title: Human Leptospirosis Infection in Fiji: An Eco-epidemiological Approach to Identifying Risk Factors and Environmental Drivers for Transmission.
abstract: Leptospirosis is an important zoonotic disease in the Pacific Islands. In Fiji, two successive cyclones and severe flooding in 2012 resulted in outbreaks with 576 reported cases and 7% case-fatality. We conducted a cross-sectional seroprevalence study and used an eco-epidemiological approach to characterize risk factors and drivers for human leptospirosis infection in Fiji, and aimed to provide an evidence base for improving the effectiveness of public health mitigation and intervention strategies. Antibodies indicative of previous or recent infection were found in 19.4% of 2152 participants (81 communities on the 3 main islands). Questionnaires and geographic information systems data were used to assess variables related to demographics, individual behaviour, contact with animals, socioeconomics, living conditions, land use, and the natural environment. On multivariable logistic regression analysis, variables associated with the presence of Leptospira antibodies included male gender (OR 1.55), iTaukei ethnicity (OR 3.51), living in villages (OR 1.64), lack of treated water at home (OR 1.52), working outdoors (1.64), living in rural areas (OR 1.43), high poverty rate (OR 1.74), living <100m from a major river (OR 1.41), pigs in the community (OR 1.54), high cattle density in the district (OR 1.04 per head/sqkm), and high maximum rainfall in the wettest month (OR 1.003 per mm). Risk factors and drivers for human leptospirosis infection in Fiji are complex and multifactorial, with environmental factors playing crucial roles. With global climate change, severe weather events and flooding are expected to intensify in the South Pacific. Population growth could also lead to more intensive livestock farming; and urbanization in developing countries is often associated with urban and peri-urban slums where diseases of poverty proliferate. Climate change, flooding, population growth, urbanization, poverty and agricultural intensification are important drivers of zoonotic disease transmission; these factors may independently, or potentially synergistically, lead to enhanced leptospirosis transmission in Fiji and other similar settings.
authors.affiliation: Children's Health and Environment Program, Centre for Child Health Research, The University of Queensland, Brisbane, Australia.|Queensland Children's Medical Research Institute, Brisbane, Australia.|Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Lau
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Conall H
authors.initials: CH
authors.lastname: Watson
authors.affiliation: School of Geography, Earth Science and Environment, University of the South Pacific, Suva, Fiji.
authors.forename: John H
authors.initials: JH
authors.lastname: Lowry
authors.affiliation: Queensland Children's Medical Research Institute, Brisbane, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: David
authors.affiliation: WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Forensic and Scientific Services, Health Support Queensland, Department of Health, Brisbane, Australia.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Craig
authors.affiliation: WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Forensic and Scientific Services, Health Support Queensland, Department of Health, Brisbane, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Wynwood
authors.affiliation: Fiji Centre for Communicable Disease Control, Ministry of Health, Suva, Fiji.
authors.forename: Mike
authors.initials: M
authors.lastname: Kama
authors.affiliation: Division of Pacific Technical Support, World Health Organization, Suva, Fiji.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Nilles
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D002417:Cattle; D002418:Cattle Diseases / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D057231:Climate Change; D003430:Cross-Sectional Studies; D017753:Ecosystem; D004777:Environment; D004812:Epidemiologic Methods; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006801:Humans; D007919:Leptospira / Q000276:immunology / Q000302:isolation & purification; D007922:Leptospirosis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult; D015047:Zoonoses / Q000097:blood / Q000453:epidemiology / Q000635:transmission*
chemical_list: D000907:Antibodies, Bacterial
references.citation: PLoS Negl Trop Dis. 2012;6(5):e1669
references.pmid: 22666516
references.citation: BMC Infect Dis. 2009;9:147
references.pmid: 19732423
references.citation: Trop Biomed. 2014 Jun;31(2):281-5
references.pmid: 25134896
references.citation: PLoS Negl Trop Dis. 2015;9(9):e0003843
references.pmid: 26379035
references.citation: Trop Med Int Health. 2009 Aug;14(8):926-9
references.pmid: 19552660
references.citation: Epidemiol Infect. 1994 Jun;112(3):527-31
references.pmid: 8005218
references.citation: BMC Infect Dis. 2015;15:230
references.pmid: 26072306
references.citation: Curr Top Microbiol Immunol. 2015;387:65-97
references.pmid: 25388133
references.citation: PLoS Negl Trop Dis. 2008;2(6):e256
references.pmid: 18575621
references.citation: Emerg Infect Dis. 2004 Jun;10(6):1016-22
references.pmid: 15207052
references.citation: Lancet. 1999 Sep 4;354(9181):820-5
references.pmid: 10485724
references.citation: Trans R Soc Trop Med Hyg. 1998 Nov-Dec;92(6):625-8
references.pmid: 10326104
references.citation: Med Hypotheses. 2011 Sep;77(3):339-44
references.pmid: 21652151
references.citation: Blood Transfus. 2015 Jan;13(1):32-6
references.pmid: 24960651
references.citation: Int J Epidemiol. 1999 Jun;28(3):583-90
references.pmid: 10405868
references.citation: Indian J Pediatr. 2002 Oct;69(10):855-8
references.pmid: 12450293
references.citation: BMC Infect Dis. 2012;12:19
references.pmid: 22273116
references.citation: Am J Trop Med Hyg. 2006 Feb;74(2):278-83
references.pmid: 16474084
references.citation: PLoS Negl Trop Dis. 2008;2(4):e228
references.pmid: 18431445
references.citation: Rev Environ Health. 2012;27(4):163-74
references.pmid: 23095181
references.citation: Int J Infect Dis. 2011 Sep;15(9):e611-9
references.pmid: 21763173
references.citation: Acta Trop. 2008 Sep;107(3):255-8
references.pmid: 18671932
references.citation: Emerg Infect Dis. 2012 Jan;18(1):91-4
references.pmid: 22257492
references.citation: Trans R Soc Trop Med Hyg. 2010 Oct;104(10):631-8
references.pmid: 20813388
references.citation: Environ Health Perspect. 2016 Nov;124(11):1707-1714
references.pmid: 26645102
references.citation: Med Trop (Mars). 2007 Apr;67(2):137-44
references.pmid: 17691431
references.citation: Ann Trop Med Parasitol. 2009 Mar;103(2):149-57
references.pmid: 19208299
references.citation: Trans R Soc Trop Med Hyg. 2007 Jul;101(7):714-21
references.pmid: 17442353
references.citation: BMC Infect Dis. 2014;14:186
references.pmid: 24708723
references.citation: Am J Trop Med Hyg. 2012 Feb;86(2):309-19
references.pmid: 22302868
references.citation: PLoS Negl Trop Dis. 2015;9(9):e0003898
references.pmid: 26379143
references.citation: Am J Trop Med Hyg. 2008 Jun;78(6):957-61
references.pmid: 18541776