Widawati Mutiara, Dhewantara Pandji Wibawa, Anasi Raras, Wahono Tri, Marina Rina, Pertiwi Intan Pandu, Wibowo Agus Ari, Ruliansyah Andri, Riandi Muhammad Umar, Widiastuti Dyah, Astuti Endang Puji
Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
Health Development Policy Agency, Ministry of Health of Indonesia, Jakarta.
Geospat Health. 2023 Oct 5;18(2). doi: 10.4081/gh.2023.1221.
Leptospirosis is neglected in many tropical developing countries, including Indonesia. Our research on this zoonotic disease aimed to investigate epidemiological features and spatial clustering of recent leptospirosis outbreaks in Pangandaran, West Java. The study analysed data on leptospirosis notifications between September 2022 and May 2023. Global Moran I and local indicator for spatial association (LISA) were applied. Comparative analysis was performed to characterise the identified hotspots of leptospirosis relative to its neighbourhoods. A total of 172 reported leptospirosis in 40 villages from 9 sub-districts in Pangandaran District were analysed. Of these, 132 cases (76.7%) were male. The median age was 49 years (interquartile range [IQR]: 34-59 years). Severe outcomes including renal failure, lung failure, and hepatic necrosis were reported in up to 5% of the cases. A total of 30 patients died, resulting in the case fatality rate (CFR) of 17.4%. Moran's I analysis showed significant spatial autocorrelation (I=0.293; p=0.002) and LISA results identified 7 High-High clusters (hotspots) in the Southwest, with the total population at risk at 26,184 people. The hotspots had more cases among older individuals (median age: 51, IQR: 36-61 years; p<0.001), more farmers (79%, p=0.001) and more evidence of the presence of rats (p=0.02). A comprehensive One Health intervention should be targeted towards these high-risk areas to control the transmission of leptospirosis. More empirical evidence is needed to understand the role of climate, animals and sociodemographic characteristics on the transmission of leptospirosis in the area studied.
包括印度尼西亚在内的许多热带发展中国家都忽视了钩端螺旋体病。我们对这种人畜共患病的研究旨在调查西爪哇省庞岸达兰近期钩端螺旋体病暴发的流行病学特征和空间聚集情况。该研究分析了2022年9月至2023年5月期间钩端螺旋体病通报的数据。应用了全局莫兰指数（Global Moran I）和空间关联局部指标（LISA）。进行了比较分析，以描述已确定的钩端螺旋体病热点地区相对于其周边地区的特征。对庞岸达兰区9个分区40个村庄报告的172例钩端螺旋体病进行了分析。其中，132例（76.7%）为男性。中位年龄为49岁（四分位间距[IQR]：34 - 59岁）。高达5%的病例报告了包括肾衰竭、肺衰竭和肝坏死在内的严重后果。共有30名患者死亡，病死率（CFR）为17.4%。莫兰指数分析显示存在显著的空间自相关性（I = 0.293；p = 0.002），LISA结果在西南部确定了7个高高聚类（热点地区），高危总人口为26,184人。这些热点地区中老年人的病例更多（中位年龄：51岁，IQR：36 - 61岁；p < 0.001），农民更多（79%，p = 0.001），且有更多老鼠出没的证据（p = 0.02）。应针对这些高危地区开展全面的一体化健康干预措施，以控制钩端螺旋体病的传播。需要更多实证证据来了解气候、动物和社会人口特征在所研究地区钩端螺旋体病传播中的作用。
