Volume 86, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Leptospirosis has recently been reported as an emerging disease worldwide, and a seroprevalence study was undertaken in American Samoa to better understand the drivers of transmission. Antibodies indicative of previous exposure to leptospirosis were found in 15.5% of 807 participants, predominantly against three serovars that were not previously known to occur in American Samoa. Questionnaires and geographic information systems data were used to assess behavioral factors and environmental determinants of disease transmission, and logistic regression was used to identify factors associated with infection. Many statistically significant factors were consistent with previous studies, but we also showed a significant association with living at lower altitudes (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.03–2.28), and having higher numbers of piggeries around the home (OR = 2.63, 95% CI: 1.52–4.40). Our findings support a multifaceted approach to combating the emergence of leptospirosis, including modification of individual behavior, but importantly also managing the evolving environmental drivers of risk.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM, , 2003. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3: 757771.[Crossref] [Google Scholar]
  2. Pappas G, Papadimitriou P, Siozopoulou V, Christou L, Akritidis N, , 2008. The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis 12: 351357.[Crossref] [Google Scholar]
  3. World Health Organization, 2011. Leptospirosis: an emerging public health problem. Wkly Epidemiol Rec 86 4550. [Google Scholar]
  4. Hartskeerl RA, Collares-Pereira M, Ellis WA, , 2011. Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world. Clin Microbiol Infect 17: 494501.[Crossref] [Google Scholar]
  5. Victoriano AF, Smythe LD, Gloriani-Barzaga N, Cavinta LL, Kasai T, Limpakarnjanarat K, Ong BL, Gongal G, Hall J, Coulombe CA, Yanagihara Y, Yoshida SI, Adler B, , 2009. Leptospirosis in the Asia Pacific region. BMC Infect Dis 9: 147.[Crossref] [Google Scholar]
  6. Tulsiani SM, Lau CL, Graham GC, Van Den Hurk AF, Jansen CC, Smythe LD, McKay DB, Craig SB, , 2010. Emerging tropical diseases in Australia. Part 1. Leptospirosis. Ann Trop Med Parasitol 104: 543556.[Crossref] [Google Scholar]
  7. Berlioz-Arthaud A, Kiedrzynski T, Singh N, Yvon JF, Roualen G, Coudert C, Uluiviti V, , 2007. Multicentre survey of incidence and public health impact of leptospirosis in the Western Pacific. Trans R Soc Trop Med Hyg 101: 714721.[Crossref] [Google Scholar]
  8. Goarant C, Laumond-Barny S, Perez J, Vernel-Pauillac F, Chanteau S, Guigon A, , 2009. Outbreak of leptospirosis in New Caledonia: diagnosis issues and burden of disease. Trop Med Int Health 14: 926929.[Crossref] [Google Scholar]
  9. Katz AR, Buchholz E, Hinson K, Park SY, Effler PV, , 2011. Leptospirosis in Hawaii, USA, 1999–2008. Emerg Infect Dis 17: 221226.[Crossref] [Google Scholar]
  10. Desvars A, Cardinale E, Michault A, , 2010. Animal leptospirosis in small tropical areas. Epidemiol Infect 139: 167188.[Crossref] [Google Scholar]
  11. Cascio A, Bosilkovski M, Rodriguez-Morales AJ, Pappas G, , 2011. The socio-ecology of zoonotic infections. Clin Microbiol Infect 17: 336342.[Crossref] [Google Scholar]
  12. Lau CL, Smythe LD, Craig SB, Weinstein P, , 2010. Climate change, flooding, urbanization and leptospirosis: fueling the fire? Trans R Soc Trop Med Hyg 104: 631638.[Crossref] [Google Scholar]
  13. Ko AI, Galvao Reis M, Ribeiro Dourado CM, Johnson WD, Jr Riley LW, , 1999. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 354: 820825.[Crossref] [Google Scholar]
  14. Lau C, Smythe L, Weinstein P, , 2010. Leptospirosis: an emerging disease in travelers. Travel Med Infect Dis 8: 3339.[Crossref] [Google Scholar]
