TY - JOUR
T1 - Leptospirosis Incidence at Four Sites in Sub-Saharan Africa and South East Asia: An International Multi-Site Hybrid Surveillance Study
AU - Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) Consortium
AU - Crump, John A.
AU - Picardeau, Mathieu
AU - Ajanovic, Sara A.
AU - Bradley, John
AU - Bramugy, Justina M.
AU - Chimenya, Mabvuto
AU - Green, Edward W.
AU - Lal, Sham
AU - Mabey, David C.W.
AU - Mayxay, Mayfong
AU - Newton, Paul N.
AU - Olaru, Ioana D.
AU - Hopkins, Heidi
AU - Bottomley, Christian
AU - Amos, Benjamin
AU - Ashley, Elizabeth A.
AU - Baerenbold, Oliver
AU - Baghoumina, Stéphanie
AU - Balanza, Núria
AU - Bandason, Tsitsi
AU - Bassat, Quique
AU - Bhattacharyya, Tapan
AU - Blacksell, Stuart D.
AU - Boca, Zumilda
AU - Chandler, Clare I.R.
AU - Chansamouth, Vilada
AU - Chipanga, Joseph
AU - Cossa, Anelsio
AU - Dauya, Ethel
AU - Davis, Catherine
AU - De Lamballerie, Xavier
AU - Dixon, Justin
AU - Douangphachanh, Somyoth
AU - Dubot-Pérès, Audrey
AU - Durkin, Michelle M.
AU - Feasey, Nicholas A.
AU - Ferrand, Rashida A.
AU - Fink, Colin
AU - Fitchett, Elizabeth J.A.
AU - Gerada, Alessandro
AU - Graves, Stephen R.
AU - Handley, Becca L.
AU - Hutchison, Coll D.
AU - Jaksuwan, Risara
AU - Jervis, Jessica
AU - Jones, Jayne
AU - Kain, Kevin C.
AU - Keddie, Suzanne H.
AU - Lalloo, David G.
AU - MacPherson, Eleanor
PY - 2026/3/1
Y1 - 2026/3/1
N2 - Background There are few leptospirosis incidence studies despite such estimates being central to accurate burden of disease estimation. We used data from the multicenter Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study to make leptospirosis incidence estimates from new sites. Methods Febrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe were enrolled and underwent standardized clinical and exposure assessment. Acute and convalescent sera were tested by Leptospira microscopic agglutination test and acute plasma by lfb1 polymerase chain reaction (PCR). Participants with ≥4-fold rise in antibody titer between acute and convalescent sample, or Leptospira PCR positive for the lfb1, had confirmed leptospirosis. Leptospirosis incidence was estimated after adjusting for incomplete enrollment of febrile patients, availability of paired sera, and use of study healthcare facilities by febrile patients based on healthcare utilization data from community controls. Results Leptospirosis incidence (95% CI) per 100 000 population per year was 1302 (1011, 1677) in Laos, 1337 (874, 2044) in Malawi, 187 (85, 409) in Mozambique, and could not be calculated for Zimbabwe. Sensitivity analysis restricted to pre-COVID years of 2018 and 2019 produced similar estimates of incidence to that of the whole study period. Conclusions Leptospirosis incidence was high at the Laos, Malawi, and Mozambique sites and at the upper end of published incidence estimates from the Asia and Africa regions. We recommend more leptospirosis incidence studies be done in areas lacking data to strengthen leptospirosis global burden of disease estimates and to stimulate progress on diagnosis, management, and control.
AB - Background There are few leptospirosis incidence studies despite such estimates being central to accurate burden of disease estimation. We used data from the multicenter Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study to make leptospirosis incidence estimates from new sites. Methods Febrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe were enrolled and underwent standardized clinical and exposure assessment. Acute and convalescent sera were tested by Leptospira microscopic agglutination test and acute plasma by lfb1 polymerase chain reaction (PCR). Participants with ≥4-fold rise in antibody titer between acute and convalescent sample, or Leptospira PCR positive for the lfb1, had confirmed leptospirosis. Leptospirosis incidence was estimated after adjusting for incomplete enrollment of febrile patients, availability of paired sera, and use of study healthcare facilities by febrile patients based on healthcare utilization data from community controls. Results Leptospirosis incidence (95% CI) per 100 000 population per year was 1302 (1011, 1677) in Laos, 1337 (874, 2044) in Malawi, 187 (85, 409) in Mozambique, and could not be calculated for Zimbabwe. Sensitivity analysis restricted to pre-COVID years of 2018 and 2019 produced similar estimates of incidence to that of the whole study period. Conclusions Leptospirosis incidence was high at the Laos, Malawi, and Mozambique sites and at the upper end of published incidence estimates from the Asia and Africa regions. We recommend more leptospirosis incidence studies be done in areas lacking data to strengthen leptospirosis global burden of disease estimates and to stimulate progress on diagnosis, management, and control.
KW - Africa
KW - Asia
KW - fever
KW - incidence
KW - leptospirosis
U2 - 10.1093/ofid/ofag021
DO - 10.1093/ofid/ofag021
M3 - Article
AN - SCOPUS:105033368416
SN - 2328-8957
VL - 13
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 3
M1 - ofag021
ER -
SDG 3 Good Health and Well-being