2 days ago
Spike in leptospirosis cases worries Health department in Kerala
Leptospirosis is yet again emerging as the single most disease killing the maximum number of people every year in Kerala.
While the pattern has been the same for the past several years, what has been immensely worrying the Health department is the huge jump in leptospirosis cases and mortality in the last three years.
Despite the early public health alerts and doxycycline prophylaxis strategy initiated by the department or the PCR testing facilities launched for early confirmation of the disease, leptospirosis continues to be a significant cause of mortality.
The disease, which used to spike during the rainy season, is no longer a seasonal one and more cases and deaths are reported even in the dry season too.
Since 2022 when the Integrated Disease Surveillance programme began entering the 'probable' cases and deaths due to infectious diseases such as dengue and leptospirosis in the official records that the mortality due to leptospirosis began standing out.
In 2022, the State recorded 5,315 probable and confirmed cases of leptospirosis and 290 deaths (both probable and confirmed). The very next year, 5,186 cases and 282 deaths were recorded. In 2024, the number of cases jumped to 5,980 and the deaths to 394. This year too, the picture looks quite alarming, with 1,451 cases and 74 deaths recorded till June 9.
Complications
Late diagnosis as well as complications and organ damage due to co-infections of dengue-leptospirosis are often cited as the major reasons for the serious loss of lives. However, the lack of intensive care facilities at the secondary level hospitals in districts is pointed out to be another important factor that could be contributing to the high mortality due to leptospirosis.
Early diagnosis of leptospirosis, a disease which presents as a high febrile illness, myalgia and headache, may not be easy as it is difficult to distinguish it from dengue or other tropical diseases, just by clinical symptoms alone. However, laboratory diagnosis of leptospirosis is also quite challenging. Current serological tests for antibodies, like ELISA, take at least seven days to give results and this totally eludes diagnosis in the acute phase of the disease.
In recent years, the Health department has introduced PCR tests for identifying leptospirosis early. However, these molecular tests are not widely available.
Leptospirosis ranges from subclinical or mild illness (anicteric) in 90%-95% cases and it is a small proportion of the cases — about 5%-10% — which can develop into a serious illness, the prognosis of which might be unpredictable. People sometimes present late at the hospital after self-treatment for days together and the deterioration into multi-organ failure and pulmonary involvement can be rapid.
These patients who develop serious illness require intensive management, but often this is where the public health system falters. A senior doctor in the Health Service points out that the intensive care units in secondary care level hospitals cannot be run 24 x7 because of acute shortage of nursing staff. Patients thus get referred to medical college hospitals, overcrowding the system.
Impossible to eliminate
Public health experts point out that leptospirosis is a risk which cannot be eliminated because over 280 serovars of the bacteria are spread out in the environment, the soil around us and these environmental factors are something over which no human controls are possible.
Many clinicians maintain that focus has to be back on preventing leptospirosis because there are limits to how early the disease can be diagnosed and how well it can be managed.
The Health department has been relying on doxycycline prophylaxis to counter the threat of leptospirosis for years now. Doctors point out that doxycycline has been found to be highly efficient even when one has been exposed to the infectious agent, provided it is consumed as per the guidelines. Yet people tend to ignore the health advisories or do not consume them as per guidelines, officials say.
As leptospirosis predominantly seems to affect those in the low-socioeconomic groups and essentially those whose occupation puts them in constant contact with soil and water — dairy farmers, farmers, animal handlers, manual labourers, gardeners — the message that doxycycline prophylaxis can be life-saving should be consistently and repeatedly communicated amongst these high-risk groups.
