Post Flood Chemoprophylaxis with Doxycycline for Leptospirosis in an Endemic Area; Case Control Study

Jayakrishnan  Thayyil; Swathi Vipinan  Koramboor; Athira  Thottathan

doi:10.5455/njcm.20210721054913

Authors

Jayakrishnan Thayyil Government Medical College, Calicut
Swathi Vipinan Koramboor Government Medical College, Calicut
Athira Thottathan Government Medical College, Calicut

DOI:

https://doi.org/10.5455/njcm.20210721054913

Keywords:

Leptospirosis, Human Risk factors, Chemoprophylaxis, Doxycycline, Post flood

Abstract

Introduction: During the year 2019, Kerala state experienced flooding during August. Following this mass chemoprophylaxis with doxycycline was given in the flood in affected areas. In this context, the study was conducted with the objectives to identify the risk factors of leptospirosis and to know the usefulness of chemoprophylaxis with doxycycline in an endemic area.

Methodology: It was conducted at a public sector tertiary care hospital setting. Cases were adult patients admitted in medical ward with confirmed diagnosis of leptospirosis and the controls were selected from the bystanders of the selected cases. Collected data were entered into MS Excel and analyzed using PASW’18 software.

Results: Among cases (n=38), 84.2% were males and the age was 43.87 (15.5) years. Among controls (n=47), 85.1% were males with age of 45.83 (14.17) years. Out of this, occupational exposure (OR 4.22, 95% CI 1.61 – 11.09, p=0.003) and any wound during past one month (OR 27.6, 95% CI 3.49.17 – 217.75,p=0.001) were significantly associated with incidence of leptospirosis. Intake of doxycycline within 2 weeks of flood was found to be protective (95% OR 0.09, 95% CI 0.01-0.72, p=0.023).

Conclusion: Our study found that occupational factors, and any wound or injury are important risk factors of leptospirosis and prophylaxis with doxycycline immediately after flood can reduce the risk of leptospirosis.

References

World Health Organization. (‎2003)‎. Human leptospirosis: guidance for diagnosis, surveillance and control. World Health Organization. https://apps.who.int/iris/handle/10665/ 42667. [Accessed May 5th 2021]

National Guidelines Diagnosis, Case Management Prevention and Control of Leptospirosis National Centre For Disease Control, (Directorate General Of Health Services)22-Sham Nath Marg, Delhi - 110 054. 2015.

Swapna RN, Tuteja U, Nair L, Sudarsana J. Seroprevalence of leptospirosis in high risk groups in Calicut, North Kerala, In-dia. Indian J Med Microbiol.2006 Oct;24(4):349-52

John TJ, Rajappan K, Arjunan KK. Communicable diseases monitored by Disease Surveillance in Kottayam district, Kerala state, India. Indian J Med Res 2004; 120 : 86-93.

Kuriakose M, Paul R, Joseph MR, Sugathan S, Sudha TN. Lepto-spirosis in a midland rural area of Kerala State. Indian J Med Res. 2008 Sep;128(3):307-12. PMID: 19052343.

Integrated Disease Surveillance Project Directorate of Health Services Office. Thiruvananthapuram. Available from: https:// dhs.kerala.gov.in/wp-content/uploads/2020/03/cddata_ 07052019.pdf

Charan J, Saxena D, Mulla S. Prophylaxis and treatment for lep-tospirosis: where are the evidences? National Journal of Physiology, Pharmacy and Pharmacology. 2012 Jul 1;2(2):78.

Supe A, Khetarpal M, Naik S, Keskar P. Leptospirosis following heavy rains in 2017 in Mumbai: Report of large-scale com-munity chemoprophylaxis. The National medical journal of India. 2018 Jan 1;31(1):19.

Brett-Major DM, Lipnick RJ. Antibiotic prophylaxis for lepto-spirosis. Cochrane Database of Systematic Reviews 2009, Is-sue3. Art. No.: CD007342. DOI: 10.1002/14651858.CD007342. pub2

Sugunan AP. Epidemiology of leptospirosis. In: World Health Organization, ed. Leptospirosis: Laboratory Manual. New Delhi, India: World Health Organization; 2007:13-21.

Faine S, Adler B, Bolin C, Perolat P. Leptospira and Leptospi-rosis. 2nd ed. Melbourne, Australia: MediSci; 2000 State Sur-veillance Unit.

