The globalization of leptospirosis: worldwide incidence trends.
OBJECTIVE
Leptospirosis continues to be a significant zoonosis of the developing world. Globalization, in the context of international travel, particularly for recreational activities and military expeditions, has led to increased exposure of individuals from the developed world to the disease, as recent outbreaks show.


METHODS
We evaluated the trends in annual leptospirosis incidence for individual countries worldwide through reports from national and international organizations, the published medical literature on the subject, and web searches with the terms 'leptospirosis' and the individual country names. Inter-country variations in leptospirosis incidence, when relevant official data were available, were also analyzed.


RESULTS
The Caribbean and Latin America, the Indian subcontinent, Southeast Asia, Oceania, and to a lesser extent Eastern Europe, are the most significant foci of the disease, including areas that are popular travel destinations.


CONCLUSIONS
Leptospirosis is a re-emerging zoonosis of global importance and unique environmental and social correlations. Attempts at global co-ordination and recognition of the true burden of an infectious disease with significant mortality should be encouraged.
Institute of Continuing Medical Education of Ioannina (ICMEI), Har. Trikoupi 10, Ioannina, 45333, Greece. gpele@otenet.gr
Georgios
G
Pappas
Photini
P
Papadimitriou
Vasiliki
V
Siozopoulou
Leonidas
L
Christou
Nikolaos
N
Akritidis
D000818:Animals; D003906:Developing Countries; D004196:Disease Outbreaks; D014943:Global Health; D006801:Humans; D007922:Leptospirosis / Q000453:epidemiology*; D015995:Prevalence; D014195:Travel; D015047:Zoonoses / Q000453:epidemiology / Q000635:transmission