Health Status of the Population
Leptospirosis is estimated to cause 1.03 million cases and 58,900 deaths each year worldwide (). In the Americas, annual morbidity rates range from a low of 3.9 per 100,000 population in southern Latin America to a high of 50.7 in the Caribbean ().
In 2015, for the first time, the PAHO Regional Core Health Data Initiative () included the number of human cases of leptospirosis according to each country’s surveillance system (). A total of 10,702 human cases were reported in 2014, with 95.5% occurring in Latin America. The countries in Latin America with the highest number of cases in 2014 were Brazil (3,974 cases; cumulative incidence rate 2.0 per 100,000 population), Peru (2,329 cases; rate 7.7), and Colombia (867 cases; rate 1.8). For the Non-Latin Caribbean, the countries reporting the highest number of cases were Trinidad and Tobago (363 cases; rate 27.0), Saint Vincent and the Grenadines (17 cases; rate 16.5), and Dominica (10 cases; rate 13.7).
Rabies is endemic throughout the world and is considered a major neglected zoonotic disease, affecting mainly poor and vulnerable populations living in areas with weak human and animal health infrastructures, whose deaths are rarely reported (). Estimates suggest that the disease kills 59,000 people per year, 95% of whom are children between the ages of 5 and 14 years, who are very vulnerable to rabies because of their frequent interaction with dogs. More than 95% of human deaths due to canine rabies occur in Asia and Africa ().
According to statistics reported by countries in the Region of the Americas, every year over 45 million dogs are vaccinated, around 1 million dog attacks on humans occur, and between 1.7 and 2 million post-exposure prophylaxis doses are applied across the Region (). The Latin America and the Caribbean region is developing an intersectoral common strategy for preventing human rabies transmitted by bats, especially in remote areas in the Amazon, including a massive pre-exposure prophylaxis campaign that started in Peru. This effort could help to prevent sylvatic rabies transmitted by hematophagous bats (). Table 1 lists the reported cases of human rabies in Latin America from 2013 to 2016.
Table 1. Human rabies cases reported in Latin America (2013–2016)
|Brazil||3||2||5||0||0||0||1||1*||2||0||3 (1$, 2**)||3|
|Peru||1||5**||6||0||0||0||1###||3 (4)**||4 (4)||0||15 (12**, 3###)||15|
|Colombia||0||0||0||0||0||0||0||1$||1||0||2 (1*, 1##)||2|
|Total||12||8||20||10||2||12||12 (1#)||6 (4)||18 (15)||10||23||33|
a Suspected case without laboratory confirmation – b Limited surveillance (lack of investigation, diagnosis, others) – c Under experimental treatment Milwaukee protocol – d Cat/dog (non-hematophagous bat variant of rabies virus) – e Cat/dog (hematophagous bat variant of rabies virus) – f Hematophagous bat – g Skunk
Numbers represent cases under conditions specified above.
Source: Data gathered from multiple outlets: SIRVERA – Rabies Surveillance System of Americas; IHR notifications; Ministries of Health contacts; PAHO local offices.
References – Leptospirosis
1. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira M, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Neglected Tropical Diseases 2015;9(9):e0003898.
2. Pan American Health Organization. Health situation in the Americas: core health indicators 2016 [Internet]; 2017. Available from: https://www.paho.org/hq/index.php? option=com_content&view=article&id=2470&Itemid=2003&lang=en.
3. Schneider MC, Leonel DG, Hamrick PN, Caldas E, Velasquez R, Mendigaña Paez FAM, et al. Leptospirosis in Latin America: exploring the first set of regional data. Revista Panamericana de Salud Pública 2017;41:e81.
References – Rabies
1. World Organization for Animal Health. OIE technical disease cards: rabies. Paris: OIE; 2014. Available from: http://www.oie.int/fileadmin/Home/eng/Animal_Health_in_the_World/docs/pdf/Disease_cards/RABIES_FINAL.pdf.
2. World Health Organization. 2016. Human rabies transmitted by dogs: current status of global data, 2015. WHO Weekly Epidemiological Record 2016;2(91):10–13. Available from:http://www.who.int/wer/2016/wer9102.pdf?ua=1.
3. Centers for Disease Control and Prevention. CDC features: World Rabies Day [Internet]; 2015. Available from: http://www.cdc.gov/features/rabies/.
4. World Health Organization. The control of neglected zoonotic diseases: from advocacy to action. Report of the fourth international meeting held at WHO headquarters, Geneva, Switzerland, 19–20 November 2014. Geneva: WHO; 2015. Available from: http://www.who.int/neglected_diseases/ISBN9789241508568_ok.pdf.
5. World Health Organization. Global elimination of dog-mediated human rabies. Report of the Rabies Global Conference, Geneva, Switzerland, 10–11 December 2015. Geneva: WHO; 2015. Available from: http://www.who.int/rabies/Book_of_abstracts.pdf .
6. Pan American Health Organization. Seminario PRE-REDIPRA. Experiencia de países y herramientas para la declaración de áreas libres de rabia canina variantes 1 y 2. Brasilia: PAHO; 2015.
7. Vigilato M, Cosivi O, Knöbl T, Clavijo A, Silva H. Rabies update for Latin America and the Caribbean. Emerging Infectious Diseases 2013;19(4):678–679.
8. Kessels JA, Recuenco S, Navarro-Vela AM, Deray R, Vigilato M, Ertl H, et al. Pre-exposure rabies prophylaxis: a systematic review. Bulletin of the World Health Organization 2017;95(3):210–219C.