An investigation of geographical clusters of leptospirosis during the outbreak in Pangandaran, West Java, Indonesia

Submitted: 6 July 2023
Accepted: 10 September 2023
Published: 5 October 2023
Abstract Views: 854
PDF: 416
HTML: 12
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Leptospirosis is neglected in many tropical developing countries, including Indonesia. Our research on this zoonotic disease aimed to investigate epidemiological features and spatial clustering of recent leptospirosis outbreaks in Pangandaran, West Java. The study analysed data on leptospirosis notifications between September 2022 and May 2023. Global Moran I and local indicator for spatial association (LISA) were applied. Comparative analysis was performed to characterise the identified hotspots of leptospirosis relative to its neighbourhoods. A total of 172 reported leptospirosis in 40 villages from 9 sub-districts in Pangandaran District were analysed. Of these, 132 cases (76.7%) were male. The median age was 49 years (interquartile range [IQR]: 34-59 years). Severe outcomes including renal failure, lung failure, and hepatic necrosis were reported in up to 5% of the cases. A total of 30 patients died, resulting in the case fatality rate (CFR) of 17.4%. Moran’s I analysis showed significant spatial autocorrelation (I=0.293; p=0.002) and LISA results identified 7 High-High clusters (hotspots) in the Southwest, with the total population at risk at 26,184 people. The hotspots had more cases among older individuals (median age: 51, IQR: 36-61 years; p<0.001), more farmers (79%, p=0.001) and more evidence of the presence of rats (p=0.02). A comprehensive One Health intervention should be targeted towards these high-risk areas to control the transmission of leptospirosis. More empirical evidence is needed to understand the role of climate, animals and sociodemographic characteristics on the transmission of leptospirosis in the area studied.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Adler B, de la Peña Moctezuma A, 2010. Leptospira and leptospirosis. Vet Microbiol 140:287-296. DOI: https://doi.org/10.1016/j.vetmic.2009.03.012
Anselin L, 1995. Local Indicators of Spatial Association—LISA. Geogr Anal 27:93-115. DOI: https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
Barcellos C, Sabroza PC, 2000. Socio-environmental determinants of the leptospirosis outbreak of 1996 in western Rio de Janeiro: A geographical approach. Int J Environ Health Res 10:301-313. DOI: https://doi.org/10.1080/0960312002001500
Central Bureau of Statistics, 2022. 2022 Pangandaran In Figures. Pangandaran Central Bureau of Statistics, Pangandaran.
Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI, 2015. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis 9:e0003898. DOI: https://doi.org/10.1371/journal.pntd.0003898
Dhewantara PW, Mamun AA, Zhang W-Y, Yin W-W, Ding F, Guo D, Hu W, Magalhães RJS, 2018. Geographical and temporal distribution of the residual clusters of human leptospirosis in China, 2005–2016. Sci Rep 8:16650. DOI: https://doi.org/10.1038/s41598-018-35074-3
Dhewantara PW, Lau CL, Allan KJ, Hu W, Zhang W, Mamun AA, Magalhães RJS, 2019a. Spatial epidemiological approaches to inform leptospirosis surveillance and control: A systematic review and critical appraisal of methods. Zoonoses Public Health 66:185-206. DOI: https://doi.org/10.1111/zph.12549
Dhewantara PW, Hu W, Zhang W, Yin W-W, Ding F, Mamun AA, Magalhães RJS, 2019b. Climate variability, satellite-derived physical environmental data and human leptospirosis: A retrospective ecological study in China. Environ Res 176:108523. DOI: https://doi.org/10.1016/j.envres.2019.06.004
Dietrich M, Gomard Y, Lagadec E, Ramasindrazana B, Le Minter G, Guernier V. Benlali A, Rocamora G, Markotter W, Goodman SM, Dellagi K, Tortosa P, 2018. Biogeography of Leptospira in wild animal communities inhabiting the insular ecosystem of the western Indian Ocean islands and neighboring Africa. Emerg Microbes Infect 7:57. DOI: https://doi.org/10.1038/s41426-018-0059-4
Dung LP, Hai PT, Hoa LM, Mai TNP, Hanh NTM, Than PD, Tran VD, Quyet NT, Hai H, Ngoc DB, Thu NT, Mai LTP, 2022. A case-control study of agricultural and behavioral factors associated with leptospirosis in Vietnam. BMC Infect Dis 22:583. DOI: https://doi.org/10.1186/s12879-022-07561-6
Environmental Health Technology and Disease Control Agency - Ministry of Health of Indonesia, 2023. Epidemiological Investigation Report - Leptospirosis in Pangandaran. Environmental Health Technology and Disease Control Agency, Ministry of Health of Indonesia, Jakarta.
Gasem MH, Hadi U, Alisjahbana B, Tjitra E, Hapsari M, Lestari ES, Aman AT, Lokida D, Salim G, Kosasih H, Merati KTP, Laras K, Arif M, Lukman N, Sudarmono P, Lisdawati V, Lau CY, Neal A, Karyana M, 2020. Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity. BMC Infect Dis 20:179. DOI: https://doi.org/10.1186/s12879-020-4903-5
