Global Morbidity and Mortality of Leptospirosis: A Systematic Review
Publication Date
September 17, 2015
Journal
PLOS Neglected Tropical Diseases
Authors
Federico Costa, José E. Hagan, Juan Calcagno, Michael Kane, et al
Volume
9
Issue
9
Pages
e0003898
DOI
https://dx.plos.org/10.1371/journal.pntd.0003898
Publisher URL
http://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0003898
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/26379143
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574773
Europe PMC
http://europepmc.org/abstract/MED/26379143
Web of Science
000363031200005
Scopus
84943161123
Mendeley
http://www.mendeley.com/research/global-morbidity-mortality-leptospirosis-systematic-review-1
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{"title"=>"Global Morbidity and Mortality of Leptospirosis: A Systematic Review", "type"=>"journal", "authors"=>[{"first_name"=>"Federico", "last_name"=>"Costa", "scopus_author_id"=>"55378617300"}, {"first_name"=>"José E.", "last_name"=>"Hagan", "scopus_author_id"=>"35233657000"}, {"first_name"=>"Juan", "last_name"=>"Calcagno", "scopus_author_id"=>"26657894500"}, {"first_name"=>"Michael", "last_name"=>"Kane", "scopus_author_id"=>"37044149100"}, {"first_name"=>"Paul", "last_name"=>"Torgerson", "scopus_author_id"=>"7005388151"}, {"first_name"=>"Martha S.", "last_name"=>"Martinez-Silveira", "scopus_author_id"=>"25641959600"}, {"first_name"=>"Claudia", "last_name"=>"Stein", "scopus_author_id"=>"55436356400"}, {"first_name"=>"Bernadette", "last_name"=>"Abela-Ridder", "scopus_author_id"=>"8740859800"}, {"first_name"=>"Albert I.", "last_name"=>"Ko", "scopus_author_id"=>"7007018347"}], "year"=>2015, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"pmid"=>"26379143", "doi"=>"10.1371/journal.pntd.0003898", "sgr"=>"84943161123", "isbn"=>"1935-2735 (Electronic) 1935-2727 (Linking)", "scopus"=>"2-s2.0-84943161123", "issn"=>"19352735", "pui"=>"606211330"}, "id"=>"d2aca7a3-ef8f-3267-9d96-b5258e3aa71b", "abstract"=>"BACKGROUND: Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.\\n\\nMETHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000-1,750,000) and 58,900 deaths (95% CI 23,800-95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40-61%) and deaths (42%, 95% CI 34-53%) were estimated to occur in adult males with age of 20-49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa.\\n\\nCONCLUSIONS/SIGNIFICANCE: Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.", "link"=>"http://www.mendeley.com/research/global-morbidity-mortality-leptospirosis-systematic-review-1", "reader_count"=>368, "reader_count_by_academic_status"=>{"Unspecified"=>14, "Professor > Associate Professor"=>9, "Librarian"=>4, "Researcher"=>59, "Student > Doctoral Student"=>27, "Student > Ph. D. Student"=>41, "Student > Postgraduate"=>30, "Student > Master"=>80, "Other"=>18, "Student > Bachelor"=>63, "Lecturer"=>9, "Professor"=>14}, "reader_count_by_user_role"=>{"Unspecified"=>14, "Professor > Associate Professor"=>9, "Librarian"=>4, "Researcher"=>59, "Student > Doctoral Student"=>27, "Student > Ph. D. Student"=>41, "Student > Postgraduate"=>30, "Student > Master"=>80, "Other"=>18, "Student > Bachelor"=>63, "Lecturer"=>9, "Professor"=>14}, "reader_count_by_subject_area"=>{"Unspecified"=>29, "Agricultural and Biological Sciences"=>79, "Arts and Humanities"=>1, "Veterinary Science and Veterinary Medicine"=>34, "Business, Management and Accounting"=>3, "Chemistry"=>5, "Computer Science"=>3, "Earth and Planetary Sciences"=>3, "Economics, Econometrics and Finance"=>2, "Energy"=>1, "Engineering"=>2, "Environmental Science"=>5, "Biochemistry, Genetics and Molecular Biology"=>22, "Nursing and Health Professions"=>14, "Materials Science"=>1, "Mathematics"=>2, "Medicine and Dentistry"=>126, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Physics and Astronomy"=>1, "Social Sciences"=>9, "Immunology and Microbiology"=>24}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>126}, "Social Sciences"=>{"Social Sciences"=>9}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>29}, "Environmental Science"=>{"Environmental Science"=>5}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>2}, "Chemistry"=>{"Chemistry"=>5}, "Energy"=>{"Energy"=>1}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>3}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>24}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>79}, "Computer Science"=>{"Computer