Leptospirosis
an underestimated and potentially severe infectious disease, particularly with the serogroup icterohaemorrhagiae
Leptospirosis, an emerging public health issue
Leptospirosis is an infectious, tropical disease. Often called "rat disease" or "swineherd's disease", it's a zoonosis, as it's transmitted from animals to humans. It is not compulsory to report it, and the incidence is probably underestimated.
It is estimated that there are more than a million severe cases of leptospirosis in humans worldwide each year, including 60,000 deaths. (1)
This zoonosis is on the rise in Europe, and France is one of the industrialised countries with the highest incidence (1 case per 100,000 inhabitants). In 2014-2018, cases of leptospirosis in metropolitan France doubled compared to previous years with an average of 600 cases, i.e. more than one case a day, the highest incidence since 1920. (2)
An average of 700 cases of leptospirosis a year have been observed in the overseas departments and territories. (2)
This increase in the number of leptospirosis cases is linked to climate change, but also to the effects of increasing urbanisation, through rats. (2)
It is estimated that there are more than a million severe cases of leptospirosis in humans worldwide each year, including 60,000 deaths. (1)
This zoonosis is on the rise in Europe, and France is one of the industrialised countries with the highest incidence (1 case per 100,000 inhabitants). In 2014-2018, cases of leptospirosis in metropolitan France doubled compared to previous years with an average of 600 cases, i.e. more than one case a day, the highest incidence since 1920. (2)
An average of 700 cases of leptospirosis a year have been observed in the overseas departments and territories. (2)
This increase in the number of leptospirosis cases is linked to climate change, but also to the effects of increasing urbanisation, through rats. (2)
Leptospirosis : a potentially severe infectious disease
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Leptospirosis is a potentially serious infectious disease caused by a bacterium from the Spirochete family (Leptospira, Treponema, Borrelia, Lyme disease and Syphilis): Leptospira.
The Leptospira interrogans species is responsible for the pathogenic forms, and includes approximately twenty serogroups. (3) |
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Leptospirosis : Icterohaemorrhagiae, the most severe serogroup
Serogroup Icterohaemorrhagiae is the most frequently implicated in the most serious forms in humans in metropolitan France: (2)
In the overseas departments and territories, serogroup Icterohaemorrhagiae is predominant in the Antilles (Guadeloupe and Martinique), in French Guyana, Reunion Island, French Polynesia and New Caledonia, with the sole exception of Mayotte, where this serogroup is not found. (1)
Worldwide, serogroup Icterohaemorrhagiae is the most lethal, with a mortality rate of 13.6% of untreated cases. (8)
- Icterohaemorrhagiae is involved in 1/3 (2) of reported cases of leptospirosis
- This serogroup is identified in 2/3 of serious hospitalised cases in metropolitan France, (4) but also in other parts of the world, such as New Caledonia, (5) and up to 91% of serious hospitalised cases in the Antilles. (6, 7)
In the overseas departments and territories, serogroup Icterohaemorrhagiae is predominant in the Antilles (Guadeloupe and Martinique), in French Guyana, Reunion Island, French Polynesia and New Caledonia, with the sole exception of Mayotte, where this serogroup is not found. (1)
Worldwide, serogroup Icterohaemorrhagiae is the most lethal, with a mortality rate of 13.6% of untreated cases. (8)
Leptospirosis : caused by a bacterium that's resistant in humid environments
This bacterium can live in a humid environment for several months, in hot or cold freshwater, even in water with a temperature of 4°C. (9)
It can be found in several mammals:
In the host organism, Leptospira multiply and spread through the blood to different organs, such as the liver, lungs, or kidneys. The bacteria in the kidneys are eliminated to the natural environment via the urine, thus contaminating the soil and waterways.
It can be found in several mammals:
- domesticated animals (dogs, horses...)
- farm animals (pigs, sheep and cattle)
- wild animals (rats, coypu...)