Haake DA, Levett PN, 2015. Leptospirosis in humans. Curr Top Microbiol Immunol 387:65-97. DOI: https://doi.org/10.1007/978-3-662-45059-8_5
Hinjoy S, Kongyu S, Doung-Ngern P, Doungchawee G, Colombe SD, Tsukayama R, Suwancharoen D, 2019. Environmental and Behavioral Risk Factors for Severe Leptospirosis in Thailand. Trop Med Infect Dis 4:79. DOI: https://doi.org/10.3390/tropicalmed4020079
Javati S, Guernier-Cambert V, Jonduo M, Robby S, Kimopa J, Maure T, McBryde ES, Pomat W, Aplin K, Helgen KM, Abdad MY, Horwood PF, 2022. Diversity of Leptospira spp. in bats and rodents from Papua New Guinea. Transbound Emerg Dis 69:4048-4054. DOI: https://doi.org/10.1111/tbed.14725
Laras K, Cao BV, Bounlu K, Nguyen TK, Olson JG, Thongchanh S, Tran NV, Hoang KL, Punjabi N, Ha BK, Ung SA, Insisiengmay S, Watts DM, Beecham HJ, Corwin AL, 2002. The importance of leptospirosis in Southeast Asia. Am J Trop Med Hyg 67:278-286. DOI: https://doi.org/10.4269/ajtmh.2002.67.278
Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14:296-326. DOI: https://doi.org/10.1128/CMR.14.2.296-326.2001
Luenam A, Puttanapong N, 2019. Spatial and statistical analysis of leptospirosis in Thailand from 2013 to 2015. Geospat Health 14:739. DOI: https://doi.org/10.4081/gh.2019.739
Ministry of Health of Indonesia, 2018. Indonesia Health Profile. Ministry of Health of Indonesia, Jakarta.
Ministry of Health of Indonesia, 2022. Leptospirosis Situation Analysis Report. Ministry of Health of Indonesia, Jakarta.
Moran PA, 1950. Notes on continuous stochastic phenomena. Biometrika 37:17-23. DOI: https://doi.org/10.1093/biomet/37.1-2.17
Mwachui MA, Crump L, Hartskeerl R, Zinsstag J, Hattendorf J, 2015. Environmental and Behavioural Determinants of Leptospirosis Transmission: A Systematic Review. PLoS Negl Trop Dis 9:e0003843. DOI: https://doi.org/10.1371/journal.pntd.0003843
Nardoni Marteli A, Guasselli LA, Diament D, Wink GO, Vasconcelos VV, 2022. Spatio-temporal analysis of leptospirosis in Brazil and its relationship with flooding. Geospat Health 17:1128. DOI: https://doi.org/10.4081/gh.2022.1128
Pongpan S, Thanatrakolsri P, Vittaporn S, Khamnuan P, Daraswang P, 2023. Prognostic Factors for Leptospirosis Infection Severity. Trop Med Infect Dis 8:112. DOI: https://doi.org/10.3390/tropicalmed8020112
Ridzuan JM, Aziah BD, Zahiruddin W, 2016. Work Environment-Related Risk Factors for Leptospirosis among Plantation Workers in Tropical Countries: Evidencefrom Malaysia. Int J Occup Environ Med 7:156. DOI: https://doi.org/10.15171/ijoem.2016.699
Sakundarno M, Bertolatti D, Maycock B, Spickett J, Dhaliwal S, 2014. Risk factors for leptospirosis infection in humans and implications for public health intervention in Indonesia and the Asia-Pacific region. Asia Pac J Public Health 26:15-32. DOI: https://doi.org/10.1177/1010539513498768
Setyaningsih Y, Kartini A, Bahtiar N, Kartini A, Pradigdo SF, Saraswati L, 2022. Presence of Leptospira sp. and leptospirosis risk factor analysis in Boyolali district, Indonesia. J Public Health Res 11. DOI: https://doi.org/10.4081/jphr.2022.2144
Sprißler F, Jongwattanapisan P, Luengyosluechakul S, Pusoonthornthum R, Prapasarakul N, Kurilung A, Goris M, Ahmed A, Reese S, Bergmann M, Dorsch R, Klaasen H, Hartmann K, 2019. Leptospira infection and shedding in cats in Thailand. Transbound Emerg Dis 66:948-956. DOI: https://doi.org/10.1111/tbed.13110
Sunaryo S, Priyanto D, 2022. Leptospirosis in rats and livestock in Bantul and Gunungkidul district, Yogyakarta, Indonesia. Vet World 15:1449-1455. DOI: https://doi.org/10.14202/vetworld.2022.1449-1455
Taber JM, Leyva B, Persoskie A, 2015. Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med 30:290-297. DOI: https://doi.org/10.1007/s11606-014-3089-1
Taylor C, Brodbelt DC, Dobson B, Catchpole B, O'Neill DG, Stevens KB, 2021. Spatio-temporal distribution and agroecological factors associated with canine leptospirosis in Great Britain. Prev Vet Med 193:105407. DOI: https://doi.org/10.1016/j.prevetmed.2021.105407
Tubiana S, Mikulski M, Becam J, Lacassin F, Lefèvre P, Gourinat AC, Goarant C, D'Ortenzio E, 2013. Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis 7:e1991. DOI: https://doi.org/10.1371/journal.pntd.0001991
Widiasih DA, Lindahl JF, Artama WT, Sutomo AH, Kutanegara PM, Mulyani GT, Widodo E, Djohan TS, Unger F, 2021. Leptospirosis in Ruminants in Yogyakarta, Indonesia: A Serological Survey with Mixed Methods to Identify Risk Factors. Trop Med Infect Dis 6. DOI: https://doi.org/10.3390/tropicalmed6020084

How to Cite

Widawati, M., Dhewantara, P. W., Anasi, R., Wahono, T., Marina, R., Pertiwi, I. P., Wibowo, A. A., Ruliansyah, A., Riandi, M. U., Widiastuti, D., & Astuti, E. P. (2023). An investigation of geographical clusters of leptospirosis during the outbreak in Pangandaran, West Java, Indonesia. Geospatial Health, 18(2). https://doi.org/10.4081/gh.2023.1221