Why does Kerala report a high leptospirosis burden?, Pg8

Key Highlights:

• Leptospirosis, a tropical zoonotic disease, has become the communicable disease with the highest mortality profile in Kerala.
• The disease claimed 50 lives in Kerala in July this year, highlighting its significant burden.
• Kerala's unique environment, with heavy monsoons and year-round moisture, creates ideal conditions for the Leptospira bacteria.
• Occupational exposure among agricultural and manual labourers is a major factor in disease transmission.
• The National Centre for Disease Control data indicates leptospirosis is endemic in at least 12 other Indian states.

Detailed Insights:

• Leptospirosis has been endemic in Kerala for over three decades, with reporting starting in 1989.
• The state's high reported burden is partly attributed to better disease surveillance and extensive diagnostic facilities.
• Traditionally an occupational hazard, the disease affects farmers, dairy farmers, cleaners, and increasingly, construction workers and urban gardeners.
• Late diagnosis and rapid progression to severe complications like pulmonary haemorrhage and multi-organ failure contribute to high fatality rates.
• Post-COVID immune dysregulation, potentially leading to a cytokine storm, has been observed in severe cases.
• Initial symptoms often overlap with other tropical fevers, leading to self-treatment and delayed medical intervention.
• Laboratory diagnosis is challenging as current serological tests like ELISA are not confirmatory in the acute phase.
• Molecular diagnosis using PCR has been introduced but lacks widespread availability across districts.
• Kerala's strategy includes chemoprophylaxis with Doxycycline for high-risk groups, though compliance remains poor.
• Primary care physicians are advised to maintain a high index of suspicion and initiate antibiotics early for high-risk patients.
• Suggested modifications include targeted prevention strategies, risk communication campaigns, and providing protective gear like gum boots and gloves to vulnerable workers.

Scientific/Technical Concepts Involved:

• Leptospirosis: A bacterial systemic infection caused by pathogenic Leptospira bacteria, transmitted from animals to humans.
• Zoonotic Disease: An infectious disease that has jumped from an animal to humans.
• Chemoprophylaxis: The use of drugs to prevent disease, in this case, Doxycycline to prevent leptospirosis.
• ELISA (Enzyme-Linked Immunosorbent Assay): A common laboratory test to detect antibodies or antigens in a sample, used for serological diagnosis.
• PCR (Polymerase Chain Reaction): A molecular biology technique used to amplify a specific DNA segment, enabling early and accurate detection of pathogens.