Human Leptospirosis in Oceania

Leptospirosis is one of the most common zoonotic bacterial diseases in the world, with particularly high disease burden in Oceania. Clinical manifestations in humans range from asymptomatic infections to mild non-specific acute febrile illnesses and severe complications such as renal failure, pulmonary haemorrhage, multi-organ failure and death. The impact of leptospirosis is not only related to the disease burden in humans but also economic impacts related to the loss of earning capacity and reduced productivity in infected livestock. Infections in humans occur through direct contact with infected animals or contact with soil or water that has been contaminated by the urine of infected animals. The risk of infection depends on behavioural factors that increase the risk of exposure, as well as environmental factors that drive the overall risk of disease transmission. In recent years, many aspects of global environmental change have combined to fuel leptospirosis transmission, resulting in increasing incidence and unprecedented outbreaks in many parts of the world. In Oceania, important environmental drivers of transmission include climate change, flooding, population growth, urbanisation, agricultural intensification and subsistence farming. Additional risks and challenges in the Pacific Islands include remoteness, isolation, difficulties with accessing health care, increasing frequency and severity of extreme weather events and limited resources to mitigate and manage natural disasters and disease outbreaks. This book chapter discusses the ecology of leptospirosis, clinical manifestations, epidemiology in Oceania, changing epidemiology and future risk in the region and strategies for prevention and control.