2004-2010
Cases

304

Chinandega

979
522
175

Leon
Managua
Othe...
Total number of cases of leptospirosis and cumulative incidence
rate (10,000 populations), by municipality, Nicaragua, 200...
Risk stratification of leptospirosis in Nicaragua
Upper quintile
cases &
incidence rate

Yes

Critical area
48

133/153

L...
Risk stratification of leptospirosis in
Nicaragua, by municipality, 2004–2010

|
Source: Ministry of Health of Nicaragua; ...
Critical areas for leptospirosis represented by incidence rate
and percentage of soil with Cambisol and Andosol, by
munici...
Average rainfall and total number of cases of
leptospirosis, in the next month, by municipality
Nicaragua, 2004–2010

|
So...
Critical areas for leptospirosis represented by incidence rate and
percentage of rural population, Nicaragua, by municipal...
Results -Exploratory Analysis
Possible drivers
% rural population

Average of
municipality

Standard
deviation

61.3

24.2...
Conclusions and Recommendations
• Outbreaks do not occur on a yearly basis
• The risk is different between the departments...
Conclusions and Recommendations
This type of information could be used in Nicaragua’s Intersectoral National Plan in
the d...
Thank you very much!
www.paho.org/leptospirosis

|
Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning
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Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning

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GRF 2nd One Health Summit 2013: Presentation by Maria Cristina Schneider, World Health Organisation

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Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning

  1. 1. Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning M C Schneider, P Najera, S Aldighieri, J Bacallao, A Soto, W Marquino, L Altamirano, C Saenz, J Marin, E Jimenez, M Moynihan, M Espinal Author from: PAHO/WHO and Ministry of Health of Nicaragua Int. J. Environ. Res. Public Health. 2012; 9(11):3883-3910.
  2. 2. Background – Leptospirosis in Americas An emerging disease of epidemic-prone Global alerts of leptospirosis, January 2010 to December 2012 Honduras 15 alerts Nicaragua 45 alerts 530 global alerts of leptospirosis: more than half (341 alerts) were in the Americas EUA 13 alerts Dominican Rep. 19 alerts Peru 16 alerts Argentina 43 alerts Source: HealthMap (http://www.healthmap.org), PAHO analysis HealthMap is a database that utilizes different online sources for real-time surveillance of | emerging public health threats.
  3. 3. Top infectious diseases in the Emergency Management System/International Health Regulations June 2007 to February 2013 Global Leptospirosis is the top 6 global infectious hazard Americas Leptospirosis is the top 3 infectious hazard in the Americas |
  4. 4. Background – Leptospirosis in Nicaragua • Nicaragua is located in one of the subregions most vulnerable to natural disasters. It faced leptospirosis outbreaks in 1995, 1998 (post-hurricane Mitch), 2007, and 2010; it has therefore acquired much experience. • The current control and prevention activities against leptospirosis in Nicaragua are being developed in all departments. • The country has information on cases of leptospirosis as well as demographic and socioeconomic data broken down by department and by municipalities. • In place a Intersectoral National Plan |
  5. 5. Objective of the Study Document the analysis of drivers in Nicaragua in order to identify areas at risk for outbreaks of leptospirosis. It is hoped that this study will serve as a methodological basis for the identification of areas at risk for leptospirosis in other countries in Latin America. |
  6. 6. Methodology Type of study, period and data source • Ecological-type study by second subnational level (153 municipalities in 17 departments of Nicaragua); retrospective and descriptive when it comes to describing outbreaks and interventions • From 2004 to 2010 • Secondary sources and data, sources from the country’s information system, the 2005 Nicaragua Census, and other different sources |
  7. 7. Methodology Steps • Description of the actions for prevention/response for leptospirosis in the country Definitions and criteria Description of the epidemiological situation and risk stratification Created from scratch a database (GIS) with cases, socioeconomic and environmental variables (by municipality) Exploratory analysis (statistic and GIS) • • • • |
  8. 8. Results Cases of leptospirosis, Nicaragua, 2004-2010 Source: Ministry of Health of Nicaragua |
  9. 9. Results Cases of leptospirosis, by department, Nicaragua, 2004-2010 Cases 304 Chinandega 979 522 175 Leon Managua Others 50% of the cases in 3 departments Source: Ministry of Health of Nicaragua |
  10. 10. Total number of cases of leptospirosis and cumulative incidence rate (10,000 populations), by municipality, Nicaragua, 2004–2010 | Source: Ministry of Health of Nicaragua; authors’ analysis
  11. 11. Risk stratification of leptospirosis in Nicaragua Upper quintile cases & incidence rate Yes Critical area 48 133/153 Lower quintiles cases & incidence rate Productive area? (occurrence of leptospirosis cases) Endemic area 85 No 20/153 Total municipalities = 153 | Silent area 20
  12. 12. Risk stratification of leptospirosis in Nicaragua, by municipality, 2004–2010 | Source: Ministry of Health of Nicaragua; authors’ analysis
  13. 13. Critical areas for leptospirosis represented by incidence rate and percentage of soil with Cambisol and Andosol, by municipality, Nicaragua, 2004–2010 Cambisol Young, with changes in color, structure, and carbonate washing Andosol Soil from volcanic ash FAO. Mapa Digital del Suelo del Mundo. Base Mundial de Referencia para los recursos del Suelo (FAO/ISRIC/SICS, 1998, rev 2010. Base de datos: GeoNetwork Bull World Health Organ. 1961; 24(1): 35–43 The effect of pH on the survival of leptospires in water* C. E. Gordon Smith and L. H. Turner http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2555367/ One of the factors on which the incidence of leptospirosis is dependent is the survival time of shed leptospires in surface water or soil water, and this time is in turn affected by the acidity or alkalinity of the water.
  14. 14. Average rainfall and total number of cases of leptospirosis, in the next month, by municipality Nicaragua, 2004–2010 | Source: Ministry of Health of Nicaragua; authors’ analysis
  15. 15. Critical areas for leptospirosis represented by incidence rate and percentage of rural population, Nicaragua, by municipality 2004–2010 | Source: Ministry of Health of Nicaragua; authors’ analysis
  16. 16. Results -Exploratory Analysis Possible drivers % rural population Average of municipality Standard deviation 61.3 24.246 Minimum rainfall per year (mm) 165.6 204.701 Average rainfall in the two months with the most rain during the year (mm) 7,403 1,490 % of type of cambisol and adenosol soil 51.7 42.470 Correlation with cumulative incidence rate 0.20666 p= 0.0104 -0.23927 p=0.0029 0.18074 p=0.0254 0.27475 P=0.0006 4 models were done for the exploratory analysis; in 3 precipitation emerge as a relevant explanatory variable; in the Poisson model these 4 variables have significant | p < 0.01.
  17. 17. Conclusions and Recommendations • Outbreaks do not occur on a yearly basis • The risk is different between the departments and municipalities • Importance of multidisciplinary study team and One Health approach • The limitations of ecological study are highlighted • Possible socioeconomic drivers are highest in the Atlantic region where environmental factors are less present (another study for the Pacific region) • Addition studies suggested: Analysis of the actions; more disaggregated analysis by household or individual; complementary studies in the animal populations • This methodology could further assist other countries in the region without a surveillance for leptospirosis to define their areas at risk. |
  18. 18. Conclusions and Recommendations This type of information could be used in Nicaragua’s Intersectoral National Plan in the definition of priority areas for action and periods of the year for time of interventions. Example of potential use of this information for planning to prevent and respond to leptospirosis outbreaks in the case of Nicaragua |
  19. 19. Thank you very much! www.paho.org/leptospirosis |

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