Molecular detection of Leptospira spp. in rats as early spatial predictor for human disease in an endemic urban area

Prevalence, genetic diversity and eco-epidemiology of pathogenic Leptospira species in small mammal communities in urban parks Lyon city, France

Rodents are recognized as the main reservoirs of Leptospira spp. Rats, in particular, serve as hosts for the widely predominant Leptospira interrogans serovar Icterohaemorrhagiae, found worldwide. Several studies have shown the importance of other reservoirs, such as mice or hedgehogs, which harbor other leptospires' serovars. Nevertheless, our knowledge of circulating Leptospira spp. in reservoirs other than rats remains limited. In this context, we proposed an eco-health approach to assess the health hazard associated with leptospires in urban green spaces, where contacts between human/small mammals and domestic animals are likely. We studied the prevalence, the diversity of circulating strains, and epidemiology of pathogenic Leptospira species in small terrestrial mammal communities (rodents and shrews), between 2020-2022, in two parks in Lyon metropolis, France. Our study showed a significant carriage of Leptospira spp. in small terrestrial mammals in these parks and unveiled a global prevalence rate of 11.4%. Significant variations of prevalence were observed among the small mammal species (from 0 to 26.1%), with Rattus norvegicus exhibiting the highest infection levels (26.1%). We also observed strong spatio-temporal variations in Leptospira spp. circulation in its reservoirs. Prevalence seems to be higher in the peri-urban park and in autumn in 2021 and 2022. This is potentially due to differences in landscape, abiotic conditions and small mammal communities' composition. Our study suggests an important public health relevance of rats and in a lesser extent of other rodents (Apodemus spp., Clethrionomys glareolus and Mus musculus) as reservoirs of L. interrogans, with rodent species carrying specific serogroups/serovars. We also emphasize the potential hazard associated between the shrew Crocidura russula and L. kirschneri. Altogether, these results improve our knowledge about the prevalence of leptospirosis in an urban environment, which is an essential prerequisite for the implementation of prevention of associated risks.

Optimal control and cost-effectiveness analysis for leptospirosis epidemic

This paper aims to apply an optimal control theory for the autonomous model of the leptospirosis epidemic to examine the effect of four time-dependent control measures on the model dynamics with cost-effectiveness. Pontryagin's Maximum Principle was used to derive the optimality system associated with the optimal control problem. Numerical simulations of the optimality system were performed for different control strategies and the results were presented graphically with and without controls. The optimality system was simulated using the Forward-Backward Sweep method in the Matlab programme. The numerical results revealed that the combination of all optimal control measures is the most effective strategy for minimizing the spread and impact of disease in the community. Furthermore, a cost-effectiveness analysis was performed to determine the most cost-effective strategy using the incremental cost-effectiveness ratio approach and we observed that the rodenticide control-only strategy is most effective to combat the spread of disease when available resources are limited.

A Mathematical Model Analysis for the Transmission Dynamics of Leptospirosis Disease in Human and Rodent Populations

This work is aimed at formulating and analyzing a compartmental mathematical model to investigate the impact of rodent-born leptospirosis on the human population by considering a load of pathogenic agents of the disease in an environment and the incidence rate of human infection due to the interaction between infected rodents and the environment. Firstly, the basic properties of the model, the equilibria points, and their stability analysis are studied. We also found the basic reproduction number (R₀) of the model using the next-generation matrix approach. From the stability analysis, we obtained that the disease-free equilibrium (DFE) is globally asymptotically stable if R₀ < 1 and unstable otherwise. The local stability of endemic equilibrium is performed using the phenomenon of the center manifold theory, and the model exhibits forward bifurcation. The most sensitive parameters on the model outcome are also identified using the normalized forward sensitivity index. Finally, numerical simulations of the model are performed to show the stability behavior of endemic equilibrium and the varying effect of the human transmission rates, human recovery rate, and the mortality rate rodents on the model dynamics. The model is simulated using the forward fourth-order Runge-Kutta method, and the results are presented graphically. From graphical stability analysis, we observed that all trajectories of the model solutions evolve towards the unique endemic equilibrium over time when R₀ > 1. Our numerical results revealed that decreasing the transmission rates and increasing the rate of recovery and reduction of the rodent population using appropriate intervention mechanisms have a significant role in reducing the spread of disease infection in the population.

