Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control
Received30 November 2009
revised24 March 2010
accepted17 May 2010
20 December 2017 (online)
Background: Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007.
Methods: Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions.
Results: After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall.
Conclusions: The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.
- 1 Pappas G., Papadimitriou P., Siozopoulou V., Christou L., Akritidis N. The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis 2008; 12 (04) 351-357.
- 2 Vijayachari P., Sugunan A.P., Shriram A.N. Leptospirosis: an emerging global public health problem. J Biosci 2008; 33 (04) 557-569.
- 3 Cruz L.S., Vargas R., Lopes A.A. Leptospirosis: a worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations. Ethn Dis 2009; 19 (1 Suppl 1). S1–S37–S41.
- 4 Margaletic J. Small rodents in the forest ecosystem as infectious disease reservoirs. Acta Med Croatica 2003; 57 (05) 421-426.
- 5 Adler B., de la Pena Moctezuma A. Leptospira and leptospirosis. Vet Microbiol 2010; 140 (03/04) 287-296.
- 6 Levett P.N. Leptospirosis. Clin Microbiol Rev 2001; 14 (02) 296-326.
- 7 Guerra M.A. Leptospirosis. J Am Vet Med Assoc 2009; 234 (04) 472–478, 430.
- 8 Nachega J.B., Bottieau E., Zech F. et al. Travel-acquired scrub typhus: emphasis on the differential diagnosis, treatment, and prevention strategies. J Travel Med 2007; 14 (05) 352-355.
- 9 Sehgal S.C. Epidemiological patterns of leptospirosis. Indian J Med Microbiol 2006; 24 (04) 310-311.
- 10 Monahan A.M., Miller I.S., Nally J.E. Leptospirosis: risks during recreational activities. J Appl Microbiol 2009; 107 (03) 707-716.
- 11 Reis R.B., Ribeiro G.S., Felzemburgh R.D. et al. Impact of environment and social gradient on Leptospira infection in urban slums. PLoS Negl Trop Dis 2008; 2 (04) e228.
- 12 Palaniappan R.U., Ramanujam S., Chang Y.F. Leptospirosis: pathogenesis, immunity, and diagnosis. Curr Opin Infect Dis 2007; 20 (03) 284-292.
- 13 Kobayashi Y. Human leptospirosis: management and prognosis. J Postgrad Med 2005; 51 (03) 201-204.
- 14 Kobayashi Y. Clinical observation and treatment of leptospirosis. J Infect Chemother 2001; 7 (02) 59-68.
- 15 Stoddard R.A., Gee J.E., Wilkins P.P. et al. Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene. Diagn Microbiol Infect Dis 2009; 64 (03) 247-255.
- 16 Brett-Major D.M., Lipnick R.J. Antibiotic prophylaxis for leptospirosis. Cochrane Database Syst Rev 2009 (03) CD007342.
- 17 Guidugli F., Castro A.A., Atallah A.N. Antibiotics for preventing leptospirosis. Cochrane Database Syst Rev 2000 4. CD001305.
- 18 Fitzgerald J. Availability of leptospirosis vaccine. Vet Rec 2009; 164 (05) 157.
- 19 Martinez Sanchez R., Obregon Fuentes A.M., Perez Sierra A. et al. The reactogenicity and immunogenicity of the first Cuban vaccine against human leptospirosis. Rev Cubana Med Trop 1998; 50 (02) 159-166.
- 20 Martinez R., Perez A., Quinones Mdel C. et al. Efficacy and safety of a vaccine against human leptospirosis in Cuba. Rev Panam Salud Publica 2004; 15 (04) 249-255.
- 21 Martinez Sanchez R., Perez Sierra A., Baro Suarez M. et al. Evaluation of the effectiveness of a new vaccine against human leptospirosis in groups at risk. Rev Panam Salud Publica 2000; 8 (06) 385-392.
