Schneider Maria Cristina, Velasco-Hernandez Jorge, Min Kyung-Duk, Leonel Deise Galan, Baca-Carrasco David, Gompper Matthew E, Hartskeerl Rudy, Munoz-Zanzi Claudia
PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA.
Instituto de Matematicas, National Autonomous University of Mexico, Juriquilla 76230, Mexico.
Int J Environ Res Public Health. 2017 Jun 3;14(6):594. doi: 10.3390/ijerph14060594.
Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types). Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.
在过去十年中，出现了破纪录的灾难性降雨事件。降雨和洪水被认为是钩端螺旋体病的主要风险因素，并且在极端天气事件之后已有多起疫情报告。在这种情况下，一种预防高危人群感染钩端螺旋体病的可能干预措施是使用化学预防法。然而，目前尚无足够证据证明其效果。本研究的目的是回顾关于钩端螺旋体病化学预防法当前实践的文献，并使用数学模型探讨各种化学预防方案如何影响钩端螺旋体病疫情的发展。我们筛选了26篇经过同行评审的出版物（10项定量研究、2项系统评价和14篇其他类型的文章）。口服强力霉素是钩端螺旋体病化学预防中最常用的抗生素。四项研究在自然灾害后评估了暴露后预防措施。尽管暴露后预防有效性的证据并不一致，但关联方向支持其对发病率和死亡率具有保护作用。理论模型显示了化学预防法假定的益处是如何受到给药时间和给药率影响的。未来的模型应考虑受影响社区的异质性，改进对化学预防法对钩端螺旋体感染和疾病影响的估计，以及潜在的有害影响。开展更多研究对于在疫情期间提供基于明确证据的钩端螺旋体病防控建议至关重要。本研究结果表明，化学预防法在高危暴露后减少钩端螺旋体病病例数方面可能提供一定保护；然而，实际益处可能取决于多种因素，如预防的时机和覆盖范围。总结的这些信息可用于支持高风险事件期间的决策制定。
