Sujet
MESH: Adolescent, MESH: Adult, MESH: Agglutination Tests, MESH: Antibodies, Bacterial/blood, MESH: Incidence, MESH: Enzyme-Linked Immunosorbent Assay, MESH: Female, MESH: Geography, MESH: Health Knowledge, Attitudes, Practice*, MESH: Humans, MESH: Leptospira/genetics, MESH: Leptospira/immunology, MESH: Male, MESH: Leptospira/isolation & purification*, MESH: Leptospira/pathogenicity, MESH: Leptospirosis/diagnosis*, MESH: Leptospirosis/epidemiology*, MESH: Leptospirosis/immunology, MESH: Middle Aged, MESH: Aged, MESH: Outpatients, MESH: Real-Time Polymerase Chain Reaction, MESH: Serogroup, MESH: Vanuatu/epidemiology, MESH: Young Adult, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases

Domaines
Sciences Sociales, Sciences du vivant, Sciences humaines

Description

International audience BACKGROUND: Estimates of leptospirosis morbidity identified Oceania as the region with highest burden. Besides Australia and New Zealand, Oceania is home of Pacific Island Countries and Territories, most of which are developing countries facing a number of challenges. Their archipelago geography notably affects health infrastructure and access to healthcare. Although human leptospirosis was formerly identified in Vanuatu, there is a lack of knowledge of this disease in the country. We aimed to identify leptospirosis in outpatients visiting the hospital.METHODOLOGY/PRINCIPAL FINDINGS: We conducted a clinical study to investigate leptospirosis as a cause of non-malarial acute febrile illness in Vanuatu. A total 161 outpatients visiting the outpatient clinics at Port Vila Central Hospital for internal medicine were recruited over 20 month. We showed that leptospirosis significantly affects humans in Vanuatu: 12 cases were confirmed by real-time PCR on acute blood samples (n = 5) or by high serology titers evidencing a recent infection (MAT titer ≥800 or ELISA≥18 Units, n = 7). A high rate of positive serology was also evidenced, by MAT (100<titer<800, 9 patients) or ELISA IgM (ELISA≥12 Units, 20 patients, including 6 also positive in MAT), showing frequent exposure to pathogenic leptospires, notably from serogroup Australis.CONCLUSIONS/SIGNIFICANCE: The high numbers of both seropositive patients and acute leptospirosis cases observed in outpatients visiting Port Vila Central Hospital suggest a high exposure to pathogenic Leptospira in the population studied. The MAT serology pointing to serogroup Australis as well as exposure history suggest that livestock animals largely contribute to the burden of human leptospirosis in Vanuatu. The analysis of residential and travel data suggests that the risk might even be higher in other islands of the Vanuatu archipelago. Altogether, our study emphasizes the need to increase awareness and build laboratory capacity to improve the medical care of leptospirosis in Vanuatu.

Mots-clés

Langue
English (en-GB)

Auteurs
Pakoa, Junior George, Soupé-Gilbert, Marie-Estelle, Girault, Dominique, Takau, Dexter, Gaviga, Justina, Gourinat, Ann-Claire, Tarantola, Arnaud, Goarant, Cyrille

Contributeurs
Ministry of health [Vanuatu], Unité de Recherche et d'Expertise Leptospirose - Leptospirosis Research and Expertise Unit [Nouméa, Nouvelle-Calédonie] (UREL) ; Institut Pasteur de Nouvelle-Calédonie ; Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Institut Pasteur de Nouvelle-Calédonie ; Réseau International des Instituts Pasteur (RIIP), This study was supported by a grant of the French Government through the Fonds de coopération économique, sociale et culturelle pour le Pacifique (« Fonds Pacifique ») and by a grant of the Government of New Caledonia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Sources
ISSN: 1935-2727, EISSN: 1935-2735, PLoS Neglected Tropical Diseases, https://hal-pasteur.archives-ouvertes.fr/pasteur-01808819, PLoS Neglected Tropical Diseases, 2018, 12 (6), pp.e0006564. ⟨10.1371/journal.pntd.0006564⟩

Relation
info:eu-repo/semantics/altIdentifier/doi/10.1371/journal.pntd.0006564
info:eu-repo/semantics/altIdentifier/pmid/29864127

Couverture
Vanuatu, Port Vila

Nom du journal