Linking rattiness, geography and environmental degradation to spillover Leptospira infections in marginalised urban settings: An eco-epidemiological community-based cohort study in Brazil

Background

Zoonotic spillover from animal reservoirs is responsible for a significant global public health burden, but the processes that promote spillover events are poorly understood in complex urban settings. Endemic transmission of Leptospira, the agent of leptospirosis, in marginalised urban communities occurs through human exposure to an environment contaminated by bacteria shed in the urine of the rat reservoir. However, it is unclear to what extent transmission is driven by variation in the distribution of rats or by the dispersal of bacteria in rainwater runoff and overflow from open sewer systems.

Methods

We conducted an eco-epidemiological study in a high-risk community in Salvador, Brazil, by prospectively following a cohort of 1401 residents to ascertain serological evidence for leptospiral infections. A concurrent rat ecology study was used to collect information on the fine-scale spatial distribution of 'rattiness', our proxy for rat abundance and exposure of interest. We developed and applied a novel geostatistical framework for joint spatial modelling of multiple indices of disease reservoir abundance and human infection risk.

Results

The estimated infection rate was 51.4 (95%CI 40.4, 64.2) infections per 1000 follow-up events. Infection risk increased with age until 30 years of age and was associated with male gender. Rattiness was positively associated with infection risk for residents across the entire study area, but this effect was stronger in higher elevation areas (OR 3.27 95% CI 1.68, 19.07) than in lower elevation areas (OR 1.14 95% CI 1.05, 1.53).

Conclusions

These findings suggest that, while frequent flooding events may disperse bacteria in regions of low elevation, environmental risk in higher elevation areas is more localised and directly driven by the distribution of local rat populations. The modelling framework developed may have broad applications in delineating complex animal-environment-human interactions during zoonotic spillover and identifying opportunities for public health intervention.

Funding

This work was supported by the Oswaldo Cruz Foundation and Secretariat of Health Surveillance, Brazilian Ministry of Health, the National Institutes of Health of the United States (grant numbers F31 AI114245, R01 AI052473, U01 AI088752, R01 TW009504 and R25 TW009338); the Wellcome Trust (102330/Z/13/Z), and by the Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB/JCB0020/2016). MTE was supported by a Medical Research UK doctorate studentship. FBS participated in this study under a FAPESB doctorate scholarship.

Seroprevalence and Molecular Characterization of Leptospira spp. in Rats Captured near Pig Farms in Colombia

Gram-negative spirochete Leptospira spp. causes leptospirosis. Leptospirosis is still a neglected disease, even though it can cause potentially fatal infections in a variety of species including humans. The purpose of this study was to determine the seroprevalence of leptospirosis in pig farm captured rodents and characterize the isolated samples. Rats were captured, sampled, and euthanized in the vicinity of pig farms to obtain serum for microagglutination tests (MAT) and kidney tissues for PCR amplification of the 16S rRNA and LipL32 genes. A fraction of the 16S rRNA PCR product was sequenced and phylogenetically analyzed. The results showed a Leptospira seroprevalence of 13.8% (77/555) among the 555 captured rats. PCR positivity for Leptospira spp. reached 31.2% (156/500), and the positivity for pathogenic Leptospira spp. was 4% (22/500). Phylogenetic analysis matched eight samples with L. interrogans serovar icterohaemorrhagiae and two with L. interrogans serovar pyrogenes. Two sequences were located within the pathogenic Leptospira clade but did not match with any specific strain. The seroprevalence found in the rats around swine farms indicates a potential risk of transmission to the pigs. The identification of pathogenic Leptospira outlines the importance of more research as well as updating the current strategies for the diagnosis, control, and prevention of porcine leptospirosis in Colombia.

