Leptospirosis Outbreak in Sri Lanka in 2008: Lessons for Assessing the Global Burden of Disease

Suneth B. Agampodi Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Sharon J. Peacock Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Vasanthi Thevanesam Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Danaseela B. Nugegoda Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Lee Smythe Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Janjira Thaipadungpanit Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Scott B. Craig Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Mary Ann Burns Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Michael Dohnt Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Siriphan Boonsilp Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Thamarasi Senaratne Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Athula Kumara Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Paba Palihawadana Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Sahan Perera Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Joseph M. Vinetz Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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DOI:
https://doi.org/10.4269/ajtmh.2011.11-0276
Volume/Issue:
Volume 85: Issue 3
Page(s):
471–478
Restricted access
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Global leptospirosis disease burden estimates are hampered by the lack of scientifically sound data from countries with probable high endemicity and limited diagnostic capacities. We describe the seroepidemiologic and clinical characteristics of the leptospirosis outbreak in 2008 in Sri Lanka. Definitive/presumptive case definitions proposed by the World Health Organization Leptospirosis Epidemiology Reference Group were used for case confirmation. Of the 404 possible cases, 155 were confirmed to have leptospirosis. Highest titers of patient seum samples reacted with serovars Pyrogenes (28.7%), Hardjo (18.8%), Javanica (11.5%), and Hebdomadis (11.5%). Sequencing of the 16S ribosomal DNA gene identified six infections: five with Leptospira interrogans and one with L. weilli. In this patient population, acute renal failure was the main complication (14.8%), followed by myocarditis (7.1%) and heart failure (3.9%). The case-fatality rate was 1.3%. This report strengthens the urgent need for increasing laboratory diagnostic capabilities to determine the causes of epidemic and endemic infectious diseases in Sri Lanka, a finding relevant to other tropical regions.

Author Notes

*Address correspondence to Suneth B. Agampodi, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura 50008, Sri Lanka. E-mail: sunethagampodi@yahoo.com

Financial support: This study was supported by World Health Organization research grants through the epidemiology unit of Sri Lanka and Welcome Trust through Oxford-Mahidol Medicine Research Unit, Bangkok, Thailand; the U.S. Public Health Service (grants K24AI068903 and D43TW007120); and the University of California San Diego School of Medicine. The ELISA kits for were provided by Inverness Medicals (Sinnamon Park, Queensland, Australia).

Authors' addresses: Suneth B. Agampodi, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka and Department of Medicine, School of Medicine, University of California, George Palade Laboratories, La Jolla, CA, E-mails: sunethagampodi@yahoo.com or suneth1@mobileemail.vodafone.ik. Sharon J. Peacock, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand, Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom. Vasanthi Thevanesam, Thamarasi Senaratne, and Athula Kumara, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka. Danaseela B. Nugegoda and Sahan Perera, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka. Lee Smythe, Mary Ann Burns, and Michael Dohnt, World Health Organization/Food and Agricultural Organization/World Organization for Animal Health, Collaborating Centre for Reference and Research on Leptospirosis, Archerfield, Queensland 4108, Australia. Janjira Thaipadungpanit and Siriphan Boonsilp, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand. Scott B. Craig, World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Archerfield, Queensland, Australia and Faculty of Science, Health and Education, University of the Sunshine Coast, Sippy Downs, Queensland, Australia. Paba Palihawadana, Epidemiology Unit, Colombo, Sri Lanka. Joseph M. Vinetz, Department of Medicine, School of Medicine, University of California, George Palade Laboratories, La Jolla, CA.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2011
Received:
28 Apr 2011
|
Accepted:
01 Jun 2011
|
Published Online:
01 Sep 2011
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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