Globalization of leptospirosis through travel and migration

Abstract

Leptospirosis remains the most widespread zoonotic disease in the world, commonly found in tropical or temperate climates. While previous studies have offered insight into intra-national and intra-regional transmission, few have analyzed transmission across international borders. Our review aimed at examining the impact of human travel and migration on the re-emergence of Leptospirosis. Results suggest that alongside regional environmental and occupational exposure, international travel now constitute a major independent risk factor for disease acquisition. Contribution of travel associated leptospirosis to total caseload is as high as 41.7% in some countries. In countries where longitudinal data is available, a clear increase of proportion of travel-associated leptospirosis over the time is noted. Reporting patterns is clearly showing a gross underestimation of this disease due to lack of diagnostic facilities. The rise in global travel and eco-tourism has led to dramatic changes in the epidemiology of Leptospirosis. We explore the obstacles to prevention, screening and diagnosis of Leptopirosis in health systems of endemic countries and of the returning migrant or traveler. We highlight the need for developing guidelines and preventive strategies of Leptospirosis related to travel and migration, including enhancing awareness of the disease among health professionals in high-income countries.

Trends in Human Leptospirosis in Denmark, 1980 to 2012

“…Travel-related exposure was seen in 13% of our cases and is observed in other European countries, as illustrated by a recent report of two confirmed cases after travel in Spain [21]. A recent review also shows a clear increase in the proportion of travel-associated leptospirosis over time [22].…”

A Comparative Study of the Epidemiology of Human Leptospirosis in Korea and Japan between 2006 and 2012

“…Human leptospirosis (HL) has been recognized as an emerging global public health issue because of its increasing incidence rates in both developing and developed countries (6). Most of the increased incidences in developed countries have been attributed to travel and associated activities in developing countries (6,7), rather than an increase of incidence in developed countries. HL is transmitted from rodents via direct contact with infected urine or from infected surfaces.…”

Redefining Gold Standard Testing for Diagnosing Leptospirosis: Further Evidence from a Well-Characterized, Flood-Related Outbreak in Sri Lanka

“…An increasing number of leptospirosis outbreaks have been reported over the past few decades, mostly associated with environmental changes and travel. 6 Leptospirosis is widely considered to be a reemerging tropical disease. 7 Globally-in the industrialized and developing worlds alike-the point-of-care and clinically actionable diagnosis of leptospirosis remains a major challenge for clinicians and public health authorities.…”