Health and Climate Foundation G lobal L eptospirosis E nvironmental A ction  N etwork Strengthen the prevention and outbre...
Leptospirosis: a public health perspective <ul><li>Complex natural history </li></ul><ul><li>Complex pathogen agent  </li>...
557,000 cases  incl.  55,800 deaths  worldwide each year.  1,730,000 cases ,  123,000 deaths  annually when adjusted for p...
Philippines, 2009 <ul><li>680 cases of leptospirosis /yr with seasonal peak during the rainy season   </li></ul>Typhoon Pe...
Looking for a clear and coherent strategy <ul><li>Detection and confirmation </li></ul><ul><ul><li>What is a leptospirosis...
The  G lobal  L eptospirosis  E nvironmental  A ction  N etwork (GLEAN) A One Health Approach GLEAN: An international Comm...
How to reduce the impact of the outbreaks ?  4 levels of potential intervention 5 years of efforts <ul><li>Determine  base...
Thanks Bangkok, October 2011
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The Global Leptospirosis Environmental Action Network: Strengthening the public health prevention and outbreak control strategy

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GRF One Health Summit 2012, Davos: Presentation by Eric BERTHERAT, WHO, Switzerland

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The Global Leptospirosis Environmental Action Network: Strengthening the public health prevention and outbreak control strategy

  1. 1. Health and Climate Foundation G lobal L eptospirosis E nvironmental A ction N etwork Strengthen the prevention and outbreak control strategy Eric Bertherat, MD, MPH, MSc Pandemic and Epidemic Diseases WHO Geneva
  2. 2. Leptospirosis: a public health perspective <ul><li>Complex natural history </li></ul><ul><li>Complex pathogen agent </li></ul><ul><li>Non specific clinical presentation + severe forms </li></ul><ul><li>Endemic + epidemic </li></ul><ul><li>Probable impact of climate change </li></ul>Increasing concerns at country level and request for technical support Ko A, Goarant C, Picardeau M. Nature Reviews Microbiology, 2009, 7: 736-747
  3. 3. 557,000 cases incl. 55,800 deaths worldwide each year. 1,730,000 cases , 123,000 deaths annually when adjusted for potential under-reporting due to incomplete case confirmation Severe outbreaks linked to natural disasters http://www.who.int/zoonoses/diseases/lerg/en/ Estimating the magnitude of the problem: the Leptospirosis Burden Epidemiology Reference Group ( LERG ) WHO mandated by expert consultation in 2006 to coordinate a comprehensive global burden of leptospirosis assessment
  4. 4. Philippines, 2009 <ul><li>680 cases of leptospirosis /yr with seasonal peak during the rainy season </li></ul>Typhoon Pepeng: 3 October Typhoon Ondoy: 26 September Thousands of people displaced and housed in emergency evacuation centers In the 2 following weeks, 505 suspect cases and 15 deaths in Manila alone !
  5. 5. Looking for a clear and coherent strategy <ul><li>Detection and confirmation </li></ul><ul><ul><li>What is a leptospirosis case ? </li></ul></ul><ul><ul><li>What is an outbreak ? </li></ul></ul><ul><ul><li>How to confirm the cases ? </li></ul></ul><ul><li>Control </li></ul><ul><ul><li>Case management: </li></ul></ul><ul><ul><ul><li>Early diagnosis and treatment. </li></ul></ul></ul><ul><ul><ul><li>Severe cases </li></ul></ul></ul><ul><ul><ul><li>Logistic issues </li></ul></ul></ul><ul><ul><li>A role for human immunization ? </li></ul></ul><ul><ul><ul><li>Vaccine serovar specific. </li></ul></ul></ul><ul><ul><ul><li>Limited availability. </li></ul></ul></ul><ul><ul><ul><li>Does not prevent carriage and release </li></ul></ul></ul><ul><ul><li>Mass chemoprophylaxis ? </li></ul></ul><ul><ul><ul><li>Efficacy, Logistic issues </li></ul></ul></ul><ul><ul><ul><li>High risk groups ? </li></ul></ul></ul><ul><ul><ul><li>Up to 6 months of flood waters </li></ul></ul></ul><ul><ul><li>Decontamination of the environment ? </li></ul></ul><ul><ul><li>Rodent control ? </li></ul></ul>Better prediction and preparedness are essential but many key questions still pending !
  6. 6. The G lobal L eptospirosis E nvironmental A ction N etwork (GLEAN) A One Health Approach GLEAN: An international Community of Practice Medical Clinicians, Public health specialists, Veterinarians, Climatologists, Statisticians, Rodent specialists, Biologists, Anthropologists, Ecologists, Water and Sanitation Specialists, Economists... Increasing the knowledge of the relationship between environmental, biological, ecological, economic, demographic factors Early warning systems and Improved prevention and control strategies Reducing the impact of leptospirosis outbreaks through cost-effective, implementable and sustainable solutions
  7. 7. How to reduce the impact of the outbreaks ? 4 levels of potential intervention 5 years of efforts <ul><li>Determine baseline disease incidence </li></ul><ul><li>What are the main drivers ? What are their predictive potential ? </li></ul><ul><li>What type of prediction to inform public health decisions ? </li></ul><ul><li>Develop tool / validate on site </li></ul><ul><li>Relative importance of potential preventive measures ? </li></ul><ul><li>Role of animals /human vaccination ? </li></ul><ul><li>Improve lab confirmation (protocols, bank of reference sera, evaluation of rapid tests, reference lab network, training ..) </li></ul><ul><li>Develop outbreak detection algorithms (case definition, epidemic threshold) </li></ul><ul><li>Guidance for outbreak control and investigation </li></ul><ul><li>Outbreak preparedness and capacity building </li></ul>Retrospective <ul><li>Retrospective analysis of leptospirosis outbreaks </li></ul>Predict Prevent Detect Intervene
  8. 8. Thanks Bangkok, October 2011

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