Neglecting the neglected during the COVID-19 pandemic: the case of leptospirosis in Sri Lanka

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has disrupted global health systems and affected the transmission dynamics as well as the surveillance of other infectious diseases. This study described the probable effect of the COVID-19 pandemic on the surveillance and control of leptospirosis in Sri Lanka. With 8,579 reported cases and more than 800 estimated deaths, the Sri Lankan public health surveillance system documented the largest outbreak of leptospirosis in Sri Lankan history in 2020. This was the worst infectious disease outbreak Sri Lanka experienced in 2020, but it was neglected, primarily due to the COVID-19 pandemic.

A global one health perspective on leptospirosis in humans and animals

“…Monthly case numbers increased dramatically in May 2020, shortly after imposition of aggressive lockdowns, and were maintained at levels above those for January through April for the remainder of the year. 75 There were 3,404 cases during the second quarter of 2020, an increase of 38.5% compared with the same period in 2019. In contrast, the number of Dengue fever cases declined from the previous year by 73.6%, possibly because of a drier first quarter of 2020, closure of schools and offices, and aggressive street and home cleaning that may have reduced mosquito breeding sites.…”

“…73,74 In 2020, the number of leptospirosis cases reported to Sri Lanka's surveillance system was the highest ever-8,579 cases and more than 800 estimated deaths. 75 This compared with 7,423 cases in 2008, the last time a large increase in leptospirosis occurred. Monthly case numbers increased dramatically in May 2020, shortly after imposition of aggressive lockdowns, and were maintained at levels above those for January through April for the remainder of the year.…”

“…76 It was suggested that the surge in leptospirosis may have occurred because of increased paddy field activity following the lockdowns as well as nonimplementation of a state-sponsored doxycycline prophylaxis program for individuals at risk during the pandemic. 75,76 Lockdowns were thought to have created the greatest economic impact on farmers engaged in cropping of perishables, such as vegetables; in contrast, rice was less prone to problems associated with market-ing interruptions. 77 With a drier first quarter of 2020 than usual and no unusual increases in rainfall for the remainder of 2020, rainfall patterns could not explain the increase in leptospirosis cases.…”

Coinfection of leptospirosis and coronavirus disease 2019: A retrospective case series from a coastal region in South India

“… 3 Amongst infections, chronic infections such as human immunodeficiency virus infection in the context of COVID‐19 have been discussed in many reports, but tropical infections such as leptospirosis have been largely neglected. 4 , 5 Although there are some reports of leptospirosis during the COVID‐pandemic, the complex interplay between COVID and leptospirosis has not been evaluated in detail to the best of our knowledge. 6 Leptospirosis is a febrile zoonotic disease with rodents and other small mammals serving as reservoirs.…”

“…Although the negative impact of noninfectious comorbidities, such as diabetes, hypertension, and chronic kidney disease has been widely studied, comorbid infections have primarily been neglected 3 . Amongst infections, chronic infections such as human immunodeficiency virus infection in the context of COVID‐19 have been discussed in many reports, but tropical infections such as leptospirosis have been largely neglected 4,5 . Although there are some reports of leptospirosis during the COVID‐pandemic, the complex interplay between COVID and leptospirosis has not been evaluated in detail to the best of our knowledge 6 .…”