The epidemiology, characteristics and outbreaks of human leptospirosis and the association with animals in Taiwan, 2007-2014: A nationwide database study

Chia-Ta Tsai; Jiun-Nong Lin; Chen-Hsiang Lee; Wu Sun; Yi-Chin Chang; Yen-Hsu Chen; Chung-Hsu Lai

doi:10.1111/zph.12667

The epidemiology, characteristics and outbreaks of human leptospirosis and the association with animals in Taiwan, 2007-2014: A nationwide database study

Zoonoses Public Health. 2020 Mar;67(2):156-166. doi: 10.1111/zph.12667. Epub 2020 Jan 9.

Authors

Chia-Ta Tsai^{1

2}, Jiun-Nong Lin^{1

3

4}, Chen-Hsiang Lee^{5

6}, Wu Sun⁷, Yi-Chin Chang⁵, Yen-Hsu Chen^{8

9

10}, Chung-Hsu Lai^{1

3}

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
² Department of Infection Control, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
³ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁴ Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
⁵ Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
⁷ Infection Control Department, Pao-Chien Hospital, Pingtung County, Taiwan.
⁸ Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁹ School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan.

PMID: 31916706
DOI: 10.1111/zph.12667

Abstract

Background: Leptospirosis (LS) is a neglected tropical zoonosis of global importance. A nationwide investigation of characteristics, epidemiology, risk factors and outbreak is crucial for awareness of this disease.

Methods: A nationwide database of reported LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan, was analysed. Geographic information system software was used to map the distribution of confirmed LS cases and pigs. Cross-matching with the databases of Q fever, scrub typhus and murine typhus was conducted to identify possible coinfections.

Results: A total of 10,917 reported cases of LS were recorded in the database, which included 665 (6.1%) confirmed LS and 10,252 (93.9%) non-confirmed LS cases. The major residences of confirmed LS were the Kaohsiung-Pingtung (248, 37.3%) and Taipei (174, 26.2%) regions. The average annual incidence was 0.4/100,000 people. Compared with non-confirmed LS cases, confirmed LS cases had significantly higher percentages of male gender (83.6% vs. 67.9%, p < .001), high-risk occupations (farmer, animal husbandry or veterinarian) (24.8% vs. 13.7%, p < .001), residence in the Kaohsiung-Pingtung region (37.3% vs. 19.6%, p < .001) and exposure to rats (8.6% vs. 4.9%, p = .001) or pigs (9.4% vs. 1.9%, p < .001) but a lower mean age (47.8 ± 15.1 vs. 51.±18.5 years old). Rat and pig exposure trends were found in the northern and southern regions, respectively. Distribution of LS was consistent with pigs, and one outbreak associated with flooding and pigs occurred in the Pingtung region in 2009. Twenty-three and four patients with LS were coinfected with scrub typhus and Q fever, respectively.

Conclusions: LS is an endemic disease in Taiwan, particularly in the Kaohsiung-Pingtung and Taipei regions. High-risk occupations and animal exposure history are important for the clinical presumptive diagnosis of LS, particularly for rats in northern Taiwan and pigs in southern Taiwan. Although uncommon, clinicians should be aware of coinfection of LS with endemic rickettsial diseases.

Keywords: Leptospirosis; Taiwan; database analysis; epidemiology; flood; outbreak; pigs; rats; rickettsioses.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Animals
Databases, Factual
Disease Outbreaks
Female
Humans
Leptospirosis / complications
Leptospirosis / epidemiology*
Leptospirosis / microbiology
Leptospirosis / veterinary
Livestock
Male
Middle Aged
Q Fever / complications
Q Fever / epidemiology
Risk Factors
Scrub Typhus / complications
Scrub Typhus / epidemiology
Taiwan / epidemiology
Typhus, Endemic Flea-Borne / complications
Typhus, Endemic Flea-Borne / epidemiology
Zoonoses