5 confirmed, 3 probable leptospirosis cases in Guam

The Department of Public Health and Social Services in Guam has received reports of five confirmed and three probable leptospirosis cases in the past seven weeks.  

Infection was recently confirmed in three cases in November: one confirmed case, along with three probable cases, all of whom were swimming in the Ylig River at the Manenggon Memorial on Veterans Day. 

For the other two confirmed cases in November, one has no additional information available and the other case involved working at an unspecified outdoor jobsite.

Infection was also recently confirmed from tests conducted off-island, in two separate U.S. Naval Hospital cases in mid-October: one active duty military member who had been hiking at San Carlos Falls on Nimitz Hill, and a military dependent whose exposure is unknown. 

Leptospirosis is a zoonotic infection, which may be fatal, that is transmitted from animals to humans by infected urine through the environment. Infection can occur through breaks in the skin or through the mucous membranes of the eyes, nose or mouth.  The wide range of leptospirosis symptoms (high fever, headache, chills, muscle aches, vomiting, jaundice, red eyes, abdominal pain, diarrhea and rash) and their poor specificity can be mistaken for other diseases (i.e. dengue fever or influenza).

Without treatment, the disease can lead to serious complications (e.g. kidney and liver failure) and even death. It is therefore crucial that people who feel sick with a fever and think they have the disease quickly consult a doctor. Early antibiotic treatment is a major determinant of rapid recovery and prevents most of the severe complications and fatalities. 

Heavy and torrential rainfall caused by tropical storms is an important trigger of leptospirosis in endemic settings like Guam and other tropical islands. Epidemiological evidence suggests that the contamination occurs at the time of heavy rain flooding events or very shortly after, thus leptospirosis cases will seek medical care one to three weeks after storms.  Since Guam has had a lot of rain and stormy weather recently, this is the likely reason why DPHSS is seeing numerous confirmed and probable leptospirosis cases. Historical information shows leptospirosis infection in Guam occurs mainly in people who have been hiking and/or swimming in streams and rivers in the southern part of the island.

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine; thus, the public may wish to refrain from such activities, particularly after a heavy rainfall, and by eliminating contact with potentially infected animals.  Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

For more information from the U.S. Centers for Disease Control and Prevention, see https://www.cdc.gov/leptospirosis/index.html and https://www.cdc.gov/leptospirosis/resources/ leptospirosis-fact-sheet.html.

To report leptospirosis cases, contact Dr. Ann Pobutsky, the Territorial Epidemiologist, at (671) 888-9276 or ann.pobutsky@dphss.guam.gov. (PR)