A Large Leptospirosis Outbreak following Successive Severe Floods in Fiji, 2012

Eri Togami Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut;

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Mike Kama Center for Communicable Disease Control, Ministry of Health, Suva, Fiji;

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Cyrille Goarant Leptospirosis Unit, Institut Pasteur in New Caledonia, Noumea, New Caledonia;

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Scott B. Craig School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia;
Forensic and Scientific Service, WHO Leptospirosis Laboratory, Brisbane, Australia;

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Colleen Lau Research School of Population Health, Australia National University, Canberra, Australia;

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Jana M. Ritter Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Allison Imrie School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia;

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Albert I. Ko Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut;

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Eric J. Nilles Division of Pacific Technical Support, World Health Organization, Suva, Fiji

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Severe flooding has been linked to outbreaks of leptospirosis. Two sequential extreme flood events in Western Fiji caused the largest outbreak of leptospirosis recorded in the South Pacific, with 1,217 total suspected cases, of which 314 were probable and confirmed. Most (83%) cases occurred within 6 weeks of the flood events, displaying a biphasic epidemic curve associated with the floods. Given the temporal proximity of cases to flooding events, most of the transmission appeared to occur during or immediately after the floods; therefore, prevention of exposure to contaminated environments is a priority in the immediate flood and post-flood period. In addition, genotyping studies suggest that multiple animal reservoirs were implicated in the outbreak, reaffirming the importance of integrated human and animal health strategies for leptospirosis control.

Author Notes

Address correspondence to Eri Togami, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510. E-mail: eri.togami1@gmail.com or Eric J. Nilles, Harvard Humanitarian Initiative, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, 02115. E-mail: enilles@bwh.harvard.edu.

Ethical approval: This study was granted scientific, technical, and ethical approval by the Fiji National Health Research and Ethics Review Committee (FNHRERC), FNRERC Number 2017.89.WES.

Authors’ addresses: Eri Togami, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, and One Health Institute, School of Veterinary Medicine, University of California, Davis, Davis, CA, E-mail: eri.togami1@gmail.com. Mike Kama, Department of Influenza, Fiji Centre for Communicable Disease Control, Suva, Fiji, E-mail: mnkama02@gmail.com. Cyrille Goarant, Leptospirosis Research and Expertise Unit, Réseau International des Instituts Pasteur, Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia, E-mail: cgoarant@pasteur.nc. Scott B. Craig, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia, and Forensic and Scientific Service, WHO Leptospirosis Laboratory, Brisbane, Australia, E-mail: scott.craig@health.qld.gov.au. Colleen Lau, Research School of Population Health, Australia National University, Canberra, Australia, E-mail: colleen.lau@anu.edu.au. Jana M. Ritter, Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, E-mail: vtr0@cdc.gov. Allison Imrie, School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia, E-mail: allison.imrie@uwa.edu.au. Albert I. Ko, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, E-mail: albert.ko@yale.edu. Eric J. Nilles, Division of Pacific Technical Support, World Health Organization, Suva, Fiji, Harvard Humanitarian Initiative, Harvard University, Boston, MA, Harvard Medical School, Harvard University, Boston, MA, and Brigham and Women’s Hospital, Harvard University, Boston, MA, E-mail: enilles@bwh.harvard.edu.

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