In the host organism, Leptospira multiply and spread through the blood to different organs, such as the liver, lungs, or kidneys. The bacteria in the kidneys are eliminated to the natural environment via the urine, thus contaminating the soil and waterways.
How is leptospirosis contracted ?
As a zoonosis, leptospirosis can be transmitted to humans : (2)
- Directly : through contact with living or dead animals
- Indirectly : through contact with water polluted with the urine of contaminated animals
Leptospira can penetrate through wounds, mucous membrane (ocular, oral, nasal, etc.), or even through healthy, macerated skin.
Leptospirosis : a disease difficult to diagnose
After an incubation period of seven to 12 days, or even a month, clinical expression manifests via an influenza-like syndrome, with possible meningeal symptoms, which can suggest several diseases. (2) It is thus difficult to diagnose this disease.
Serious cases develop into potentially fatal multiple-organ failure, characterised by kidney failure, internal bleeding and jaundice, all of which can lead to hospital admission in the intensive care unit. (1, 10) For this reason, it's important to look for at-risk activities, to guide diagnosis as quickly as possible, and offer effective treatment before the effects intensify.
Serious cases develop into potentially fatal multiple-organ failure, characterised by kidney failure, internal bleeding and jaundice, all of which can lead to hospital admission in the intensive care unit. (1, 10) For this reason, it's important to look for at-risk activities, to guide diagnosis as quickly as possible, and offer effective treatment before the effects intensify.
Leptospirosis : an occupational and recreational disease
Professionals : Leptospirosis is a recognised occupational disease, and is included in table 19A of the general regime and table 5 of the agricultural regime. (11, 12)
Non-exhaustive list of at-risk professions :
· Water and sanitation workers
· Public works professionals
· Maintenance workers
· Those who work in supervisory or rescue roles for water-based activities (other than maritime)
· Farmers, particularly fish farmers
· Those in contact with mammals and rodents
Epidemiological studies demonstrate that more than half of leptospirosis cases in the working population are as a result of professional activity. (13, 14)
Leisure and sporting activities: (15)
The general population is exposed to risk when swimming or during freshwater-based leisure activities such as rafting, canyoning, triathlon, fishing, hunting, trapping etc.
Non-exhaustive list of at-risk professions :
· Water and sanitation workers
· Public works professionals
· Maintenance workers
· Those who work in supervisory or rescue roles for water-based activities (other than maritime)
· Farmers, particularly fish farmers
· Those in contact with mammals and rodents
Epidemiological studies demonstrate that more than half of leptospirosis cases in the working population are as a result of professional activity. (13, 14)
Leisure and sporting activities: (15)
The general population is exposed to risk when swimming or during freshwater-based leisure activities such as rafting, canyoning, triathlon, fishing, hunting, trapping etc.
How to protect against leptospirosis?
Prevention in a professional setting is a significant issue.
Collective prevention : (16)
· Fight against reservoirs: limit the proliferation of rodents
· Waste management: identify specific areas and ensure that waste is collected regularly
Individual prevention : (16)
· Adhere to safety instructions
· Wear appropriate protective equipment (boots, wetsuit, protective goggles)
· Avoid all contact between contaminated hands and the eyes, nose or mouth
· Disinfect and protect cutaneous wounds
· Vaccinate exposed subjects. Use should be based on official recommendations. Ask your doctor for advice.
General population : (15)
· Wash your hands with soap and water after freshwater-based leisure or sporting activities.
· If you regularly practice activities with a risk of leptospirosis, consult your doctor, who will follow the official recommendations for the general population.
Collective prevention : (16)
· Fight against reservoirs: limit the proliferation of rodents
· Waste management: identify specific areas and ensure that waste is collected regularly
Individual prevention : (16)
· Adhere to safety instructions
· Wear appropriate protective equipment (boots, wetsuit, protective goggles)
· Avoid all contact between contaminated hands and the eyes, nose or mouth
· Disinfect and protect cutaneous wounds
· Vaccinate exposed subjects. Use should be based on official recommendations. Ask your doctor for advice.
