Buonora, S. 1 ; Chieppe, A. 2; Teixeira, G. 2; Moza, P. 2

1 Rio de Janeiro State Health Department, Fiocruz, Rio de Janeiro Federal University; 2Rio de Janeiro State Health Department, Rio de Janeiro, Brazil.

Leptospirosis cases and the Rio de Janeiro state catastrophic landslide and intense rainfall In January 2011: Strategies to reduce deaths

Rio de Janeiro State

Health Department E-mail: sbuonora@yahoo.com.br

Background

Leptospirosis is endemic in Brazil and outbreaks of the disease occur annually in areas with heavy rainfall and inundation. It is a disease of compulsory notification in the country. In January 2011 catastrophic landslides in the mountainous region of Rio de Janeiro State caused more than 1,500 deaths and large destruction. Actively seeking, identifying and reporting cases of leptospirosis were performed by local and state epidemiological surveillance services in order to promptly assist and treat the patients.

Figure 1: Downtown Nova Friburgo, January 2011

Methods

The Superintendence of Epidemiological and Environmental Surveillance of the State Secretary of Health of Rio de Janeiro conducted active surveillance for leptospirosis and adopted a protocol of assistance and treatment to be used by local epidemiology services and health professionals during 2011, after the catastrophic rainfall at the mountainous region of the state.

On the very next day of the rainfall, the Rio de Janeiro Health Secretariat began distributing 200,000 pamphlets about the disease throughout the region affected by the flood. Anticipating the problem, the awareness campaign material was promptly distributed. In some places, inaccessible by car, the material was sent by helicopter. There were over 150 visits to shelters. A protocol to syndromic post-flood disease approach was implemented in all municipalities, with doing little or no laboratory tests. In all health units a flowchart explaining health care for suspected cases of leptospirosis was distributed.

Results During 2011, surveillance identified 1,157 cases of leptospirosis of which 709 were laboratory-confirmed with the occurrence of 27 deaths. Most of the cases (447 - 63%) occurred at the mountainous region of the state and the majority of them during January. The state annual reported incidence was 4,4 cases per 100,000 inhabitants, although two cities at the mountainous region have 145,96 (Teresopolis) and 91,7 (Nova Friburgo) cases per 100,000 inhabitants. At this region only one fatal case was reported after the catastrophic rainfall. Figure 3: Attempt to rescue firefighters deceased during the landslide

Figure 4: Mobile health unit, Downtown Nova Friburgo, 2011

Conclusion High rate of misdiagnosis of leptospirosis and other clinically indistinguishable acute febrile illnesses such as dengue may increase rate mortality. Thus, rapid identification of cases and institution of a protocol of assistance and treatment are important tools for surveillance, public health intervention and alerting health professionals. Timely interventions should be adopted in order to minimize fatal cases of leptospirosis. In catastrophic situations, health care providers, epidemiological surveillance services and government should work in partnership at the control of epidemic diseases.

Figure 2: Fallen building after landslide, Nova Friburgo 2011

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