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A Case–Control Study of Environmental and Occupational Risks of Leptospirosis in Sri Lanka

A Correction to this article was published on 01 September 2019

This article has been updated

Abstract

Sri Lanka has one of the highest incidences of human leptospirosis worldwide. Outbreaks of this zoonotic infection are related to the monsoons and flooding. The study investigates risk factors associated with environmental, animal and occupational exposure while acknowledging the potential bias due to hanta viral infections in the study samples. Data were obtained from structured interviews with 483 patients (276 cases and 207 controls). Risk exposures were studied for the entire population and for two stratified occupational groups: non-paddy workers and paddy workers. A higher odds ratio (OR) of leptospirosis transmission for paddy workers was observed compared to non-paddy workers (OR 1.905, 95% CI 1.274–2.856). Rat exposure was not associated with a significant higher risk for any of the groups. Instead, cattle and household animals seemed to be important for transmission of leptospirosis to humans, especially among non-paddy workers (OR 10.655, 95% CI 1.213–93.582). Leptospirosis in paddy workers was associated with environmental factors linked to contamination and wetness in paddy fields. Interestingly, abandoned paddy fields were found to have a protective effect against transmission to paddy workers (OR 0.421, 95% CI 0.237–0.748). Keeping animals on these dryer fields may act as a boundary for contamination of paddy fields with infectious animal urine. This finding may be considered as a public health intervention targeting leptospirosis among paddy workers.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

  • 12 November 2019

    The original version of this article unfortunately contained a mistake in one of the co-author’s family name. The correct name should be Janith Warnasekara instead of Janith Warnasuriya. The original article has been corrected.

References

  1. Agampodi SB, Agampodi TC, Thalagala E, Perera S, Chandraratne S and Fernando S (2010a) Do People Know Adequately about Leptospirosis? A Knowledge Assessment Survey in Post-outbreak Situation in Sri Lanka, International Journal of Preventive Medicine. India: Medknow Publications, 1(3), pp. 158–163. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075525/

  2. Agampodi SB, Peacock S, Thevanesam V et al. (2011) ‘Leptospirosis outbreak in Sri Lanka in 2008: lessons for assessing the global burden of disease’, The American Journal of Tropical Medicine and Hygiene, 85(3), pp. 471–478. https://doi.org/10.4269/ajtmh.2011.11-0276

    Article  PubMed  PubMed Central  Google Scholar 

  3. Agampodi SB. Matthias M, Moreno A et al. (2012) ‘Utility of Quantitative Polymerase Chain Reaction in Leptospirosis Diagnosis: Association of Level of Leptospiremia and Clinical Manifestations in Sri Lanka’, Clinical Infectious Diseases. Oxford University Press, 54(9), pp. 1249–1255. https://doi.org/10.1093/cid/cis035.

    CAS  Article  Google Scholar 

  4. Agampodi SB, Moreno A, Vinetz J et al. (2013) ‘Short report: Utility and limitations of direct multi-locus sequence typing on qPCR-positive blood to determine infecting Leptospira strain’, American Journal of Tropical Medicine and Hygiene, 88(1), pp. 184–185. https://doi.org/10.4269/ajtmh.2012.12-0526.

    CAS  Article  PubMed  Google Scholar 

  5. Agampodi SB, Dahanayaka N, Bandaranayaka A et al. (2014) ‘Regional differences of leptospirosis in Sri Lanka: observations from a flood-associated outbreak in 2011’, PLoS neglected tropical diseases, 8(1), p. e2626. https://doi.org/10.1371/journal.pntd.0002626.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Agampodi SB, Nugegoda D, Thevanesam V et al. (2015) ‘Characteristics of rural leptospirosis patients admitted to referral hospitals during the 2008 leptospirosis outbreak in Sri Lanka: implications for developing public health control measures’, The American Journal of Tropical Medicine and Hygiene, 92(1), pp. 139–144. https://doi.org/10.4269/ajtmh.14-0465.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Agampodi SB, Dahanayaka N, Nöckler K et al. (2016) ‘Redefining gold standard testing for diagnosing leptospirosis: Further evidence from a well-characterized, flood-related outbreak in Sri Lanka’, American Journal of Tropical Medicine and Hygiene, 95(3), pp. 531–536. https://doi.org/10.4269/ajtmh.16-0033.