General population : (15)
· Wash your hands with soap and water after freshwater-based leisure or sporting activities.
· If you regularly practice activities with a risk of leptospirosis, consult your doctor, who will follow the official recommendations for the general population.
Leptospirosis : legal employee-protection obligations
Leptospirosis is recognised as an occupational disease
Even in the absence of illness, some companies have been convicted for not taking sufficient measures to protect employees potentially at risk of leptospirosis. In recent years, at least a half-dozen cases that have come before tribunals ended in compensation payments of up to €23,000. (19) The plaintiffs had not necessarily contracted the disease.
- worldwide, by the International Labour Organization
- in Europe, by European Directive 2000/54/EC (OJEC L. 262, 17/10/2000)
- in France, by table 19A of the General Regime, and table 5 of the Agricultural Regime of the Social Security Code(11, 12)
- In the event of failure, in the most extreme cases, the employer risks: An increase of up to €539,000 in occupational liability insurance, to be repaid to social security. (17)
- Up to five years' imprisonment (18) and a fine for the management team in the event of negligence, failed duty of care, or inexcusable conduct causing injury to an employee.
Even in the absence of illness, some companies have been convicted for not taking sufficient measures to protect employees potentially at risk of leptospirosis. In recent years, at least a half-dozen cases that have come before tribunals ended in compensation payments of up to €23,000. (19) The plaintiffs had not necessarily contracted the disease.
- In the framework of the new labour law, and decree no. 2016-1908, published in December 2016, those exposed to group 2 biological agents such as leptospirosis, must see a workplace healthcare professional :for an initial consultation, which must be conducted before taking up the position (Information and Prevention Consultation)
- for periodic medical consultations which must be scheduled at most every five years, and should be adjusted as needed (implementation of vaccination schedule, for example).
References
(1) L. Filleul et al. ; Santé Publique France - La leptospirose dans les régions et départements français d’outre-mer; Bulletin Epidémiologique Hebdomadaire ; 4 avril 2017 ; numéro 8-9
(2) M. Picardeau, Rapport annuel d’activité du CNRL 2019 pour l’année d’exercice 2018
(3) Adler B. (Ed) Leptospira and Leptospirosis, Current Topics in Microbiology and Immunology Sringer-Verlag Berlin Heidelberg 2015; 387: 1-293. DOI 10.1007/978-3- 662-45059-8
(4) JM. Estavoyer, « Leptospirose en Franche-Comté : données cliniques, biologiques et thérapeutiques. Médecine et maladies infectieuses »; Septembre 2013: pages 379-385
(5) S.Tubiana, «Risk Factors and Predictors of Severe Leptospirosis in New Caledonia» PLoS Negl Trop Dis. 2013 Jan; 7(1): e1991.
(6) P. Hochedez, «Factors Associated with Severe Leptospirosis», Martinique 2010–2013», Emerg Infect Dis. 2015 Dec; 21(12): 2221-2224.
(7) Herrmann-Storck C. ar al. Severe Leptospirosis in Hospitalized Patients, Guadeloupe.
Emerging Infectious Diseases 2010; 16(2): 331-334. doi: 10,3201/eid1602,030139
(8) Andrew J. Taylord. «A Systematic Review of the Mortality from Untreated Leptospirosis. PLoS Negl Trop Dis.»;Juin2015
(9) G. André-Fontaine, «Waterborne Leptospirosis: Survival and Preservation of the Virulence of Pathogenic Leptospira spp. in Fresh Water. »Curr Microbiol. 2015 Jul;71(1):136-42
(10) Hartskeerl et al, Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world, 2011, Clinical Microbiology and Infection, vol 17: 494- 501
(11) Decree no. 2009-1194, Journal Officiel, 07/10/2009 (Social Security Code) /
(12) Decree no. 2007-1121, 19/07/2007 (Social Security Code)
(13) Baranton G, Postic D Centre National de Référence des leptospires, Institut Pasteur Paris, Synthèse La leptospirose en France de 2001 à 2003 : 1-8.