Epitools. Available at epitools.ausvet.com.au/case control. [Accessed 28 Aug 2019]

Pappachan MJ, Mathew S, Aravindan KP, Khader AY, Bhar-ghavan PV, Kareem MM, Tuteja U, Shukla J, Batra HV. Risk fac-tors for mortality in patients with leptospirosis during an ep-idemic in northern Kerala. Natl Med J India. 2004 Sep 1;17(5):240-.

Tangkanakul W, Tharmaphornpil P, Plikaytis BD, et al. Risk factors associated with leptospirosis in northeastern Thai-land, 1998. Am J Trop Med Hyg. 2000;63:204-208.

Murhekar MV, Sugunan AP, Vijayachari P, Sharma S, Sehgal SC. Risk factors in the transmission of leptospiral infection. Indi-an J Med Res. 1998;107:218-223.

Sugunan AP, Vijayachari P, Sharma S, et al. Risk factors associ-ated with leptospirosis during an outbreak in Middle Anda-man, India. Indian J Med Res. 2009;130:67-73.

Sakundarno M, Bertolatti D, Maycock B, Spickett J, Dhaliwal S. Risk Factors for Leptospirosis Infection in Humans and Im-plications for Public Health Intervention in Indonesia and the Asia-Pacific Region. Asia Pacific Journal of Public Health. 2014;26(1):15-32. doi:10.1177/1010539513498768

Leal-Castellanos CB, Garcia-Suarez R, Gonzalez-Figueroa E, Fuentes-Allen JL, Escobedo-De La Pena J. Risk factors and the prevalence of leptospirosis infection in a rural community of Chiapas, Mexico. Epidemiology & Infection. 2003 Dec; 131(3): 1149-56.

Sehgal S, Sugunan A, Vijayachari P. Leptospirosis disease bur-den estimation and surveillance networking in India. South-east Asian J Trop Med Public Health. 2003;34(suppl 2):170-177.

Sasaki DM, Pang L, Minette HP, et al. Active surveillance and risk factors for leptospirosis in Hawaii. Am J Trop Med Hyg. 1993;48:35-43.

Pappachan MJ, Sheela M, Aravindan KP. Relation of rainfall pattern and epidemic leptospirosis in the Indian state of Kerala. J Epidemiol Community Health 2004; 58 : 1054.

Bhardwaj P, Kosambiya JK, Desai VK. A case control study to explore the risk factors for acquisition of leptospirosis in Su-rat city, after flood. Indian J Med Sci. 2008;62:431-438

Takafuji ET, Kirkpatrick JW, Miller RN, Karwacki JJ, Kelley PW, Gray MR, McNeill KM, Timboe HL, Kane RE, Sanchez JL. An efficacy trial of doxycycline chemoprophylaxis against lep-tospirosis. N Engl J Med. 1984 Feb 23; 310(8): 497-500. doi: 10. 1056/NEJM198402233100805. PMID: 6363930.

Sehgal SC, Sugunan AP, Murhekar MV, Sharma S, Vijayachari P. Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area. Int J Antimicrob Agents. 2000 Feb;13(4):249-55. doi: 10.1016/s0924-8579 (99)00134-x. PMID: 10755239.

Schneider MC, Velasco-Hernandez J, Min KD, Leonel DG, Baca-Carrasco D, Gompper ME, et al. The use of chemoprophylaxis after floods to reduce the occurrence and impact of leptospi-rosis outbreaks. Int J Environ Res Public Health 2017;14:594.]

Chusri S, McNeil EB, Hortiwakul T, Charernmak B, Sritrairatchai S, Santimaleeworagun W, Pattharachayakul S, Suksanan P, Thaisomboonsuk B, Jarman RG. Single dosage of doxycycline for prophylaxis against leptospiral infection and leptospirosis during urban flooding in southern Thailand: a non-randomized controlled trial. J Infect Chemother. 2014 Nov;20(11):709-15. doi: 10.1016/j.jiac.2014.07.016. Epub 2014 Sep 22. PMID: 25172777.

Alikhani A, Salehifar E, Zameni F, Rafiei A, Yazdani-Charati J, Delavaryan L, Akbari A, Babamahmoudi F. Comparison of azithromycin vs doxycycline prophylaxis in leptospirosis, a randomized double blind placebo-controlled trial. The Jour-nal of Infection in Developing Countries. 2018 Nov 30;12(11): 991-5.