- 22 Sanchez R.M., Sierra A.P., Obregon Fuentes A.M. et al. Reactogenicity and immunogenicity of Cuban trivalent inactivated vaccine against human leptospirosis in different vaccination schedules. Rev Cubana Med Trop 2002; 54 (01) 37-43.
- 23 Obregon A.M., Martinez G., Martinez R. et al. Serological response by ELISA and MAT in Cuban volunteers vaccinated with vax SPIRAL. Rev Cubana Med Trop 2004; 56 (02) 148-151.
- 24 Rodriguez I., Martinez R., Zamora Y. et al. Response of antileptospira IgG antibodies in individuals immunized with vax-SPIRAL. Rev Cubana Med Trop 2005; 57 (01) 32-37.
- 25 Wang Z., Jin L., Wegrzyn A. Leptospirosis vaccines. Microb Cell Fact 2007; 6: 39.
- 26 Castro D., Nogueira G.G. Use of the nosode meningococcinum as a preventative against meningitis. J Am Inst Homeopath 1975; 68: 211-219.
- 27 Leary B. The homoeopathic management of cholera in the nineteenth century with special reference to the epidemic in London, 1854. Med Ges Gesch 1997; 16: 125-144.
- 28 Jonas W.B. Do homeopathic nosodes protect against infection? An experimental test. Altern Ther Health Med 1999; 5 (05) 36-40.
- 29 Mroninski C.R.L., Adriano E.J., Mattos G. Meningococcinum, its protective effect against meningococcal disease. Homoeopath Links 2001; 14 (04) 230-234.
- 30 Golden I. Vaccination & homoeoprophylaxis? A review of risk and alternatives. 6th edn. Canberra: Isaac Golden Publications; 2005. (2007) 1–240.
- 31 Vickers A.J., Smith C. Homoeopathic oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev 2006; 3: CD001957.
- 32 Dean M. Comparative evaluation of homeopathy and allopathy within the Parisian hospital system, 1849–1851. J R Soc Med 2010; 103 (01) 34-36.
- 33 Pruna P.M. Homeopathic immunization against yellow fever in Havana, 1855. Asclepio 1991; 43 (02) 59-68.
- 34 de Almeida L.R., Campos M.C., Herrera H.M. et al. Effects of homeopathy in mice experimentally infected with Trypanosoma cruzi . Homeopathy 2008; 97 (02) 65-69.
- 35 Shah-Rossi D., Heusser P., Baumgartner S. Homeopathic treatment of Arabidopsis thaliana plants infected with Pseudomonas syringae . Scientific WorldJournal 2009; 9: 320-330.
- 36 Watson J.T., Gayer M., Connolly M.A. Epidemics after natural disasters. Emerg Infect Dis 2007; 13 (01) 1-5.
- 37 Kawaguchi L., Sengkeopraseuth B., Tsuyuoka R. et al. Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR. Am J Trop Med Hyg 2008; 78 (06) 957-961.
- 38 Campanella N. Infectious diseases and natural disasters: the effects of Hurricane Mitch over Villanueva municipal area, Nicaragua. Public Health Rev 1999; 27 (04) 311-319.
- 39 Sanders E.J., Rigau-Perez J.G., Smits H.L. et al. Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996 [correction of 1966]. Am J Trop Med Hyg 1999; 61 (03) 399-404.
- 40 Niwetpathomwat A., Niwatayakul K., Doungchawee G. Surveillance of leptospirosis after flooding at Loei Province, Thailand by year 2002. Southeast Asian J Trop Med Public Health 2005; 36 (Suppl. 04) 202-205.
- 41 Sehgal S.C., Sugunan A.P., Vijayachari P. Outbreak of leptospirosis after the cyclone in Orissa. Natl Med J India 2002; 15 (01) 22-23.
- 42 Tan H., Ping W., Yang T. et al. The synthetic evaluation model for analysis of flooding hazards. Eur J Public Health 2007; 17 (02) 206-210.
- 43 John T.J. The prevention and control of human leptospirosis. J Postgrad Med 2005; 51 (03) 205-209.