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LECTURE 45 Leptospirosis Albert Icksang Ko, MD aik2001med.cornell

Describe the changing pattern of health problems which has emerged in Brazil due to rapid urbanizationIllustrate leptospirosis as an example of a slum health problemDefine factors that influence transmission and the natural history of the diseaseProvide examples of study designs and methods th

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LECTURE 45 Leptospirosis Albert Icksang Ko, MD aik2001med.cornell

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    31. Burden of Illness Pyramid

    38. Pau da Lima Cohort Study Methods Census in 2003 14,122 inhabitants 57.8 severe cases per 100,000 pop. Cohort population 9,862 subjects Residents >5 years of age Informed consent Exposure measurements: Interviews on demographics and exposures Inspection of household environment GIS surveys for environmental sources

    46. Control and Prevention of Urban Leptospirosis Intervention strategies: Prevent disease and severe outcomes in the human host Control the animal reservoir Interupt exposure to transmission sources

    47. Preventing Disease and Severe Outcomes in the Human Host Chemoprophylaxis: Doxycycline 100 mg bid Immunization: Available bacterin-based vaccines are not effective and have unacceptable rates of adverse reactions Timely identification and treatment of leptospirosis to prevent severe disease forms. Community education Access to care Early warning/rapid response (disasters) Training HCW to recognize early-phase illness Developing point-of-care diagnostic tests.

    52. Reduce reservoir density Pesticides Deny access to human living environment Deny access to food and water Remove food sources and ecological habitats Limitations: Pesticides are costly. Rodent control can not be accomplished by chemical interventions alone (recrudescence, pesticide resistance). Control of Rodent Sources of Transmission

    54. Prevent Exposures to Transmission Sources Disinfecting areas of contaminated environment (hypochlorite) Protective clothing (boots, gloves) Cleaning wounds after exposure Prevention of contact with ill or dead animals Health education on risk exposures Remove transmission sources

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