Leptospirosis in the western Indian Ocean islands: what is known so far?

Abstract

In the past decade, leptospirosis has emerged as a major zoonosis with a worldwide distribution. The disease is caused by bacteria of the genus Leptospira. The western Indian Ocean includes more than one hundred tropical or subequatorial islands where leptospirosis constitutes a major public health problem. The clinical signs of the human disease are generally similar to an influenza-like syndrome, but acute forms of the disease are reported and mortality remains significant in this region. In animals, clinical forms are mainly asymptomatic but leptospirosis reduces the fertility of livestock, resulting in economic losses. The data available about human and animal leptospirosis in the western Indian Ocean islands are diverse: human leptospirosis has been extensively studied in Reunion Island, Mayotte, and the Seychelles, whereas the human clinical disease has never been described in Madagascar, Comoros, Mauritius, or Rodrigues, mainly because of the deficiency in appropriate medical and diagnostic structures. The rat is recognized as the major reservoir host for the bacteria on all islands, but recent data from Reunion Island indicates that almost all mammals can be a source of contamination. The incidence of leptospirosis in humans is highly seasonal, and linked to the rainy season, which is favorable for the environmental maintenance and transmission of the bacteria. The epidemiology of leptospirosis is fully island-dependent, related to the number of mammalian species, the origins of the introduced mammalian species, the relationships between humans and fauna, and environmental as well as cultural and socio-economic factors.

Figure 1

Map of the western Indian Ocean region. Gray flags indicate islands for which data on leptospirosis is available.

Figure 2

Global methods of investigation of leptospirosis. Islands are small (except Madagascar) closed territories in which the number of mammal species is known (except in Madagascar) and each can be studied. Transdisciplinary approaches, incorporating diverse disciplines and approaches specific to leptospirosis should contribute to a better understanding of the mechanisms of transmission in the different ecosystems across the region. Interaction and data exchange between the various research teams of the western Indian Ocean islands is crucial.