Leptospirosis is a worldwide zoonosis and common in tropical and subtropical areas with high rainfall. It should be noted as an imported infectious disease although it is sporadic in Japan. Some imported cases already have been reported in Japan and these cases occurred mainly in Southeast Asia. The case discussed in this article is the first reported Japanese case infected in Vietnam. Four days after returning back to Japan after a two-week stay in the mountain area near Hue, in the middle part of Vietnam, the patient suddenly experienced chills, a high fever, sore throat, gastrocnemius pain, and headache. Conjunctival jaundice, renal function disorder, and proteinuria were observed on the third day of onset. Significant increase in antibody titers against serovar Australis and Autumnalis strains was observed in paired serum samples by microscopic agglutination test (MAT). Consequently we recognized this case as a diagnosis of severe leptospirosis (Weil’s disease). Finally, renal function disorder did not deteriorate further, and then the patient recovered after the tenth day of onset with the administration of antibiotics and supportive care without sequelae. We experienced the first imported Japanese case of severe human leptospirosis infection from Vietnam that was successfully treated with ceftriaxone and minocycline.

Background In Malawi, hematobium schistosomiasis is highly endemic. According to previous studies, countermeasures have been conducted mainly in school-aged children. In this study, we focused on the age groups, which are assumed to be major labor force generation. Hematobium schistosomiasis is supposed to be related to occupational activities in schistosome-endemic countries because of its infectious route. We chronologically followed the transition of schistosome egg-positive prevalence before and after mass drug administration of praziquantel (MDA) by using a urine filtering examination. We also analyzed the effectiveness of urine reagent strips from the cost perspective. Results The egg-positive prevalence was 34.3% (95% CI 28.5–40.5) just before MDA in June 2010 and the highest prevalence was in the age of twenties. The egg-positive prevalence reduced to 12.7% (95% CI 9.2–17.3, p < 0.01) 8 weeks after the first MDA and the prevalence reduced to 6.9% (95% CI 4.6–10.0, p < 0.01) after the second MDA in August 2011. The egg-positive prevalence after MDA in 2013 was reduced from 3.8% (95% CI 2.1–6.9) to 0.9% (95% CI 0.3–3.4) and p value was 0.050. Using urine reagent strips after MDA, the positive predictive value decreased, but the negative predictive value remained high. The cost of one urine reagent strip and one tablet of praziquantel were US$0.06 and US$0.125 in 2013 in Malawi. If the egg-positive prevalence is 40%, screening subjects for MDA using urine reagent strips, the cost reduction can be estimated to be about 24%, showing an overall cost reduction. Conclusions MDA of praziquantel can assuredly reduce schistosome egg-positive prevalence. The combination of MDA and urine reagent strips could be both a practical and cost-effective countermeasure for hematobium schistosomiasis. It is key to recognize that hematobium schistosomiasis could be considered a disease that is assumed to have some concern with occupational risk at Nkhotakota and Lilongwe in Malawi. From this point of view, it is very important to manage workers’ health; the sound labor force generation is vital for economic growth and development in these areas and countries.

24Background: In Malawi, haematobium schistosomiasis is highly endemic. According to previous studies, 25 countermeasures have been conducted mainly in school-aged children. In this study, we focused on the 26 age groups, which are assumed to be major labour force generation. Haematobium schistosomiasis is 27 supposed to be related to occupational activities in schistosome endemic countries. 28Methods: We chronologically followed the transition of schistosome egg positive prevalence before and 29 after mass drug administration of praziquantel (MDA) by using a urine filtering examination. We also 30 analyzed the effectiveness of urine reagent strips from the cost perspective. 31Findings: The egg positive prevalence was 34.3% (95%CI: 28.5-40.5) just before MDA in June 2010 and 32 the highest prevalence was in the age of twenties. The egg positive prevalence reduced to 12.7% (95%CI: 33 9.2-17.3, p<0.01) eight weeks after the first MDA and the prevalence reduced to 6.9% (95%CI: 4.6-10.0, 34 p<0.01) after the second MDA in August 2011. The egg positive prevalence after MDA in 2013 was 35 reduced from 3.8% (95%CI: 2.1-6.9) to 0.9% (95%CI: 0.3-3.4) and p value was 0.050. Using urine 36 reagent strips after MDA, the positive predictive value decreased, but the negative predictive value 37 remained high. The cost of one urine reagent strip and one tablet of praziquantel were US$0.06 and 38 US$0.125 in 2013 in Malawi. If the egg positive prevalence is 40%, screening subjects for MDA using 39 urine reagent strips, the cost reduction can be estimated to be about 24% -showing an overall cost 40 reduction. 41Conclusion: The combination of MDA and urine reagent strips could be both a practical and 42 cost-effective countermeasure for haematobium schistosomiasis. It is key to recognize that haematobium 43 schistosomiasis could be considered a disease that is assumed to have some concern with occupational 44 risk in tropical agricultural countries such as Malawi. From this point of view, it is very important to 45 protect the health of workers; the sound labour force generation is vital for economic growth and 46 development in these countries. 48Author summary 49 Schistosomiasis is widely endemic in the tropical and subtropical countries including Malawi, and it is 50 related that more than 300 million people suffer from associated severe morbidity. The pathway of 51 transmission is mainly contacting infested fresh water and it is inevitable to contact fresh water through 52 their daily activities in Malawi. Then, they are routinely exposed to the risk of schistosome infection. 53Previously the main targets of schistosome control were school-aged children, but our research showed 54 main population of schistosome infection was twenties that was presumed to be major labour force. 55Agriculture is the dominant industry in Malawi and it can be related to be at risk of schistosome infection 56 during agricultural work. Schistosomiasis is presumed to have occupation-related risks, we consider that 57 schistosome control will be a val...