title: Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa.
abstract: BACKGROUND
  Leptospirosis is an important but neglected bacterial zoonosis that has been largely overlooked in Africa. In this systematic review, we aimed to summarise and compare current knowledge of: (1) the geographic distribution, prevalence, incidence and diversity of acute human leptospirosis in Africa; and (2) the geographic distribution, host range, prevalence and diversity of Leptospira spp. infection in animal hosts in Africa.
  
  
  METHODS
  Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched for studies that described (1) acute human leptospirosis and (2) pathogenic Leptospira spp. infection in animals. We performed a literature search using eight international and regional databases for English and non-English articles published between January 1930 to October 2014 that met out pre-defined inclusion criteria and strict case definitions.
  
  
  CONCLUSIONS
  We identified 97 studies that described acute human leptospirosis (n = 46) or animal Leptospira infection (n = 51) in 26 African countries. The prevalence of acute human leptospirosis ranged from 2 3% to 19 8% (n = 11) in hospital patients with febrile illness. Incidence estimates were largely restricted to the Indian Ocean islands (3 to 101 cases per 100,000 per year (n = 6)). Data from Tanzania indicate that human disease incidence is also high in mainland Africa (75 to 102 cases per 100,000 per year). Three major species (Leptospira borgpetersenii, L. interrogans and L. kirschneri) are predominant in reports from Africa and isolates from a diverse range of serogroups have been reported in human and animal infections. Cattle appear to be important hosts of a large number of Leptospira serogroups in Africa, but few data are available to allow comparison of Leptospira infection in linked human and animal populations. We advocate a 'One Health' approach to promote multidisciplinary research efforts to improve understanding of the animal to human transmission of leptospirosis on the African continent.
authors.affiliation: The Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Allan
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.affiliation: The Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Jo E B
authors.initials: JE
authors.lastname: Halliday
authors.affiliation: Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Rudovick R
authors.initials: RR
authors.lastname: Kazwala
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania.
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
authors.affiliation: The Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America; Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000349:Africa / Q000453:epidemiology; D000818:Animals; D002417:Cattle / Q000382:microbiology; D004197:Disease Reservoirs; D006801:Humans; D015994:Incidence; D007919:Leptospira / Q000145:classification / Q000302:isolation & purification; D007922:Leptospirosis / Q000453:epidemiology* / Q000473:pathology* / Q000662:veterinary; D058069:Neglected Diseases / Q000453:epidemiology*; D015995:Prevalence; D019371:Topography, Medical; D015047:Zoonoses / Q000453:epidemiology*