Strengthen the prevention and outbreak control strategy
Strengthen the prevention and
outbreak control strategy
Eric Bertherat, MD, MPH, MSc
Pandemic and Epidemic Diseases
Health and Climate
Leptospirosis: a multifaceted disease
Zoonosis + Environmental disease + Occupational disease
Complex natural history
Complex pathogen agent
Non specific clinical
presentation + severe forms
Endemic + seasonal
variations / epidemic
Ko A, Goarant C, Picardeau M. Nature Reviews Microbiology, 2009, 7: 736-747
1,000,000 cases / 60,000 deaths annually
in some areas as high as 975 cases per 100 000
680 cases of leptospirosis /yr with seasonal peak during the rainy season
Thousands of people displaced and
housed in emergency evacuation
In the 2 following weeks, 505 suspect
! cases and 15 deaths in Manila alone
Looking for a clear and coherent strategy
Detection and confirmation
What is a leptospirosis case ?
What is an outbreak ?
How to confirm the cases ?
A role for human immunization ?
Vaccine serovar specific.
Does not prevent carriage and release
Mass chemoprophylaxis ?
Early diagnosis and treatment.
Efficacy, Logistic issues
High risk groups ?
Up to 6 months of flood waters
Decontamination of the environment ?
Rodent control ?
!Better prediction and preparedness are essential but many key questions still pending
The Global Leptospirosis Environmental Action Network (GLEAN)
A One Health Approach
To reduce the impact that leptospirosis outbreaks have on communities
through providing cost-effective, implementable and sustainable solutions
Reducing the impact
knowledge of the
GLEAN: An international Community of Practice
Medical Clinicians, Public health specialists, Veterinarians, Climatologists,
Statisticians, Rodent specialists, Biologists, Anthropologists, Ecologists, Water and
Sanitation Specialists, Economists...
How to reduce the impact of the outbreaks ?
Retrospective analysis of leptospirosis outbreaks
What are the main
drivers? What are their
predictive potential ?
What type of
prediction to inform
Develop tool /
validate on site
(protocols, bank of
evaluation of rapid
tests, reference lab
Role of animals
epidemic threshold ?)
outbreak control and
3rd GLEAN annual meeting, Brasilia, March 2013