    CAS  Article  PubMed  Google Scholar 

  8. Agampodi SB, Nugegoda DB and Thevanesam V (2010b) ‘Determinants of leptospirosis in Sri Lanka: Study Protocol’, BMC Infectious Diseases. BioMed Central, 10(1), p. 332. https://doi.org/10.1186/1471-2334-10-332.

    Article  Google Scholar 

  9. Alderman K, Turner LR and Tong S (2012) ‘Floods and human health: a systematic review’, Environment International, 47, pp. 37–47. https://doi.org/10.1016/j.envint.2012.06.003.

    Article  PubMed  Google Scholar 

  10. Anonymous (2011) Second National Communication on Climate ChangeSubmission to UNFCCC Secretariat. Ministry of Environment. Available at: http://www.climatechange.lk/Publications.html (Accessed: 7 January 2018).

  11. Chadsuthi S, Modchang C, Lenbury Y et al. (2012) ‘Modeling seasonal leptospirosis transmission and its association with rainfall and temperature in Thailand using time-series and ARIMAX analyses’, Asian Pacific Journal of Tropical Medicine, 5(7), pp. 539–546. https://doi.org/10.1016/s1995-7645(12)60095-9.

    Article  PubMed  Google Scholar 

  12. Clement J, Nield G, Hinrichsen, SL et al. (1999) ‘Urban leptospirosis versus urban hantavirus infection in Brazil’, The Lancet, 354, 2003-2004.

    CAS  Article  Google Scholar 

  13. Clement J, Van Esbroeck M, Lagrou K et al. (2014) ‘Letter to the Editor: Leptospirosis versus hantavirus infections in the Netherlands and in Belgium, 2000 to 2014’, Eurosurveillance, 19(38), pp. 2–3. https://doi.org/10.2807/1560-7917.es2014.19.38.20912.

    Article  Google Scholar 

  14. Costa F, Hagan J, Calcagno J et al. (2015) ‘Global Morbidity and Mortality of Leptospirosis: A Systematic Review’, PLoS neglected tropical diseases, 9(9), p. e0003898. https://doi.org/10.1371/journal.pntd.0003898.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dahanayaka NJ, Warnasekara Y, Rajapakse R et al. (2017) ‘Validity of Lateral Flow Immunochromatographic-Assays (LFIA) in diagnosis of leptospirosis’, Ceylon Medical Journal. The Sri Lanka Medical Association, 62(4), p. 248. https://doi.org/10.4038/cmj.v62i4.8579.

    CAS  Article  Google Scholar 

  16. Ellis WA (1994) ‘Leptospirosis as a cause of reproductive failure’, The Veterinary Clinics of North America. Food Animal Practice, 10(3), pp. 463–478.

    CAS  Article  Google Scholar 

  17. Finlayson CM and Horwitz P (2015) ‘Wetlands as Settings for Human Health—the Benefits and the Paradox’, in Finlayson CM, Horwitz P and Weinstein P (eds) Wetlands and Human Health. Dordrecht: Springer Netherlands, pp. 1–13.

    Chapter  Google Scholar 

  18. Gamage CD, Yasuda S, Nishio S et al. (2011) ‘Serological evidence of Thailand virus-related hantavirus infection among suspected leptospirosis patients in Kandy, Sri Lanka’, Japanese Journal of Infectious Diseases, 64(1), pp. 72–75.

    PubMed  Google Scholar 

  19. Gamage CD, Koizumi N, Perera A et al. (2014) ‘Carrier status of leptospirosis among cattle in Sri Lanka: A zoonotic threat to public health’, Transboundary and Emerging Diseases, 61(1), pp. 91–96. https://doi.org/10.1111/tbed.12014.

