Leptospirosis Incidence at Four Sites in Sub-Saharan Africa and South East Asia: An International Multi-Site Hybrid Surveillance Study

Issued Date

2026-03-01

Resource Type

Article

eISSN

23288957

DOI

10.1093/ofid/ofag021

Scopus ID

2-s2.0-105033368416

Journal Title

Open Forum Infectious Diseases

Volume

13

Issue

3

Rights Holder(s)

SCOPUS

Bibliographic Citation

Open Forum Infectious Diseases Vol.13 No.3 (2026)

Suggested Citation

Crump J.A., Picardeau M., Ajanovic S.A., Bradley J., Bramugy J.M., Chimenya M., Green E.W., Lal S., Mabey D.C.W., Mayxay M., Newton P.N., Olaru I.D., Hopkins H., Bottomley C., Amos B., Ashley E.A., Baerenbold O., Baghoumina S., Balanza N., Bandason T., Bassat Q., Bhattacharyya T., Blacksell S.D., Boca Z., Chandler C.I.R., Chansamouth V., Chipanga J., Cossa A., Dauya E., Davis C., De Lamballerie X., Dixon J., Douangphachanh S., Dubot-Pérès A., Durkin M.M., Feasey N.A., Ferrand R.A., Fink C., Fitchett E.J.A., Gerada A., Graves S.R., Handley B.L., Hutchison C.D., Jaksuwan R., Jervis J., Jones J., Kain K.C., Keddie S.H., Khounpaseuth K., Kranzer K., Kunlaya K., Lal P., Lalloo D.G., Luangraj M., Lubell Y., MacPherson E., Makoga F., Manichan S., Marlais T., Maurer F., Miles M., Mogeni P., Mucasse C., Nguyen C., Phimolsarnnousith V., Roberts C.H., Sengduangphachanh A., Sengsavang S., Sibanda M., Singha S., Stenos J., Tanganuchitcharnchai A., Tanvir H., Ussher J.E., Valente M., Voice M.A., Vongsouvath M., Wamaka M., Wheat L.J., Yeung S. Leptospirosis Incidence at Four Sites in Sub-Saharan Africa and South East Asia: An International Multi-Site Hybrid Surveillance Study. Open Forum Infectious Diseases Vol.13 No.3 (2026). doi:10.1093/ofid/ofag021 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115910

Title

Leptospirosis Incidence at Four Sites in Sub-Saharan Africa and South East Asia: An International Multi-Site Hybrid Surveillance Study

Author(s)

Crump J.A.
 Picardeau M.
 Ajanovic S.A.
 Bradley J.
 Bramugy J.M.
 Chimenya M.
 Green E.W.
 Lal S.
 Mabey D.C.W.
 Mayxay M.
 Newton P.N.
 Olaru I.D.
 Hopkins H.
 Bottomley C.
 Amos B.
 Ashley E.A.
 Baerenbold O.
 Baghoumina S.
 Balanza N.
 Bandason T.
 Bassat Q.
 Bhattacharyya T.
 Blacksell S.D.
 Boca Z.
 Chandler C.I.R.
 Chansamouth V.
 Chipanga J.
 Cossa A.
 Dauya E.
 Davis C.
 De Lamballerie X.
 Dixon J.
 Douangphachanh S.
 Dubot-Pérès A.
 Durkin M.M.
 Feasey N.A.
 Ferrand R.A.
 Fink C.
 Fitchett E.J.A.
 Gerada A.
 Graves S.R.
 Handley B.L.
 Hutchison C.D.
 Jaksuwan R.
 Jervis J.
 Jones J.
 Kain K.C.
 Keddie S.H.
 Khounpaseuth K.
 Kranzer K.
 Kunlaya K.
 Lal P.
 Lalloo D.G.
 Luangraj M.
 Lubell Y.
 MacPherson E.
 Makoga F.
 Manichan S.
 Marlais T.
 Maurer F.
 Miles M.
 Mogeni P.
 Mucasse C.
 Nguyen C.
 Phimolsarnnousith V.
 Roberts C.H.
 Sengduangphachanh A.
 Sengsavang S.
 Sibanda M.
 Singha S.
 Stenos J.
 Tanganuchitcharnchai A.
 Tanvir H.
 Ussher J.E.
 Valente M.
 Voice M.A.
 Vongsouvath M.
 Wamaka M.
 Wheat L.J.
 Yeung S.

Author's Affiliation

Universitat de Barcelona
 University of Glasgow
 University of Toronto Faculty of Medicine
 University of Warwick
 University of Otago
 London School of Hygiene & Tropical Medicine
 University Health Network
 Institut Pasteur, Paris
 Institució Catalana de Recerca i Estudis Avançats
 Nuffield Department of Medicine
 Toronto General Hospital
 Liverpool School of Tropical Medicine
 Instituto de Salud Global de Barcelona
 Forschungszentrum Borstel - Zentrum für Medizin und Biowissenschaften
 Mahidol Oxford Tropical Medicine Research Unit
 Malawi-Liverpool-Wellcome Trust Clinical Research Programme
 Ministry of Health Malawai
 Institut Pasteur de Dakar
 Centro de Investigação em Saúde de Manhiça CISM
 Émergence des Pathologies Virales
 Biomedical Research and Training Institute Harare
 Mahosot Hospital, Lao
 University Hospital Geelong
 MiraVista Diagnostics
 Liverpool Clinical Laboratories
 Awanui Laboratories
 Vientiane Provincial Hospital
 UHS

Corresponding Author(s)

Crump J.A.

Other Contributor(s)

Mahidol University

Abstract

Background There are few leptospirosis incidence studies despite such estimates being central to accurate burden of disease estimation. We used data from the multicenter Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study to make leptospirosis incidence estimates from new sites. Methods Febrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe were enrolled and underwent standardized clinical and exposure assessment. Acute and convalescent sera were tested by Leptospira microscopic agglutination test and acute plasma by lfb1 polymerase chain reaction (PCR). Participants with ≥4-fold rise in antibody titer between acute and convalescent sample, or Leptospira PCR positive for the lfb1, had confirmed leptospirosis. Leptospirosis incidence was estimated after adjusting for incomplete enrollment of febrile patients, availability of paired sera, and use of study healthcare facilities by febrile patients based on healthcare utilization data from community controls. Results Leptospirosis incidence (95% CI) per 100 000 population per year was 1302 (1011, 1677) in Laos, 1337 (874, 2044) in Malawi, 187 (85, 409) in Mozambique, and could not be calculated for Zimbabwe. Sensitivity analysis restricted to pre-COVID years of 2018 and 2019 produced similar estimates of incidence to that of the whole study period. Conclusions Leptospirosis incidence was high at the Laos, Malawi, and Mozambique sites and at the upper end of published incidence estimates from the Asia and Africa regions. We recommend more leptospirosis incidence studies be done in areas lacking data to strengthen leptospirosis global burden of disease estimates and to stimulate progress on diagnosis, management, and control.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/115910

Collections

Scopus 2026