title: Underestimation of Leptospirosis Incidence in the French West Indies.
abstract: BACKGROUND
  Leptospirosis is a neglected zoonosis affecting mainly tropical and subtropical regions worldwide, particularly South America and the Caribbean. As in many other countries, under-reporting of cases was suspected in the French West Indies because of inadequate access to diagnostic tests for the general population.
  
  
  RESULTS
  In order to estimate the real incidence of leptospirosis in Guadeloupe and Martinique, a study was performed in 2011 using the three prevailing available biological tests for diagnosis: Microscopic Agglutination Test (MAT), IgM ELISA and PCR. The study investigated inpatients and outpatients and used active case ascertainment from data provided by a general practitioners' sentinel network. The epidemiology of the disease was also described in terms of severity and demographic characteristics. Leptospirosis incidence was estimated at 69.4 (95%CI 47.6-91.1) and 60.6 (95%CI 36.3-85.0) annual cases per 100,000 inhabitants in Guadeloupe and Martinique, respectively, which was 3 and 4 times higher than previous estimations.
  
  
  CONCLUSIONS
  Inclusion of PCR and IgM ELISA tests for diagnosis of leptospirosis resulted in improved sensitivity in comparison with MAT alone. Our results highlighted the substantial health burden of the disease in these two territories and the importance of access to appropriate laboratory tests. Based on our results, PCR and IgM ELISA tests have now been included in the list of tests reimbursed by the national system of social security insurance in France. Our results also underline the relevance of implementing an integrated strategy for the surveillance, prevention and control of leptospirosis in the French West Indies.
authors.affiliation: Interregional Epidemiology Unit for Antilles-Guyane, French Institute for Public Health Surveillance, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cassadou
authors.affiliation: Interregional Epidemiology Unit for Antilles-Guyane, French Institute for Public Health Surveillance, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Rosine
authors.affiliation: Interregional Epidemiology Unit for Antilles-Guyane, French Institute for Public Health Surveillance, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Flamand
authors.affiliation: Interregional Epidemiology Unit for Antilles-Guyane, French Institute for Public Health Surveillance, Paris, France.
authors.forename: Martina
authors.initials: M
authors.lastname: Escher
authors.affiliation: Interregional Epidemiology Unit for Antilles-Guyane, French Institute for Public Health Surveillance, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Ledrans
authors.affiliation: Institut Pasteur, "Biology of Spirochetes" unit, National Reference Center and WHO Collaborating Center for leptospirosis, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Bourhy
authors.affiliation: Institut Pasteur, "Biology of Spirochetes" unit, National Reference Center and WHO Collaborating Center for leptospirosis, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Picardeau
authors.affiliation: French Institute for Public Health Surveillance, Fort de France, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Quénel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000372:Agglutination Tests; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000097:blood; D003710:Demography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005602:France; D019430:Guadeloupe / Q000453:epidemiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008395:Martinique / Q000453:epidemiology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D016054:DNA, Protozoan; D007075:Immunoglobulin M