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. 2019 Jun 5;6(7):ofz261.
doi: 10.1093/ofid/ofz261. eCollection 2019 Jul.

First Reported Human Cases of Leptospirosis in the United States Virgin Islands in the Aftermath of Hurricanes Irma and Maria, September-November 2017

Atanaska Marinova-Petkova  1   2 , Irene Guendel  3 , Jonathan P Strysko  4   5 , Lisa LaPlace Ekpo  3 , Renee Galloway  1 , Jonathan Yoder  4 , Amy Kahler  4 , Aileen Artus  1 , Alex R Hoffmaster  1 , William A Bower  1 , Henry Walke  1 , Brett R Ellis  6 , Tai Hunte-Ceasar  7 , Esther M Ellis  3 , Ilana J Schafer  1
Affiliations

First Reported Human Cases of Leptospirosis in the United States Virgin Islands in the Aftermath of Hurricanes Irma and Maria, September-November 2017

Atanaska Marinova-Petkova et al. Open Forum Infect Dis. .

Abstract

Objective: Following Hurricanes Irma and Maria, the first case of human leptospirosis ever identified in the US Virgin Islands (USVI) was reported to the Virgin Islands Department of Health. Leptospirosis is a potentially fatal bacterial disease caused by Leptospira species found in animal urine and urine-contaminated water and soil. Outbreaks can occur following extreme weather events.

Method: Additional cases of leptospirosis were identified in the 2.5 months post-hurricanes by reviewing emergency department (ED) records from territorial hospitals for patients demonstrating leptospirosis-consistent symptoms, testing symptomatic patients previously enrolled in the USVI arbovirus surveillance system (VIASS), and adding leptospirosis testing prospectively to VIASS. Available patient sera underwent local rapid diagnostic testing for anti-Leptospira IgM followed by confirmatory microscopic agglutination testing at the US Centers for Disease Control and Prevention. Water was collected from cisterns with epidemiologic links to confirmed cases and tested by real-time PCR (qPCR) for pathogenic Leptospira spp.

Results: Sixteen retrospectively identified symptomatic patients were enrolled in VIASS; 15 with available samples tested negative. Based on review of 5226 ED charts, 6 patients were further investigated; of these, 5 were tested of which 1 was positive. Prospective leptospirosis surveillance tested 57 additional patients; of these, 1 was positive. Water from 1 of 5 tested cisterns was found positive by qPCR.

Conclusions: This investigation documents the first 3 cases of leptospirosis reported in the USVI and demonstrates how VIASS successfully was adapted to establish leptospirosis surveillance. Contaminated cistern water was identified as a potential source for Leptospira spp. transmission, highlighting the need for additional post-hurricane remediation and disinfection guidance.

Keywords: US Virgin Islands; cistern water; hurricane response; leptospirosis; syndromic surveillance; zoonotic disease.

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Figures

Figure 1.
Figure 1.
Timeline of the events summarizing the public health investigation of the first reported leptospirosis cases in the US Virgin Islands, 2017. Case numbering is based on the timeline of their identification by the USVI Department of Health and the Centers for Disease Control and Prevention.
Figure 2.
Figure 2.
Household cistern epidemiologically linked to the index case of leptospirosis in the US Virgin Islands, 2017. Water collected from the cistern tested positive for pathogenic Leptospira spp., E. coli, and total coliforms.
See this image and copyright information in PMC

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