Clinical Updates
23 May 2012
Flooding and leptospirosis: Peru
On 12 March 2012, Peru’s Ministry of Health reported that the Amazon River exceeded a height of 117 metres, resulting in significant flooding in many areas [1].
Peru’s National Civil Defence Institute estimates 649, 526 people throughout the country have been affected. The districts of Belen, Iquitos, Punchana and San Juan are the most severely affected. The majority of roads in Peru have been damaged, making access to some areas difficult [2].
Heavy rains in the mountains near Lima have triggered a series of flash floods and mudslides, destroying houses, roads and compromising water and electricity supplies [3].
In the Amazon department of Loreto, it is estimated that 202,676 people have been displaced, particularly in the district of Iquitos: relief efforts are focused on this region. On 29 March 2012, a State of Emergency, lasting 60 days, was declared for 18 of Peru’s 24 departments [2].
View a map of the affected areas as of 17 April 2012 [2].
Leptospirosis cases are reported throughout Peru, with 90% of cases from Iquitos district in Loreto [4, 5]. As of 17 May 2012 in Loreto 462 cases of leptospirosis (86 confirmed) and 5 deaths have been reported [6]. The majority of confirmed cases (63%) have been reported in adults between the ages of 15 and 49 years [4].
Leptospirosis
Leptospirosis is an infection caused by the bacteria Leptospira. It is transmitted by contact with infected animals (usually rats, dogs or livestock), soil or water contaminated with the urine of infected animals. Transmission is year-round in tropical areas, with increased rates during periods of heavy rainfall and flooding.
Following an incubation period of seven to ten days, illness is asymptomatic, or self-limiting in most individuals. Symptomatic disease includes fever, headache, skin rash, myalgia and meningitis. Severe illness, termed Weil’s disease, is characterised by renal and hepatic impairment and complications of arrhythmias, myocarditis, renal failure and respiratory distress and occurs in approximately 10% of cases. Between 15% and 40% of cases of severe leptospirosis are fatal, particularly in older people [7].
Advice for travellers: flooding
Flooding increases the risk of diseases transmitted by food, water and insect vectors, as well as accidents and injuries.
Tourists are advised to avoid flood affected areas. Travellers should check with the Foreign and Commonwealth Office for current travel advice.
Country-specific advice for travellers to countries to Peru is available on the NaTHNaC Country Information Pages.
General advice can also be found in NaTHNaC’s health information sheet: Advice for relief workers and other travellers to areas affected by natural disasters.
Anyone wishing to join the emergency relief effort should contact appropriate aid and charity agencies for guidance. Travelling independently, without adequate preparation, is likely to put a strain on Peru’s already challenged emergency and medical services.
Advice for travellers: leptospirosis
The risk of leptospirosis for tourists to Peru is low. Aid workers helping the flood relief effort and travellers visiting family and friends in flooded areas are at greater risk.
Measures to minimise exposure to the urine of infected animals include:
- Limiting contact with fresh water that may have been contaminated by rodent or other mammalian urine.
- Clearing rubbish from campsites and dwellings and preventing rodent access into accommodation.
- Protective clothing should be worn if in direct contact with rodents, sewage or water.
- Cuts and grazes should be covered.
There is no vaccine to prevent leptospirosis. Pre-exposure antibiotic chemoprophylaxis (doxycycline 200 mg weekly for adults) can be prescribed for individuals with unavoidable occupational or recreational exposure [7].
References
1. Peru Ministry of Health. Situacion de la Inundacion en la provincial de Maynas en el departmento Loreto 2012. 16 April 2012. [In Spanish]. [Accessed 23 May 2012]. Available at:
http://www.diresaloreto.gob.pe/portal/files/Sala_situacional_
2. International Federation of Red Cross and Red Crescent Societies. Peru: Floods. Disaster relief emergency fund operation No: MDRPE00. 17 April 2012. [Accessed 23 May 2012]. Available at:
http://adore.ifrc.org/Download.aspx?FileId=24425
3. Act Alliance Alert. Flash Mud floods in provinces of Lima and Huarochiri. 11 April 2012. [Accessed 23 May 2012]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/Alert13_
4. Peru Ministry of Health. Boletin Epidemiologico. 21 April 2012. [In Spanish]. [Accessed 23 May 2012]. Available at:
http://www.dge.gob.pe/Boletin_sem/2012/SE16/se16-03.pdf
5. Peru Ministry of Health. Direccion General de Epidemiologia: Casos Notificados de Leptospirosis. Direcciones de Salud – Ano 2012 SE.17. 28 April 2012. [In Spanish]. [Accessed 23 May 2012]. Available at: http://www.dge.gob.pe/vigilancia/descargas/2012/17/
6. Organización Panamericana de la Salud. Informe De Situacion No 3. Region Loreto: Llavias e inundacions. 17 May 2012. [In Spanish]. [Accessed 23 May 2012]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/Informe%
7. Field VF, Ford L, Hill DR eds. Leptospirosis. In: Health Information for Overseas Travel, National Travel Health Network and Centre, London, UK, 2010.
Links
Foreign and Commonwealth Office: Peru
Health Protection Agency: Leptospirosis
NaTHNaC Health Information Sheet: Leptospirosis
World Health Organization: Flooding and communicable diseases
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