Leptospirosis in Puerto Rico

On 24 October 2017, Dr. Carmen Deseda, the State Epidemiologist for Puerto Rico reported via media 76 cases of leptospirosis, including 2 deaths in the month after Hurricane Maria.

Leptospirosis occurs in most countries and can be transmitted by contact with, or drinking water contaminated with animal urine. An increase in case numbers may occur following flooding.

Advice for Travellers

As the epidemiology of leptospirosis evolves, increasing numbers of cases in the developed world are associated with travel and recreational activities particularly after heavy rains and flooding. Travellers participating in adventure/ecotourism, water-based sports activities, athletic endurance events, mountain biking and military exercises have an increased chance of exposure, especially if travelling to high-risk destinations. Veterinarians and humanitarian relief/aid workers are at risk when travelling overseas to work.

Travellers at increased risk should be advised:

• Of the risk of infection and to seek medical help after potential exposure if they become symptomatic.
• To avoid exposure to potentially contaminated water especially of mucosa (swallowing/inhaling water) and abraded skin (including excoriated insect bites).
• To wear protective clothing if exposure unavoidable.
• To cover open skin lesions with waterproof plasters and wash/disinfects any injuries sustained during possible exposure.
• To wash/shower thoroughly after possible exposure.

No vaccine is available in Britain although some countries may have limited supplies of locally produced vaccine for those at serious occupational risk; its effectiveness is uncertain.

There is insufficient evidence to recommend pre-exposure prophylaxis with doxycycline against leptospirosis.

For further information see Leptospirosis.