  15. Johnson MA, Smith H, Joeph P, Gilman RH, Bautista CT, Campos KJ, Cespedes M, Klatsky P, Vidal C, Terry H, Calderon MM, Coral C, Cabrera L, Parmar PS, Vinetz JM, , 2004. Environmental exposure and leptospirosis, Peru. Emerg Infect Dis 10: 10161022.[Crossref] [Google Scholar]
  16. Derne BT, Fearnley EJ, Lau CL, Paynter S, Weinstein P, , 2011. Biodiversity and leptospirosis risk: a case of pathogen regulation? Med Hypotheses 77: 339344.[Crossref] [Google Scholar]
  17. Keesing F, Belden LK, Daszak P, Dobson A, Harvell CD, Holt RD, Hudson P, Jolles A, Jones KE, Mitchell CE, Myers SS, Bogish T, Ostfeld RS, , 2010. Impacts of biodiversity on the emergence and transmission of infectious diseases. Nature 468: 647652.[Crossref] [Google Scholar]
  18. Reis RB, Ribeiro GS, Felzemburgh RD, Santana FS, Mohr S, Melendez AX, Queiroz A, Santos AC, Ravines RR, Tassinari WS, Carvalho MS, Reis MG, Ko AI, , 2008. Impact of environment and social gradient on Leptospira infection in urban slums. PLoS Negl Trop Dis 2: e228.[Crossref] [Google Scholar]
  19. Barcellos C, Sabroza PC, , 2000. Socio-environmental determinants of the leptospirosis outbreak of 1996 in western Rio de Janeiro: a geographical approach. Int J Environ Health Res 10: 301313.[Crossref] [Google Scholar]
  20. Barcellos C, Sabroza PC, , 2001. The place behind the case: leptospirosis risks and associated environmental conditions in a flood-related outbreak in Rio de Janeiro. Cad Saude Publica 17 (Suppl): 5967. [Google Scholar]
  21. Central Intelligence Agency, 2010. The World Factbook: American Samoa (Territory of the US). Available at: http://www.cia.gov/library/publications/the-world-factbook/geos/aq.html. Accessed April 3, 2011. [Google Scholar]
  22. ProMED-mail, 2004. Leptospirosis, Fatal: USA (American Samoa). ProMED-mail; 19 Aug: 20040820.2307.Available at: http://www.promedmail.org. Accessed March 28, 2011. [Google Scholar]
  23. Winger K, , 2004. Leptospirosis: A Seroprevalence Survey on American Samoa. Available at: http://www.botany.hawaii.edu/basch/uhnpscesu/pdfs/sam/Winger2004AS.pdf. Accessed September 12, 2009. [Google Scholar]
  24. National Oceanic and Atmospheric Administration, National Weather Service, 2011. Pago Pago, American Samoa. NOWData: NOAA Online Weather Data. Available at: http://www.weather.gov/climate/xmacis.php?wfo=samoa. Accessed March 27, 2011. [Google Scholar]
  25. American Samoa GIS User Group, 2011. Available at: http://gis.doc.as/. Accessed March 21, 2011.
  26. Lim E, Taylor LA, Eakins BW, Carignan KS, Grothe PR, Caldwell RJ, Friday DZ, , 2010. Digital Elevation Models of Pago Pago, American Samoa: Procedures, Data Sources and Analysis. Boulder, CO: National Geophysical Data Center, Marine Geology and Geophysics Division. [Google Scholar]
  27. WHO, 2003. Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control. Available at: http://www.who.int/zoonoses/resources/Leptospirosis/en/. Accessed August 8, 2009. [Google Scholar]
  28. Faine S, Adler B, Bolin C, Perolat P, , 1999. Leptospira and Leptospirosis. Second edition. Melbourne, Australia: MediSci. [Google Scholar]
  29. Silverman BW, , 1986. Density Estimation for Statistics and Data Analysis. New York: Chapman and Hall.[Crossref] [Google Scholar]
  30. Everard CO, Fraser-Chanpong GM, James AC, Butcher LV, , 1985. Serological studies on leptospirosis in livestock and chickens from Grenada and Trinidad. Trans R Soc Trop Med Hyg 79: 859864.[Crossref] [Google Scholar]
  31. Simms J, , 1997. Animal leptospirosis in the Federated States of Micronesia. Pac Health Dialog 5: 3037. [Google Scholar]
  32. American Samoa Environmental Protection Agency. Piggery Compliance. Available at: http://asepa.gov/piggery-compliance.asp. Accessed March 2, 2011. [Google Scholar]

Data & Media loading...

  • Received : 22 Jun 2011
  • Accepted : 09 Oct 2011
  • Published online : 01 Feb 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error