Leptospirosis – A Lethal Killer Living Among Us

For the first time, villagers of Korobebe Village in Sabeto, Nadi, lost two young lives to a lethal bacteria.

Families of the two victims, Kave­kini Tubuisusu and Marika Lagilo­lo, are still reeling from the sudden loss of their family members six months later.

The two, aged 17 and 22, died at the height of the outbreak of leptospi­rosis.

Leptospirosis, also known as Weil’s disease, is a bacteria that mostly spreads through the urine of in­fected animals and can cause severe flu-like symptoms in people. In some cases, it causes death.

Responding to emailed questions, the Ministry of Health and Medical Services (MOHMS) said leptospiro­sis was an endemic disease in Fiji and was responsible for substan­tial morbidity and mortality in the country.

MOH data indicated that in 2012, two large outbreaks occurred with 576 reported cases and 40 deaths.

In comparison, previous studies in Fiji reported 487 cases during a 13-year period from 1969-1981, and 576 cases during an eight-year period from 2000 – 2007 with 40 deaths.

This year alone, the death toll stands at 36 as of May 17. Every year, leptospirosis continues to claim peo­ple’s lives.

Experts argue that Fiji needs a One Health (OH) framework to tackle problems like leptospirosis. OH en­courages multisectoral collabora­tion where effective policies relating to animal, public and environmen­tal health can be formulated.

Such collaboration requires activi­ties that support the community to understand their own environment.

Associate Professor Global Disease Control at the University of Queens­land, Simon Reid, said developing a local strategy that reduced the risk of infection took longer.

“The most immediate thing we can do is reduce the risk of severe dis­ease and death, by educating people to present early to a health care fa­cility,” Mr Reid said.

Mr Reid conducts zoonotic re­search in the Pacific, including Fiji. One of the studies he co-authored explored the possibility for a OH col­laboration for leptospirosis in Fiji.

Brothers Tevita Saukuru (left) and Simione Dusilele, with a photo of their late brother, Marika Lagilolo, at their home in Korobebe Village, Sabeto, Nadi. Photo: Leon Lord

THE CASES

Like in Korobebe Village, there are Fijians who are oblivious and even ignorant to the fatal impact of lep­tospirosis.

For this year alone, the cases re­corded in the different divisions in Fiji are as follows:

• Western Division 858 cases;
• Central Division 605 cases;
• Northern Division 367 cases; and
• Eastern Division 58 cases.

A health inspector for 10 years said the Western Division was always at risk because it was predominantly an agricultural region and was flood-prone. The health inspector, who spoke on the condition of ano­nymity because he was not allowed to speak to the media, said neglect­ing the advice by the health inspec­tors increased the number of cases.

Minister for Health and Medical Services Dr Ifereimi Waqainabete said statements indicating that the disease was prevalent among iTaukei communities were incor­rect.

“It’s not purely negligence, it’s just the fact that we [people] fail to un­derstand the depth of what source reduction is and if we don’t do it, what it can do to us,” he said.

“People don’t understand that with communicable diseases, people die within a week, within a few days af­ter the incubation period.”

The health inspector said the num­ber of infections had decreased dur­ing the COVID-19 lockdown because there was no movement by the peo­ple, but this changed when the lock­down was lifted.

A senior health official, who is not authorised to speak to the media, said medical officers were advised to be alert for those presenting with symptoms during and after a heavy downpour.

Asked about the impact of climate change on the number of outbreaks over the years, she said: “Climate change is affecting the pattern of the disasters.

Leptospirosis is associated with flooding when there’s a disaster, hence affects the outbreaks.”

MECHANISMS OF CONTROL

Within village perimeters, health officials are tasked with carrying out awareness, including advising against the enclosure of animals such as horses, cattle, and pigs close to the village.

In instances where villagers do not abide by the warning, the village headman is involved, and matters are dealt directly by the Ministry of iTaukei Affairs (MoIA).

The villages and peri-urban settle­ments comprising mainly iTaukei are governed by the by-laws under the iTaukei Affairs Act, adminis­tered by the Ministry of iTaukei Af­fairs.

Despite the by-laws not being for­mally gazetted, there are guidelines that govern the villages.

Deputy chief executive officer for iTaukei Affairs Board Josefa To­ganivalu said if there’s an outbreak in the village, the village headman and community health worker would diagnose the situation before informing the district nurse.

CONCLUSION

MOH says leptospirosis is difficult to eliminate, therefore minimisa­tion is the best option for managing risk. One way this is carried out is through awareness about leptospi­rosis and its transmission cycle.

A study titled “A process for devel­oping multisectoral strategies for zoonoses: the case of leptospirosis in Fiji”, indicate that “leptospirosis only receives wide-spread attention in outbreaks when there is media coverage of deaths or a large num­ber of hospitalisations”.

Permanent Secretary for Agricul­ture Vinesh Kumar said the coordi­nation between the line ministries and relevant stakeholders must be strengthened.

Like the sporadic spread of lepto­spirosis, formal engagement among stakeholders to combat the disease seems disorganised.

To effectively address leptospirosis outbreaks, vigorous awareness ac­tivities must be carried out so that communities fully understand the cause and transmission of this dis­ease, and the best preventive meas­ures.

This article is part of Earth Journalism Network’s special collaborative project on One Health and meat in the Asia Pacific entitled “More Than Meats the Eye.” It brings together 8 media outlets from different countries and more than a dozen reporters to cover the impact of meat on animal, human and environmental health in the Asia-Pacific region.

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