(14) Watrin M. Étude descriptive des cas de leptospirose diagnostiqués en Normandie sur la période 2010-2014. Saint-Maurice : Institut de veille sanitaire ; 2016: 1-28.
(15) Opinion of the French High Council for Public Health on the recommendations to prevent leptospirosis in the general population (meeting of 30 September 2005)
(16) Opinion of the French High Council for Public Health on the recommendations to prevent leptospirosis in at-risk professionals (meeting of 18 March 2005)
(17) J.O., 23.11.2016 Text 19 of 113
(18) Penal Code – Article 221-6
(19) Cass. Soc. 14.10.2011 : n° 11/01292
(2) M. Picardeau, Rapport annuel d’activité du CNRL 2019 pour l’année d’exercice 2018
(3) Adler B. (Ed) Leptospira and Leptospirosis, Current Topics in Microbiology and Immunology Sringer-Verlag Berlin Heidelberg 2015; 387: 1-293. DOI 10.1007/978-3- 662-45059-8
(4) JM. Estavoyer, « Leptospirose en Franche-Comté : données cliniques, biologiques et thérapeutiques. Médecine et maladies infectieuses »; Septembre 2013: pages 379-385
(5) S.Tubiana, «Risk Factors and Predictors of Severe Leptospirosis in New Caledonia» PLoS Negl Trop Dis. 2013 Jan; 7(1): e1991.
(6) P. Hochedez, «Factors Associated with Severe Leptospirosis», Martinique 2010–2013», Emerg Infect Dis. 2015 Dec; 21(12): 2221-2224.
(7) Herrmann-Storck C. ar al. Severe Leptospirosis in Hospitalized Patients, Guadeloupe.
Emerging Infectious Diseases 2010; 16(2): 331-334. doi: 10,3201/eid1602,030139
(8) Andrew J. Taylord. «A Systematic Review of the Mortality from Untreated Leptospirosis. PLoS Negl Trop Dis.»;Juin2015
(9) G. André-Fontaine, «Waterborne Leptospirosis: Survival and Preservation of the Virulence of Pathogenic Leptospira spp. in Fresh Water. »Curr Microbiol. 2015 Jul;71(1):136-42
(10) Hartskeerl et al, Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world, 2011, Clinical Microbiology and Infection, vol 17: 494- 501
(11) Decree no. 2009-1194, Journal Officiel, 07/10/2009 (Social Security Code) /
(12) Decree no. 2007-1121, 19/07/2007 (Social Security Code)
(13) Baranton G, Postic D Centre National de Référence des leptospires, Institut Pasteur Paris, Synthèse La leptospirose en France de 2001 à 2003 : 1-8.
(14) Watrin M. Étude descriptive des cas de leptospirose diagnostiqués en Normandie sur la période 2010-2014. Saint-Maurice : Institut de veille sanitaire ; 2016: 1-28.
(15) Opinion of the French High Council for Public Health on the recommendations to prevent leptospirosis in the general population (meeting of 30 September 2005)
(16) Opinion of the French High Council for Public Health on the recommendations to prevent leptospirosis in at-risk professionals (meeting of 18 March 2005)
(17) J.O., 23.11.2016 Text 19 of 113
(18) Penal Code – Article 221-6
(19) Cass. Soc. 14.10.2011 : n° 11/01292
Documentation
Leaflet: Additional information for professionals activities at risk
To learn more about leptospirosis and its prevention: https://leptospirosis-prevention.com/
To learn more about leptospirosis and its prevention: https://leptospirosis-prevention.com/
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- In accordance with the articles 39 and the following of the law n°78-17 of the 6th of January 1978 amended in 2004 relating to data, files and freedom, and GDPR of 25 May 2018, every person can obtain information held on file concerning him or herself and, if necessary, may demand rectification or deletion of this own information by contacting IMAXIO S.A. – 5, 7 Rue Saint Roch – 75001 PARIS – France.