Leptospirosis in Hawaii, 1974-1998: Epidemiologic analysis of 353 laboratory-confirmed cases

Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu 96822, USA.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 02/2002; 66(1):61-70.
Source: PubMed


The epidemiologic characterization of leptospirosis in the United States has been limited by difficulties associated with both case detection and confirmation. In addition, leptospirosis was eliminated from the list of National Notifiable Diseases in 1995. From 1974 until the cessation of national surveillance, Hawaii consistently had the highest reported annual incidence rate in the United States. From 1974 through 1998, 752 leptospirosis cases were reported in the State of Hawaii. Of these, 353 had exposures within the state and were laboratory confirmed. The mean annual incidence rate was 1.29 per 100,000. Cases were predominately male. Rates were highest in rural areas. Occupational exposures diminished over time while recreational exposures increased. This series represents the first large U.S. leptospirosis surveillance report since 1979. With leptospirosis recently being identified as a re-emerging zoonosis, continued national surveillance and case reporting should be reconsidered.

Full-text preview

Available from:
  • Source
    • "Our findings corroborate other large case series that show that the most common clinical manifestation of leptosporisis are nonspecific signs or symptoms, such as fever, headache, and mylagias (5,22,25–27). The case-fatality rate (0.5%) is lower than that reported from Brazil (25), Barbados (28), Guadeloupe (22), and the Andaman Islands (26), but similar to the rates found in our earlier study (5) and in a recent case series from France (27). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999-2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.
    Preview · Article · Feb 2011 · Emerging Infectious Diseases
  • Source
    • "Leptospirosis is considered the most common zoonosis worldwide and is endemic in tropical environments (Katz et al., 2002). It has recently been classified as a re-emerging disease, largely because of increased recognition and recent rediscovery that it can present as a severe hemorrhagic illness, easily confused with some viral hemorrhagic fever (Monsuez et al., 1997). "

    Full-text · Article · Sep 2008
  • Source
    • "This disease is common in farmers and veterinarians, but can also be transmitted through contaminated water in flooded areas. In particular, leptospirosis is one of the most important infectious diseases contracted in waterlogging areas and rice paddies (Katz et al., 2002; Kariv et al., 2001; Kupek et al., 2000). Leptospira is divided into Leptospira interrogans and Leptospira biflexa. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the existence of genus-specific antigens in outer membrane proteins (OMPs) of leptospira with different virulence. Microscope agglutination test (MAT) was applied to detect the agglutination between commercial rabbit antiserum against leptospiral genus-specific TR/Patoc I antigen and 17 strains of Leptospira interrongans belonging to 15 serogroups and 2 strains of Leptospira biflexa belonging to 2 serogroups. The outer envelopes (OEs) of L.interrogans serogroup Icterohaemorrhagiae serovar lai strain lai (56601) with strong virulence and serogroup Pomona serovar pomona strain Luo (56608) with low virulence, and L.biflexa serogroup Semaranga serovar patoc strain Patoc I without virulence were prepared by using the method reported in Auran et al.(1972). OMPs in the OEs were obtained by treatment with sodium deoxycholate. SDS-PAGE and western blot were used for analyzing the features of the OMPs on electrophoretic pattern and the immunoreactivity to the antiserum against TR/Patoc I antigen, respectively. All the tested strains belonging to different leptospiral serogroups agglutinated to the antiserum against leptospiral genus-specific TR/Patoc I antigen with agglutination titers ranging from 1:256-1:512. A similar SDS-PAGE pattern of the OMPs from the three strains of leptospira with different virulence was shown and the molecular weight of a major protein fragment in the OMPs was found to be approximately 60 KDa. A positive protein fragment with approximately 32 KDa confirmed by Western blot, was able to react with the antiserum against leptospiral genus-specific TR/Patoc I antigen, and was found in each the OMPs of the three stains of leptospira. There are genus-specific antigens on the surface of L.interrogans and L.biflexa. The OMP with molecular weight of 32 KDa may be one of the genus-specific protein antigens of leptospira.
    Preview · Article · May 2004 · Journal of Zhejiang University SCIENCE
Show more