Monitoring Urban Zoonotic Virus Activity: Are City Rats a Promising Surveillance Tool for Emerging Viruses?

Urban environments represent unique ecosystems where dense human populations may come into contact with wildlife species, some of which are established or potential reservoirs for zoonotic pathogens that cause human diseases. Finding practical ways to monitor the presence and/or abundance of zoonotic pathogens is important to estimate the risk of spillover to humans in cities. As brown rats (Rattus norvegicus) are ubiquitous in urban habitats, and are hosts of several zoonotic viruses, we conducted longitudinal sampling of brown rats in Vienna, Austria, a large population center in Central Europe. We investigated rat tissues for the presence of several zoonotic viruses, including flaviviruses, hantaviruses, coronaviruses, poxviruses, hepatitis E virus, encephalomyocarditis virus, and influenza A virus. Although we found no evidence of active infections (all were negative for viral nucleic acids) among 96 rats captured between 2016 and 2018, our study supports the findings of others, suggesting that monitoring urban rats may be an efficient way to estimate the activity of zoonotic viruses in urban environments.

Effect of Sewerage on the Contamination of Soil with Pathogenic Leptospira in Urban Slums

Leptospirosis is an environmentally transmitted zoonotic disease caused by pathogenic Leptospira spp. that affects poor communities worldwide. In urban slums, leptospirosis is associated with deficient sanitary infrastructure. Yet, the role of sewerage in the reduction of the environmental contamination with pathogenic Leptospira has not been explored. Here, we conducted a survey of the pathogen in soils surrounding open and closed sewer sections in six urban slums in Brazil. We found that soils surrounding conventionally closed sewers (governmental interventions) were 3 times less likely to contain pathogenic Leptospira (inverse OR 3.44, 95% CI = 1.66-8.33; p < 0.001) and contained a 6 times lower load of the pathogen (0.82 log10 units difference, p < 0.01) when compared to their open counterparts. However, no differences were observed in community-closed sewers (poor-quality closings performed by the slum dwellers). Human fecal markers (BacHum) were positively associated with pathogenic Leptospira even in closed sewers, and rat presence was not predictive of the presence of the pathogen in soils, suggesting that site-specific rodent control may not be sufficient to reduce the environmental contamination with Leptospira. Overall, our results indicate that sewerage expansion to urban slums may help reduce the environmental contamination with the pathogen and therefore reduce the risk of human leptospirosis.

The Behavior of Consumers and Producers of Food of Animal Origin and Their Impacts in One Health

Most people consume animal foods, for example meats, but few are concerned with the quality and origin of these products. Many studies point out hygiene problems of these foods after production; however, the lack of knowledge of the consumers of animal products about the importance of hygienic-sanitary control during the production process can lead them to a bad choice when buying these products and, consequently, expose themselves to the risk of acquiring many diseases, such as zoonosis. In this perspective, the objective of this work is to reflect about the consumers' role in the production of safe food of animal origin and to show that the population's health education is necessary and urgent. Only by helping the consumers to obtain knowledge about the production of animal products origin will there be a change in consumption habits, preventing the ingestion of contaminated foods that can cause damage to human health and to the environment, consequently, promoting one's health.

Leptospira interrogans infection of southern tamanduas (Tamandua tetradactyla, Linnaeus, 1758) in Brazil

Leptospirosis is a zoonotic disease of global importance caused by an obligate aerobic spirochaete that infects a wide variety of domestic and wild animals. Natural hosts are asymptomatic or show moderate signs of the disease. Accidental hosts develop a severe, often lethal, form of the disease. All young southern tamanduas died suddenly at the zoo in the city of João Pessoa, Brazil. The animals were found dead without any noticeable clinical signs. Necropsy revealed extensive haemorrhage in the subcutaneous tissues, kidneys, lungs in addition to the presence of red fluid in the thoracic, abdominal and pericardial cavities. Histopathology of kidneys exhibited acute interstitial nephritis and tubular necrosis. Immunohistochemical staining revealed typical leptospiral wavy forms and aggregates in the lumen of several kidney tubules and lungs. Pathological and molecular investigations confirmed Leptospira interrogans infection. The adult tamanduas did not present with clinical alterations. To our knowledge, this investigation is the first study to report that leptospirosis should be considered as a possible cause of death in tamanduas. This article warns of the risks of anthropization with respect to Leptospira transmission to tamanduas, other animals and humans.