Science"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>14}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>22}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>34}}, "reader_count_by_country"=>{"Colombia"=>6, "Argentina"=>1, "Netherlands"=>1, "Japan"=>1, "Brazil"=>5, "United Kingdom"=>3, "Mexico"=>2, "Malaysia"=>1, "India"=>2, "Indonesia"=>1}, "group_count"=>15}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2269041"], "description"=>"<p>We extracted information on leptospirosis disease incidence, case fatality, age and gender distribution of cases and deaths, and the ratios of clinically suspected to laboratory confirmed cases and deaths from studies that met quality assurance criteria. Data outputs are depicted in open boxes. Processes and analyses are depicted in shaded boxes. Equations are detailed in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.s013\" target=\"_blank\">S10 Table</a>.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547212, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.g003", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Approach_used_to_estimate_global_leptospirosis_morbidity_and_mortality_/1547212", "title"=>"Approach used to estimate global leptospirosis morbidity and mortality.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269037"], "description"=>"<p><sup>a</sup>65 published and 7 grey literature studies. <sup>b</sup>Two published reports (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.s002\" target=\"_blank\">S1 Protocol</a> references [<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.ref039\" target=\"_blank\">39</a>],[<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.ref056\" target=\"_blank\">56</a>]) were each separated into two studies as they contained separate data from urban and rural populations. <sup>c</sup>94 published and 2 grey literature studies.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547208, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.g001", "stats"=>{"downloads"=>2, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_diagram_for_selection_of_studies_/1547208", "title"=>"Flow diagram for selection of studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269045"], "description"=>"<p><sup>a</sup> Definitions and sources of variables are described in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.s002\" target=\"_blank\">S1 Protocol</a> pp. 6–7.</p><p><sup>b</sup> Adjusted R<sup>2</sup> is the adjusted proportion of the variance explained by the complete model, with adjustment for the number of variables in the model.</p><p>Variables incorporated in the final multivariable linear regression prediction model for leptospirosis morbidity in 34 countries.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547217, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.t002", "stats"=>{"downloads"=>1, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Variables_incorporated_in_the_final_multivariable_linear_regression_prediction_model_for_leptospirosis_morbidity_in_34_countries_/1547217", "title"=>"Variables incorporated in the final multivariable linear regression prediction model for leptospirosis morbidity in 34 countries.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269044"], "description"=>"<p>NA, not applicable.</p><p><sup>a</sup>Annual leptospirosis morbidity and mortality rates are shown as cases or deaths, respectively, per 100 000 population, and evaluated based on numbers of determined by reported laboratory-confirmed cases and deaths, respectively.</p><p><sup>b</sup> p<0.01</p><p><sup>c</sup> p<0.05</p><p><sup>d</sup> p<0.05 (comparing incidence from studies of urban or rural populations).</p><p>Reported leptospirosis morbidity, mortality, and case fatality, according to study characteristic.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547215, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.t001", "stats"=>{"downloads"=>4, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Reported_leptospirosis_morbidity_mortality_and_case_fatality_according_to_study_characteristic_/1547215", "title"=>"Reported leptospirosis morbidity, mortality, and case fatality, according to study characteristic.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269043"], "description"=>"<p>Mean and standard deviation of the relative risks are presented for males (blue bars) and females (red bars).</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547214, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.g004", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_relative_risk_for_membership_in_age_and_gender_groups_among_leptospirosis_cases_A_and_deaths_B_/1547214", "title"=>"Mean relative risk for membership in age and gender groups among leptospirosis cases (A) and deaths (B).