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The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks

Author

Listed:
  • Maria Cristina Schneider

    (PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA)

  • Jorge Velasco-Hernandez

    (Instituto de Matematicas, National Autonomous University of Mexico, Juriquilla 76230, Mexico)

  • Kyung-duk Min

    (PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA)

  • Deise Galan Leonel

    (PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA)

  • David Baca-Carrasco

    (Instituto de Matematicas, National Autonomous University of Mexico, Juriquilla 76230, Mexico)

  • Matthew E. Gompper

    (School of Natural Resources, University of Missouri, Columbia, MO 65211, USA)

  • Rudy Hartskeerl

    (WHO/FAO/OIE and National Leptospirosis Reference Centre, Amsterdam 1105, The Netherlands)

  • Claudia Munoz-Zanzi

    (Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA)

Abstract

Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types). Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.

Suggested Citation

  • Maria Cristina Schneider & Jorge Velasco-Hernandez & Kyung-duk Min & Deise Galan Leonel & David Baca-Carrasco & Matthew E. Gompper & Rudy Hartskeerl & Claudia Munoz-Zanzi, 2017. "The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks," IJERPH, MDPI, vol. 14(6), pages 1-18, June.
    • Handle: RePEc:gam:jijerp:v:14:y:2017:i:6:p:594-:d:100441
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    References listed on IDEAS

    as
    1. Julienne Rawlins & Alexandra Portanova & Ilana Zuckerman & Amanda Loftis & Pietro Ceccato & Arve Lee Willingham & Ashutosh Verma, 2014. "Molecular Detection of Leptospiral DNA in Environmental Water on St. Kitts," IJERPH, MDPI, vol. 11(8), pages 1-8, August.
    2. Jorge Bacallao & Maria Cristina Schneider & Patricia Najera & Sylvain Aldighieri & Aida Soto & Wilmer Marquiño & Carlos Sáenz & Eduardo Jiménez & Gilberto Moreno & Octavio Chávez & Deise I. Galan & Ma, 2014. "Socioeconomic Factors and Vulnerability to Outbreaks of Leptospirosis in Nicaragua," IJERPH, MDPI, vol. 11(8), pages 1-18, August.
    3. Maria Cristina Schneider & Michel Jancloes & Daniel F. Buss & Sylvain Aldighieri & Eric Bertherat & Patricia Najera & Deise I. Galan & Kara Durski & Marcos A. Espinal, 2013. "Leptospirosis: A Silent Epidemic Disease," IJERPH, MDPI, vol. 10(12), pages 1-6, December.
    4. Kara N. Durski & Michel Jancloes & Tej Chowdhary & Eric Bertherat, 2014. "A Global, Multi-Disciplinary, Multi-Sectorial Initiative to Combat Leptospirosis: Global Leptospirosis Environmental Action Network (GLEAN)," IJERPH, MDPI, vol. 11(6), pages 1-9, June.
    5. Claudia Muñoz-Zanzi & Meghan R. Mason & Carolina Encina & Angel Astroza & Alex Romero, 2014. "Leptospira Contamination in Household and Environmental Water in Rural Communities in Southern Chile," IJERPH, MDPI, vol. 11(7), pages 1-15, June.
    6. Dim Coumou & Stefan Rahmstorf, 2012. "A decade of weather extremes," Nature Climate Change, Nature, vol. 2(7), pages 491-496, July.
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