The Department of Health (DOH) on Monday, Sept. 18, underscored the urgent need to implement self-preventive measures and adherence to guidelines to mitigate risks brought about by the increasing leptospirosis in the country. 

In a Department of Health (DOH) #MediaSolusyon Kapihan with Media Partners, DOH Epidemiology Bureau Director IV Dr. Alethea De Guzman gave an update on the current status of leptospirosis which is a potentially deadly infectious disease caused by the Leptospira genus, impacting both humans and animals.

She stated that leptospirosis is “more prevalent” during the rainy season and is transmitted via contact with the urine of infected animals or contaminated environments, such as floodwaters.

This global issue is particularly common in tropical and temperate climates, affecting regions like sub-Saharan Africa, Latin America, the Caribbean, South and Southeast Asia, and Oceania, De Guzman said.

Based on DOH data, there are less than one million reported cases worldwide annually, resulting in approximately 59,000 deaths. 

Suspected cases exhibit an acute febrile illness with symptoms such as headaches, body aches, eye redness, reduced urination, bleeding, cardiac issues, or skin rashes, typically following exposure to infected animals or contaminated areas, De Guzman said.

DOH classified cases into suspect, probable, and confirmed categories, with laboratory confirmation managed by the Research Institute for Tropical Medicine. 

All cases are recorded in the Epidemic-prone Disease Case Surveillance Information System (EDCS-IS), DOH said.

Cases on the rise 

Based on the DOH data from Jan. 1, 2023, to Sept. 2, 2023, there have been 3,728 suspect cases reported nationally --- a 70 percent increase from the previous year.

De Guzman said that a surge occurred in August, followed by a decline. The rise began in mid-July, coinciding with storms intensified by the southwest monsoon, she added.  

DOH stated that in the most recent three to four weeks, 733 cases were recorded nationwide, a 32 percent increase compared to the prior five to six weeks.

De Guzman also stressed continuous monitoring, despite recent decreases, due to ongoing adverse weather conditions and potential storms.

On the other hand, the national case fatality rate is 11 percent, with six out of 17 regions reporting increased leptospirosis cases. Luzon regions are most affected, including BARMM, NCR, Region I, IV-A, VII, IX, X, and XI, based on the DOH data.

De Guzman underscored that the 20 to 49 age group remains the most affected, representing 50 percent of 2023 cases. Males constitute 87 percent of total cases.

Over the past five years, she also noted that nine percent to 14 percent of cases have been in individuals with farming occupations. Laborers, students, drivers, and those with fishing-related jobs are also affected.

The DOH data showed most cases in the last four weeks were flood-related, but agricultural exposure occurs even in dry seasons.

De Guzman noted that leptospirosis cases increase during the wet season --- with 2023 cases exceeding the five-year average.

Cases are also detected during the dry season, often linked to job-related exposures, especially in agriculture, De Guzman added.

To mitigate the risks, De Guzman stressed the importance of self-preventive measures and adherence to DOH guidelines. 

Guidelines for leptospirosis prevention and control

Meanwhile, DOH Diseases Prevention and Control Bureau, Adult Health Division Medical Officer IV Dr. Ma. Regina De Jesus Valdez shared critical insights into combating leptospirosis.

DOH has taken proactive measures by releasing Department Memorandum No. 2023-0309, offering comprehensive guidelines for leptospirosis prevention, control, management, and surveillance.

Valdez stressed the memorandum's importance, providing a roadmap for the public and healthcare professionals to combat the disease effectively. It includes information on suitable antibiotics for exposure or symptomatic cases.

She also emphasized that leptospirosis is “preventable” by advocating self-protective measures.

These include maintaining personal hygiene, especially treating leg and foot wounds, avoiding contaminated floodwaters, wearing protective footwear, and washing legs or feet with soap and water after exposure. 

Keeping the environment clean is also crucial, Valdez said.

Likewise, public awareness of leptospirosis symptoms is essential, as per the DOH. Key messages should be disseminated through various platforms, including radio and public announcement systems, it added. 

Valdez said that addressing the disease's root causes involves environmental sanitation interventions, such as eliminating rat habitats, monitoring vermin activity, and maintaining clean surroundings.

However, for treatment, Valdez noted that pre-exposure chemoprophylaxis is not routinely recommended but may be given to individuals with short-term exposure to endemic areas. 

Travelers, soldiers, and disaster relief workers may receive Doxycycline 200 mg orally once a week, starting before exposure.

For those with exposure, antibiotic treatment depends on the level: mild exposure gets a single Doxycycline 200 mg dose within 24 to 72 hours, moderate exposure receives Doxycycline 200 mg once daily for 3-5 days, and high-risk exposure requires Doxycycline 200 mg once weekly until exposure ends.

Pregnant women can take amoxicillin 500 mg twice daily for three days or erythromycin if allergic. Children may receive a single Doxycycline 4 mg dose, with azithromycin and amoxicillin as alternatives.

The DOH underscored that all suspected leptospirosis cases should start antimicrobial therapy regardless of the disaster phase or symptom duration to minimize illness impact. (Zekinah Elize Espina)