Send Orders for Reprints to
[email protected] Recent Patents on Anti-Infective Drug Discovery, 2015, 10, 42-50
42
Geographical and Occupational Aspects of Coffee-Triangle Region of Colombia, 2007-2011
Leptospirosis
in
the
Laura M. García-Ramírez1, Jasmin Y. Giraldo-Pulgarin1, Nelly Agudelo-Marín1, Yeimer A. Holguin-Rivera1, Sebastián Gómez-Sierra1, Paola V. Ortiz-Revelo1, Néstor J. Velásquez-Bonilla2, Yohama Caraballo-Arias3, Alvaro Mondragon-Cardona1,4, Carlos O. Lozada-Riascos5 and Alfonso J. Rodríguez-Morales1,2,6,7* 1
Public Health and Infection Research and Incubator Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; 2 Department of Community Medicine, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; 3Cathedra of Occupational Medicine, Department of Preventive and Social Medicine, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; 4Universidad Surcolombiana, Neiva, Huila, Colombia; 5Regional Information System, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; 6Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, United Kingdom; 7Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia Received: November 20, 2014; Revised: February 25, 2015; Accepted: March 27, 2015
Abstract: Background: There are few studies occupationally profiling as well as using Geographic information system (GIS) to map human leptospirosis. There are no detailed, municipality-level, epidemiological maps in Colombia neither in South America. We developed such maps for the Coffee-triangle region, Colombia and assess some occupational issues. Methods: surveillance cases data (2007-2011) were used to estimate the annual incidence rates (cases/100,000 population) of leptospirosis to develop the first maps of disease in the 53 municipalities of the Coffee-triangle region of Colombia. GIS used was Kosmo® 3.1. Five thematic maps were developed according to municipalities and years. Using labor official information, analyses between agriculture (harvested areas) with disease occurrence was done (linear regression). Results: Between 2007 and 2011, 786 cases were reported (77.8% from one department, Risaralda), for a cumulated rate of 32.18 cases/100,000 population. The highest rate was reported in the less developed municipality of one department (Pueblo Rico, Risaralda) with 1535.05 cases/100,000 population (187 cases, 2009). Armenia (Quindio department capital city), reported 23.41 cases/100,000pop (2011). In those patients with identified occupations, 33.3% were agriculture workers, finding a significant relationship between the number of cases in 2008 and the harvested area by municipality (r2=0.48; p=0.0083). Conclusion: one of the 53 municipalities contributed with almost a quarter of the cases. Agriculture was significantly associated with the incidence. Use of GIS-based epidemiological maps allow to focus actions in prevention and control for risk zones for leptospirosis which still represents a significant issue in the region and Colombia, particularly in agriculture workers.
Keywords: Colombia, epidemiology, geographic information systems, leptospirosis, occupational diseases, occupational health. INTRODUCTION Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira, and mainly the *Address correspondence to this author at the Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia; Tel:/Fax: 573008847448; E-mai:
[email protected] -/15 $100.00+.00
species Leptospira interrogans serovars, present in both, humans and animals. The main sources of infection are food and water contaminated by rodent urine reservoirs -firstly-, and other accidental hosts (goats, cattle, pigs, cats, dogs, etc.); clinical presentation covers mild manifestations (or anicteric syndrome) with flu-like symptoms and severe © 2015 Bentham Science Publishers
Geographical and Occupational Aspects
Recent Patents on Anti-Infective Drug Discovery, 2015, Vol. 10, No. 1
clinical presentations with jaundice syndrome or Weil's disease with liver damage, bleeding, jaundice and kidney failure with a prevalence of 5% to 10% of the cases. The fatality rate is 25% to 50%, exceeding the most severe presentation of Weil's disease, pulmonary hemorrhage syndrome [1-6], with different clinical and demographic characteristics hampering the timely diagnosis [7]. Worldwide leptospirosis is endemic in the Caribbean, Central and South America, Southeast Asia and Oceania, the highest annual incidence rates per million population worldwide occur in Seychelles 432.1, Trinidad & Tobago 120.4, and 100.3 Barbados [8].
Colombia has an annual incidence of 1.6% per million habitants [8], the only documented outbreak was in August 1995, in the department of Atlantic, with 284 suspected cases and 47 confirmed cases, with a mortality of 17% within the confirmed cases [5]. The departments with the highest number of confirmed cases were: Antioquia (246 cases-23.6%), Valle del Cauca (224 cases - 21.5%), Bolivar and Tolima (59 cases 5.7% each one) and Risaralda (57 cases 5.5%) [6]. During the period 2007-2011, 11,786 records were presented with confirmed 4.621 (39.2%) leptospirosis cases and a fatality rate of 4.5%, also the largest number of cases were found in urban areas of Colombia [19].
To highlight, in the "List of Occupational Diseases” revised in 2010 by the International Labor Office (ILO), leptospirosis is included as a diseases due to biological and infectious agents or parasitic diseases, to comply criteria as: 1) To have a causal relationship with an agent, exposure or specific work process. 2) To occur in relation to the specific working environment and/or in specific occupations. 3) To affect certain groups of people with a higher frequency than the average rate of the rest of the population morbidity. 4) There is scientific evidence of a clearly defined picture of disease resulting from exposure and plausibility of cause. Multiple risk factors are associated with leptospirosis such as activities including adventure sports such as swimming in rivers, kayaking, caving, jungle trekking and camping due to the constant direct or indirect exposure to contaminated water. The disease is often manifested during trips in which contact with these activities will be presented [9-12]. Another important risk factor is climate change and multiple leptospirosis outbreaks have been reported after rainy seasons or floods [13-15]. The occupations in which direct or indirect contact exists with animals or contaminated water represent one of the most associated risk factors of leptospirosis [16, 17]. In South America, the countries with the highest incidence are Uruguay 25; Argentina 12.8 and Brazil 9.5 per 100,000 habitants [8], while the countries that had the highest fatality rate during 1996-2005 were Chile 12.9%, Brazil 12%, Venezuela 9.4% and Uruguay 6.1% [18].
43
Leptospirosis can be considered an occupational health problem especially those related to the agricultural sector [20, 21]. In a Colombian study conducted in Córdoba, out of 344 samples studied, it was found that the occupation of farming or ranching operator had a prevalence of 42.44% and a greater association with infection (OR = 2.04; 95%CI 1.080 to 3.85) compared to that obtained by workers engaged in the killing of animals and hygiene and sanitation workers [22]. In Sri Lanka the peak incidence is associated with the harvest season, 43.5% of cases had been exposed to the rice fields, occupational risk among farmers [21] and New Zealand in 1990-1998 of 992 cases of leptospirosis, a total of 539 (51%) cases were exposed [23]. Livestock production increases the number of water reservoirs in the Coffee-triangle region of Colombia; 292 samples evaluated from different sources of water used for washing and animal consumption in swine showed a contamination of 20.5%, [24] similar to this, in 12 pig farms in this region, 75 rodents, of which 82, 7% presented infection with Leptospira [25]. In the Coffee-triangle region of Colombia, epidemiological maps of leptospirosis have not been published in humans, nor the occupational component of the disease evaluated, which carried out this work. MATERIAL AND METHODS A cross-sectional retrospective study was performed. The incidence of leptospirosis was calcu-
44 Recent Patents on Anti-Infective Drug Discovery, 2015, Vol. 10, No. 1
García-Ramírez et al.
lated, incidence rates were estimated for each year of municipalities in the Coffee-triangle region and epidemiological mapping of the disease developed in the period between 2007 and 2011.
by quartiles (high incidence 10 cases / 100,000 population; average 5 to 9.99 cases / 100,000 population and low
