An outbreak of leptospirosis is currently being reported in Fiji. Is this a concern for travellers?

More than 200 cases have been reported in the Western medical division of Fiji and a further 31 from the subdivision of Kadavu. This is higher than what might be expected year to date. Most cases are in the 10-29 years age group.

What is Leptospirosis?

Leptospirosis is a bacterial disease which can be transmitted to humans through skin abrasions and by ingestion. It is found in soil which is contaminated by the urine of animals. Some of the identified animals include:

• Rodents
• Cattle
• Dogs
• Pigs
• Horses
• Wildlife

Infected animals usually have no symptoms of the disease. They can infect the environment over a long period of time.

The disease is much more common in tropical and subtropical climates. It is estimated there are over a million severe cases globally each year and about 60,000 deaths.

Who is at risk of leptospirosis?

The disease is usually viewed as a rural farming disease. It is mostly seen in workers who are occupationally related to farm animals. Severe weather events which lead to flooding are often the precipitating factor for an outbreak. Contamination of the waterways occurs with flooding. The disease is much more likely in younger people whose recreational activities put them at risk. Exposure occurs when swimming or wading in potentially contaminated water. It may become more common with climate change.

Are travelers at risk of leptospirosis?

Leptospirosis is often mentioned in databases as a health risk for travellers to low-income countries globally.

This may be true, but the disease is not confined to just low and low-middle income countries where environmental sanitation may be poor. Leptospirosis is often diagnosed in individuals who live in high income countries such as Australia. An outbreak of more than 80 cases occurred amongst raspberry workers in a mixed berry farm in NSW in 2018. The disease was identified in mice, and it was suggested the workers became infected through injuries to their hands from thorns on the plant. Control measures included better hand protection. Another outbreak occurred in early 2011 after major flooding in Central Queensland. Nine cases were proven but the source was never identified.

In one study confined to travellers, researchers in the Netherlands investigated cases over 7 years. Over 220 cases were reported. More than 60% of cases contracted their disease in southeast Asia. Most experienced a mild disease and there were no fatalities. They concluded that leptospirosis was increasingly being seen in returned travellers and anyone with a fever and returning from overseas should be investigated for leptospirosis. Risk factors included water exposure post flooding plus recreational water-related activities. It may be confused with other tropical diseases in which a fever is also associated (dengue, chikungunya, malaria, typhoid etc).

The risk to travellers would be viewed as low. Further resources can be found on in this edition of AJGP.

Leptospirosis is a notifiable disease in Australia.

One hundred and twenty-seven cases have been notified in the past 12 months, to March 31st, 2024. This is less than the 5-year average but includes the pandemic years when the international borders were closed.

Eighty-six cases were notified in QLD during 2023. Most were recorded during the wet season months.