Epidemiology, clinical and laboratory findings of leptospirosis in Southwestern Greece

Background: Leptospirosis is a zoonosis with global distribution. The aim of the present study was to determine epidemiological, clinical and laboratory characteristics of leptospirosis in Greece.Methods: We retrospectively reviewed the clinical and laboratory profile as well as the outcome of all adults with confirmed leptospirosis in our Tertiary Referral centre in Southwestern Greece from 2013 to 2017.Results: Thirty-one men and fourteen women (mean age: 55.5 ± 13.8 years), were diagnosed with leptospirosis based on compatible clinical course and positive serology for IgM antibodies. Thirty-two (71.1%) lived in rural areas and the majority of infections (88.8%) were autochthonous, acquired in Southwestern Greece. Eighteen patients (40%) reported occupational exposure. The most prevalent clinical feature was fever (93.3%), followed by headache (66%), hematuria (31.1%), conjunctival suffusion and hepatomegaly (26.6%), dyspnoea, tachypnoea and splenomegaly (17.7%). One patient died due to pulmonary hemorrhage. Increased CRP (median 19 mg/dL) was the most common laboratory abnormality detected (93.3%), followed by thrombocytopenia (80%), increased aminotransferases (AST in 73.3% and ALT in 66.6%), anemia (66.6%) and hematuria (>100 RBC per high power field) in 66.6%. Empiric treatment with at least one active antibiotic against Leptospira was administered in 40 patients (88.8%).Conclusions: We found a higher disease incidence in our area compared to previous reports in Greece. Clinical signs of leptospirosis are diverse and generally nonspecific. Further epidemiological studies conducted ideally at a national level are required to determine the true disease incidence and better understand risk factors associated with unfavorable outcomes.

Prevalence and risk factors of Leptospira infection in urban brown rats (Rattus norvegicus), Vienna, Austria

Leptospirosis is a worldwide bacterial zoonosis which incidence is expected to increase in conjunction with global change. In urban ecosystems, synanthropic rats are the key source of Leptospira infection in humans and other animals. Risk assessment and prediction of human leptospirosis require investigations of the environment associated with the bacteria and infection patterns in the reservoir hosts. The objective of this study was to address the prevalence of mixed Leptospira infection in the lungs and kidneys of brown rats captured in three sites of the city centre of Vienna, Austria, between 2016 and 2018. A total of 96 brown rats were examined for the presence of Leptospira using PCR. Occurrence of mixed Leptospira infections was explored through next-generation sequencing (NGS). A logistic regression model was built to predict the individual infection status using morphological and land-use data. Overall, the prevalence of Leptospira interrogans in the kidney was 25% but varied among sites (0–36%). We did not evidence any pulmonary nor mixed infections. Host body mass and sex were strong predictors of Leptospira carriage in the sampled rats (relative variable importance (RVI) = 0.98 and 0.89, respectively) while the presence of water affected it moderately (RVI = 0.44). Our findings demonstrate that NGS is an unbiased approach to the direct characterisation of mixed leptospiral infections that could provide further insights into the ecology of Leptospira. Future surveillance programmes should consider the use of rats as sentinels for the early detection of emerging pathogenic Leptospira in urban ecosystems.

Leptospirosis trends in China, 2007-2018: A retrospective observational study

Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re-emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007-2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660-0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60-75), males, farmers, students and field workers were high-risk populations. During the 2007-2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re-emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China.