High incidence of leptospirosis in an observational study of hospital outpatients in Vanuatu highlights the need for improved awareness and diagnostic capacities

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.