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269039"], "description"=>"<p>Annual disease incidence is represented as an exponential colour gradient from white (0–3), yellow (7–10), orange (20–25) to red (over 100), in cases per 100,000 population. Circles and triangles indicate the countries of origin for published and grey literature quality-assured studies, respectively.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547210, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.g002", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_annual_morbidity_of_leptospirosis_by_country_or_territory_/1547210", "title"=>"Estimated annual morbidity of leptospirosis by country or territory.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269051", "https://ndownloader.figshare.com/files/2269053", "https://ndownloader.figshare.com/files/2269054", "https://ndownloader.figshare.com/files/2269055", "https://ndownloader.figshare.com/files/2269056", "https://ndownloader.figshare.com/files/2269057", "https://ndownloader.figshare.com/files/2269058", "https://ndownloader.figshare.com/files/2269059", "https://ndownloader.figshare.com/files/2269060", "https://ndownloader.figshare.com/files/2269061", "https://ndownloader.figshare.com/files/2269062", "https://ndownloader.figshare.com/files/2269063", "https://ndownloader.figshare.com/files/2269064", "https://ndownloader.figshare.com/files/2269065", "https://ndownloader.figshare.com/files/2269066", "https://ndownloader.figshare.com/files/2269067"], "description"=>"<div><p>Background</p><p>Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.</p><p>Methodology/Principal Findings</p><p>We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R<sup>2</sup> = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa.</p><p>Conclusions/Significance</p><p>Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.</p></div>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547223, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>["https://dx.doi.org/10.1371/journal.pntd.0003898.s001", "https://dx.doi.org/10.1371/journal.pntd.0003898.s002", "https://dx.doi.org/10.1371/journal.pntd.0003898.s003", "https://dx.doi.org/10.1371/journal.pntd.0003898.s004", "https://dx.doi.org/10.1371/journal.pntd.0003898.s005", "https://dx.doi.org/10.1371/journal.pntd.0003898.s006", "https://dx.doi.org/10.1371/journal.pntd.0003898.s007", "https://dx.doi.org/10.1371/journal.pntd.0003898.s008", "https://dx.doi.org/10.1371/journal.pntd.0003898.s009", "https://dx.doi.org/10.1371/journal.pntd.0003898.s010", "https://dx.doi.org/10.1371/journal.pntd.0003898.s011", "https://dx.doi.org/10.1371/journal.pntd.0003898.s012", "https://dx.doi.org/10.1371/journal.pntd.0003898.s013", "https://dx.doi.org/10.1371/journal.pntd.0003898.s014", "https://dx.doi.org/10.1371/journal.pntd.0003898.s015", "https://dx.doi.org/10.1371/journal.pntd.0003898.s016"], "stats"=>{"downloads"=>10, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Global_Morbidity_and_Mortality_of_Leptospirosis_A_Systematic_Review_/1547223", "title"=>"Global Morbidity and Mortality of Leptospirosis: A Systematic Review", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-09-17 03:06:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/2269047"], "description"=>"<p><sup>a</sup>Annual leptospirosis morbidity and mortality rates are shown as cases or deaths, respectively, per 100,000 population.</p><p>Estimated annual leptospirosis morbidity and mortality according to GBD region.</p>", "links"=>[], "tags"=>["disease morbidity", "mortality", "Systematic Review BackgroundLeptospirosis", "gbd", "region", "Monte Carlo modelling", "leptospirosi", "case fatality ratios", "disease incidence", "ci", "Tropical Latin America"], "article_id"=>1547218, "categories"=>["Uncategorised"], "users"=>["Federico Costa", "José E. Hagan", "Juan Calcagno", "Michael Kane", "Paul Torgerson", "Martha S. Martinez-Silveira", "Claudia Stein", "Bernadette Abela-Ridder", "Albert I. Ko"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003898.t003", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_annual_leptospirosis_morbidity_and_mortality_according_to_GBD_region_/1547218", "title"=>"Estimated annual leptospirosis morbidity and mortality according to GBD region.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-09-17 03:06:57"}

PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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