Eric BERTHERAT1, Michel JANCLOES2, Emily FIRTH1, Kara DURSKI1 1WHO, Switzerland; 2Health and Climate Foundation

1. LEPTOSPIROSIS:
Strengthening the public health prevention
and outbreak control strategy
Michel Jancloes
MD, MPH, PHD
Health and Climate Foundation
4th International Disaster and Risk Conference Davos 2012

2. Global
Leptospirosis
Environmental
Action
Network
An intersectoral initiative
ERIC BERTHERAT, MD, MPH, MSc
GLEAN COORDINATOR
Pandemic and Epidemic Disease
WHO Geneva
Health and Climate
Global risk Forum Davos 28 08 2012 Foundation

3. LEPTOSPIROSIS: Magnitude
• A global endemic +epidemic disease
• Of increasing magnitude through severe
post-disaster outbreaks
• Counting annually worldwide,
– 557,000 cases
– 55,8000 deaths
• Estimated, when adjusted(LERG OMS) for
potential underreporting to cause annually
– 1,730,000 cases,
– 123,000 deaths
• http://www.who.int/zoonoses/diseases/lerg/en/
Global risk Forum Davos 28 08 2012

4. A Public Health Threat
• A Major,
– yet neglected,
– non-detected,
– under-reported disease
• Absence of control strategy due to
– Nonspecific symptoms
– Complex transmission
– Complex pathogen agent with
multiple variants
(>250 sero-variants)
• Economic Impact: an important zoonosis
• Probable impact of climate change
• Increasing concerns at country level and
request for technical support
Global risk Forum Davos 28 08 2012

5. Philippines, 2009
680 cases of leptospirosis /yr with seasonal peak during the rainy season
Typhoon
Pepeng:
3 October
Typhoon Ondoy:
26 September
Thousands of people displaced and In the 2 following weeks, 505 suspect
housed in emergency evacuation ! cases and 15 deaths in Manila alone
centers
Global risk Forum Davos 28 08 2012

6. The Global Leptospirosis Environmental Action Network
GLEAN:
GLEAN: A response to a multidisciplinary and inter-sectorial
challenge for clinicians, public health, water and sanitation
specialists, veterinarians, climatologists, biologists, statisticians,
anthropologists, economists.
Global risk Forum Davos 28 08 2012

7. GLEAN Development
To reduce the impact of post disaster outbreaks:
1. Inventory of scientific evidence-state of the arts:
Marseille 7-8 February 2011
2. Identification of knowledge and capacity gaps
ISPRA 17—19 January 2012
Detection and confirmation:
Case management
Vaccination
Mass chemoprophylaxis
Rodent control
Decontamination
Environment
Global risk Forum Davos 28 08 2012

8. GLEAN Objectives
5 years strategic plan
PREDICT PREVENT DETECT INTERVENE
Baseline Incidence? Case definition? Operational
Effectiveness of
preventive Guidance for
Main drivers and measures? outbreak control
predictive Laboratory case
value? Role of vectors? confirmation? Outbreak
preparedness
Informing public Role of human Algorithms for
health decision? and animal outbreak
vaccination ? detection ?
Tools to validate at
risk sites?
Global risk Forum Davos 28 08 2012

9. Global risk Forum Davos 28 08 2012

10. Plan 2012
• Preliminary recommendations for the control of human
leptospirosis in post disasters situations .
• Informing and mobilizing new partnership
– Literature review (Minnesota University)
– World mapping of the leptospirosis (endemic and epidemics)
(WHO Washington)
– Economic impact studies.
• Laboratory consortium development
• Rapid tests document (KIT Amsterdam et Pasteur Institut Paris)
Global risk Forum Davos 28 08 2012

11. Operational Recommendations
summary
Based on current scientific evidence based data,
the following may be recommended
1. Systematic detection and empirical treatment of probable cases
2. Collection and sending in number of laboratory samples of suspected
cases to the laboratories of reference(confirmation and identification of
pathogenic agents
3. Protection of individuals at risk by port of protection devices
4. Chemo prophylaxis of individuals at high risk
5. Mass information.(integrated health education)
In post-catastrophe phases, there is currently no evidence of impact of:
1. Mass Vaccination: (human and animal)
2. Mass chemo prophylaxis nor disinfecting waters : these measures are
limited to for high-risk workers.
3. Control of rodents out of context epidemic-(late intervention without on
human transmission)
Global risk Forum Davos 28 08 2012

12. Health and
Climate
THANKS! (photos thanks to SABY) Foundation
Global risk Forum Davos 28 08 2012