    CAS  Article  PubMed  Google Scholar 

  20. Haake DA and Levett PN (2015) ‘Leptospirosis in humans’, Current Topics in Microbiology and Immunology, 387, pp. 65–97. https://doi.org/10.1007/978-3-662-45059-8_5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. Lau CL, Smythe L, Craig S et al. (2010) ‘Climate change, flooding, urbanisation and leptospirosis: fuelling the fire?’, Transactions of the Royal Society of Tropical Medicine and Hygiene, 104(10), pp. 631–638. https://doi.org/10.1016/j.trstmh.2010.07.002.

    Article  PubMed  Google Scholar 

  22. Mwachui MA, Crump L, Hartskeerl R et al. (2015) ‘Environmental and Behavioural Determinants of Leptospirosis Transmission: A Systematic Review’, PLoS neglected tropical diseases, 9(9), p. e0003843. https://doi.org/10.1371/journal.pntd.0003843.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Niloofa R, Fernando N, de Silva N et al (2015) Diagnosis of Leptospirosis: Comparison between Microscopic Agglutination Test, IgM-ELISA and IgM Rapid Immunochromatography Test. PloS one 10(6):e0129236. 10.1371/journal.pone.0129236.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Samarakoon YM and Gunawardena N (2013) ‘Knowledge and self-reported practices regarding leptospirosis among adolescent school children in a highly endemic rural area in Sri Lanka’, Rural and Remote Health, 13(4), p. 2360.

    PubMed  Google Scholar 

  25. Sunil-Chandra NP, Clement J, Maes P et al. (2015) ‘Concomitant leptospirosis-hantavirus co-infection in acute patients hospitalized in Sri Lanka: Implications for a potentially worldwide underestimated problem’, Epidemiology and Infection, 143(10), pp. 2081–2093. https://doi.org/10.1017/s0950268814003707.

    CAS  Article  PubMed  Google Scholar 

  26. Terpstra WJ (ed.) (2003) Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization.

    Google Scholar 

  27. Torgerson PR, Hagan J, Costa F et al. (2015) ‘Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years’, PLoS neglected tropical diseases, 9(10), p. e0004122. https://doi.org/10.1371/journal.pntd.0004122.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Warnasekara JN and Agampodi SB (2017) Leptospirosis in Sri Lanka. Sri Lankan Journal of Infectious Diseases. 7 (2), 67-75 https://doi.org/10.4038/sljid.v7i2.8155.

    Article  Google Scholar 

  29. Warnasekara J, Koralegedara I and Agampodi S (2019) ‘Estimating the burden of leptospirosis in Sri Lanka; A systematic review’, BMC Infectious Diseases, 19 (1), 1–12. https://doi.org/10.1186/s12879-018-3655-y.

    Article  Google Scholar 

  30. Whitmee S, Haines A, Beyrer C et al. (2015) ‘Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation-Lancet Commission on planetary health’, The Lancet. Elsevier Ltd, 386(10007), 1973–2028. https://doi.org/10.1016/s0140-6736(15)60901-1.

    Article  Google Scholar 

  31. Zhang C, Wang H and Yan J (2012) ‘Leptospirosis prevalence in Chinese populations in the last two decades’, Microbes and Infection, 14(4), pp. 317–323. https://doi.org/10.1016/j.micinf.2011.11.007.

    Article  PubMed  Google Scholar 

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Correspondence to Peter Furu.

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The authors declare that they have no conflict of interest.

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“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Additional information

The original version of this article was revised: the family name of the co-author Janith Warnasekara was corrected.

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Schønning, M.H., Phelps, M.D., Warnasekara, J. et al. A Case–Control Study of Environmental and Occupational Risks of Leptospirosis in Sri Lanka. EcoHealth 16, 534–543 (2019). https://doi.org/10.1007/s10393-019-01448-w

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Keywords

  • Zoonoses
  • Leptospirosis risk factors
  • Planetary health