21 November 2007

Leptospirosis in the Dominican Republic and Nicaragua

An outbreak of leptospirosis has been reported in the Dominican Republic associated with Tropical Storm Noel which passed through the Caribbean in the beginning of November 2007 [1]. A total of 26 people are reported to have died in recent weeks, although the number of new cases is now declining. The areas most affected are those that suffered flood damage following the storm in the provinces of Santo Domingo, San Cristóbal, Barahona and the National District. The main tourist areas of Dominican Republic were not affected.

Nicaragua has also reported an outbreak of leptospirosis following flooding from the storm. While six departments were affected, the majority of cases were in the departments of Chinandega and Leon, in the northwest of the country [2].

Leptospirosis is likely to be a risk in other Central American and Caribbean countries affected by Tropical Storm Noel.

The disease can occur following heavy rains and flooding when Leptospira that have contaminated soil or other ground surfaces, are washed into flooded areas.  

Advice for travellers

Leptospirosis is caused by bacteria of the genus Leptospira. The bacteria are harboured in the kidneys of animal hosts, including rodents, dogs and cattle, and are then excreted in urine. Transmission to humans occurs when the bacteria penetrate skin or mucous membranes following contact with infected animals, or soil and water contaminated by animal urine. Travellers at higher risk include adventure travellers who participate in water sports including swimming or white water rafting.

Travellers are advised to avoid exposure to fresh water or soil that may have been contaminated by rodent or other mammal urine. Travellers going for relief or aid work should wear protective clothing and cover cuts and abrasions with waterproof bandages. Antibiotic prophylaxis with doxycycline can be offered to travellers who may be unavoidably exposed to rodents or water [3].

Travellers to areas affected by flooding are also at increased risk of other hazards including food and water borne illnesses and insect borne diseases such as dengue. Specific advice for travellers to Dominican Republic and Nicaragua can be found on the NaTHNaC Country Information Page.

References

1. Secretaría de Estado de Salud Pública y Asistencia Social. Se reduce el ingreso de pacientes afectados de leptospirosis en los hospitales del país en las ultimas 72 horas. 19 November 2007. [Accessed 21 November 2007]. [In Spanish] Available at http://www.sespas.gov.do/Institucional/noticias_sespas_

full.asp?id_news=176

2. Centers for Disease Control and Prevention. Flooding and Leptospirosis in Nicaragua. 6 November 2007. [Accessed 21 November 2007]. Available at: http://wwwn.cdc.gov/travel/contentNicaraguaLepto.aspx

3. Takafuji ET, Kirkpatrick JW, Miller RN, et al. An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. N Engl J Med 310:497-500, 1984

Link

NaTHNaC Health Information Sheet on Leptospirosis

http://www.nathnac.org/travel/factsheets/leptospirosis.htm