Leptospirosis
	Know before you go!
	Disease profile
	Transmission
	Geographic distribution
	Symptoms
	Treatment
	Prevention & precautions
	Some things to think about

Leptospirosis

July 14, 2004

Know before you go!

Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
The Public Health Agency of Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician 6 to 8 weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.

Some facts from the experts
The information below has been developed and is updated in consultation with Public Health Agency of Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT).The recommendations are intended as general advice about the prevention of leptospirosis for Canadians travelling internationally.

Leptospirosis is a bacterial disease caused by the bacteria Leptospira. It primarily affects animals, but can be transmitted to humans through water, soil or vegetation contaminated with urine from infected animals. Leptospirosis occurs worldwide in both urban and rural areas, and has been associated with such recreational activities as swimming, wading and rafting. In humid tropical and subtropical areas, where most developing countries are found, it is a greater problem than in those with a temperate climate.

Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of other unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these infections, in particular dengue, may lead to epidemics, and cases of leptospirosis that occur during such epidemics may be overlooked. Since the symptoms of leptospirosis can easily be mistaken for other diseases, it may not be diagnosed properly. Without proper treatment, patients can suffer kidney damage, meningitis, liver failure and breathing problems. In rare cases, death can occur.

Leptospirosis is found in many different wild and domestic animals. Humans become infected through direct or indirect contact with the urine of infected animals. Most outbreaks of leptospirosis are caused by exposure to contaminated water. The bacteria can be swallowed, intentionally or accidentally while participating in recreational activities, or it can be transmitted through broken skin or through the mucous membranes found in the eyes and the nose.

Transmission can also occur through contact with moist soil or vegetation contaminated with urine of infected animals. Occasionally, transmission occurs through eating food contaminated with the urine of infected rats or by inhaling small droplets (aerosols) of contaminated fluids. Transmission from person to person is rare.

Leptospirosis occurs worldwide, in both urban and rural, developed and undeveloped areas, and is most common in tropical and subtropical areas with high rainfall and flooding. The bacteria is often spread during a period of flooding after heavy rainfall, as the bacteria can spread to open surface water. In the last decade, outbreaks have been reported in countries as diverse as Nicaragua, India, Malaysia, Thailand, Peru, and USA (Hawaii) .

In the UK, New Zealand and Australia, the bacteria is most commonly spread through contact with infected livestock.

The first symptoms of leptospirosis appear approximately 10 days after exposure. Typically the illness has two phases. During the first phase the symptoms are flu-like, consisting of fever, headache, and muscle aches along with stomache ache, vomiting, diarrhea, and red eyes. After a brief period without fever, one may see rash, meningitis, yellow skin and eyes, bleeding, or kidney failure. Overlap with other conditions often results in misdiagnosis. However, some infected persons experience no symptoms at all.

Symptoms generally last from a few days to 4 weeks.Treatment will shorten the duration of illness and may prevent complications if given early .Death is rare, but risk increases with age.

Leptospirosis is treated with antibiotics such as doxycycline or penicillin which are most effective if begun early in the course of the disease. More severe cases may require intravenous antibiotics.

Recommendations
The Public Health Agency of Canada advises travellers to areas experiencing an outbreak of leptospirosis to avoid contact with animal urine, infected animals or an infected environment. Specifically, travellers should avoid ingestion of water if engaging in water sports (i.e., swimming, wading or rafting) and avoid swimming or wading in potentially contaminated waters if possible. Where appropriate, protective clothing should be worn and wounds covered with waterproof dressings to reduce the chance of infection if exposure is likely, e.g. due to occupational or recreational activities.

Leptospirosis is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading and white water rafting. Travellers should try to determine the likelihood that water may be contaminated before engaging in any water sport.

Public Health Agency of Canada recommends as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.

References:

• World Health Organization. Human leptospirosis : guidance for diagnosis, surveillance and control.
• Centers for Disease Control and Prevention. Frequently Asked Questions: Leptospirosis and Leptospirosis

For more information...

• For more Know before you go! information, click here.
• For health care practitioners, to view Public Health Agency of Canada Material Safety Data Sheet on Leptospira interrogans.