Leptospirosis is a bacterial disease that affects both humans and animals. It is most commonly contracted through nose, mouth or eyes; or skin abrasions when a person is exposed to water contaminated by urine from infected animals. In humans, leptospirosis can cause a wide range of symptoms, such as high fever, headache, muscle aches, vomiting, etc. Most of these symptoms can be mistaken for other diseases. Without treatment, leptospirosis can be fatal, or lead to kidney damage, meningitis, liver failure, or respiratory distress.
Indonesia is at high risk for leptospirosis, given the incidence of flooding and subsequent presence of stagnant water and poor sewer and sanitation conditions in some housing areas. In 2021, leptospirosis cases were reported from eight provinces: East Java, Central Java, Yogyakarta, Banten, DKI Jakarta, North Kalimantan, West Java, and East Kalimantan.
Risks arise when people or animals encounter contaminated environments such as muddy rivers or flood waters; or when swimming, bathing or washing in a river. Exposure to these risks is higher for people working in paddy fields, collecting wood in the forest, or clearing garbage, especially if not equipped with proper protective equipment. The disease can manifest as mild fever, chills, conjunctival suffusion, headache, myalgia; but it may also cause jaundice, kidney failure, haemorrhage, meningitis, and respiratory failure.
As part of improving leptospirosis prevention and control in Indonesia, the Ministry of Health (MoH), Ministry of Agriculture (MoA), and Ministry of Environment and Forestry (MoEF) are establishing a pilot programme for rodent sentinel surveillance in 10 districts and initiating integrated surveillance for leptospirosis involving human, animal and wildlife sectors in selected districts. As part of the initiative, WHO, in collaboration with GLEAN, supported a series of virtual meetings on leptospirosis surveillance through a One Health approach.
“To prevent and control leptospirosis effectively, it is essential to coordinate multisectoral collaboration involving a multidisciplinary team or known as the One Health approach," said dr. Endang Budi Hastuti, Director of Health Surveillance and Quarantine of MoH, in the meeting.
To prevent and control leptospirosis effectively, it is essential to coordinate multisectoral collaboration involving a multidisciplinary team or known as the One Health approach
Integrated leptospirosis prevention and control through this approach should involve multiple sectors involving humans, animals, wildlife and the environment to reduce risk factors and enable early detection and prompt response. This was reflected in the composition of meetings participants: officers from the human, animal and wildlife sectors; clinicians, as well as laboratory technicians.
The first virtual meeting on 29 March 2022, attended by 300 participants, discussed how sentinel surveillance can identify target rodent reservoirs responsible for human leptospirosis.
During the meeting, MoH shared the results of rodent sentinel surveillance in 10 sites (Asahan North Sumatera, Serang Banten, Bogor West Java, Demak Central Java, Bantul DI Yogyakarta, Probolinggo East Java, Banjar South Kalimantan, Tarakan North Kalimantan, Enrekang South Sulawesi, Ambon Maluku). The sentinel surveillance indicated that all 10 sentinel locations are at-risk areas for leptospirosis, with a successful trap rate above 1%. This rate is considered high and should be improved by implementing better rodent control.
Meanwhile, GLEAN experts presented topics covering (1) Rodent as risk factors for leptospirosis; (2) Methods of rodent surveillance in community and sylvatic area setting; (3) Sample collection and laboratory testing for leptospirosis from rodent and identification of pathogenic Leptospira species and molecular characterisation; (4) Examples of rodent sentinel surveillance in other countries such as Brazil, Southern Chile, and Malaysia integrating rodent sentinel surveillance with human and environment, and data analysis of rodent surveillance used to inform human leptospirosis risk.
The second virtual meeting on 19-21 April 2022, which gathered around 90 participants, explored the integrated leptospirosis sentinel surveillance.
In this meeting, MoH presented the epidemiology of leptospirosis in Indonesia as well as guidelines for leptospirosis control and sentinel surveillance in Banten, South Sumatera, DKI Jakarta, Probolinggo city East Java, Kebumen and Sragen district Central Java, West Java, South Kalimantan, East Kalimantan, North Kalimantan and DI Yogyakarta. MoA shared about leptospirosis surveillance in animals in Indonesia, including risk-based surveillance.
In addition, WHO experts explained the implementation of integrated surveillance through a One Health approach, while GLEAN experts covered leptospirosis clinical management, laboratory diagnosis, sentinel surveillance in humans and animals, sentinel surveillance in rodents, and integrated surveillance and data analysis.
These meetings are parts of a collaborative effort in Indonesia to improve awareness on leptospirosis risk factors. Better awareness will lead to better prevention, early detection of cases and prompt response toward leptospirosis.
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