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cerrar este libroWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
Ver el documentoAcknowledgements
Ver el documentoAcronyms
Ver el documentoIntroduction
Ver el documentoNational Coordination of Communicable Disease Surveillance
Ver el documentoExplanatory notes
Ver el documentoSurveillance activities: criteria and WHO Department
Ver el documentoCommunicable disease contacts in Regional Offices
cerrar esta carpetaDiseases
Ver el documentoB20-B21-B22-B23-B24 AIDS
Ver el documentoA22 Anthrax
Ver el documentoA23 Brucellosis
Ver el documentoA00 Cholera
Ver el documentoA81.0 Creutzfeldt-Jakob disease
Ver el documentoA90, A91 Dengue fever (A90) including Dengue haemorrhagic fever (DHF) & Dengue shock syndrome (DSS, A91)
Ver el documentoA36 Diphtheria
Ver el documentoB72 Dracunculiasis (Guinea worm disease)
Ver el documentoA98.3, A98.4 Ebola-Marburg viral diseases
Ver el documentoA83.0 Japanese encephalitis
Ver el documentoB74 Lymphatic filariasis
Ver el documentoB96.3 Haemophilus influenzae type b
Ver el documentoB15-B17 Acute viral hepatitis
Ver el documentoB20-B24 HIV infection
Ver el documentoJ10, J11 Influenza
Ver el documentoA96.2 Lassa fever
Ver el documentoA48.1 Legionellosis
Ver el documentoB55.1, B55.2 Cutaneous leishmaniasis
Ver el documentoLeishmania / HIV co-infections
Ver el documentoB55.0 Visceral leishmaniasis
Ver el documentoA30 Leprosy
Ver el documentoA27 Leptospirosis
Ver el documentoB50-54 Malaria
Ver el documentoB05 Measles
Ver el documentoA39 Meningococcal disease
Ver el documentoA87 Viral meningitis
Ver el documentoB73 Onchocerciasis
Ver el documentoA37.0 Pertussis
Ver el documentoA20 Plague
Ver el documentoA36 Poliomyelitis
Ver el documentoA82 Rabies
Ver el documentoA02.0 Salmonellosis
Ver el documentoB65 Schistosomiasis
Ver el documentoA50-52 Syphilis
Ver el documentoA33 Tetanus, neonatal
Ver el documentoB56-0, B56-1 African trypanosomiasis
Ver el documentoB57 American trypanosomiasis
Ver el documentoA15-A19 Tuberculosis
Ver el documentoA75.3 Scrub typhus
Ver el documentoA95.9 Yellow fever
abrir esta carpeta y ver su contenidoSyndromes
Ver el documentoAnnex 1 Software free and in the public domain
Ver el documentoAnnex 2 Proposed surveillance definitions
Ver el documentoAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance

A27 Leptospirosis


This zoonosis with worldwide distribution occurs seasonally in countries with a humid subtropical or tropical climate. It is often linked to occupation, sometimes in outbreaks. Feral and domestic animal species may serve as sources of infection with one of the Leptospira serovars. Infection is transmitted to humans through direct contact with (the urine of) infected animals or a urine-contaminated environment, mainly surface waters, soil and plants. The course of disease in humans ranges from mild to lethal. Leptospirosis is probably underreported in many countries because of difficult clinical diagnosis and lack of diagnostic laboratory services. Surveillance provides the basis for intervention strategies in human or veterinary public health.


Clinical description

Acute febrile illness with headache, myalgia and prostration associated with any of the following symptoms:


• conjunctival suffusion
• meningeal irritation
• anuria or oliguria and/or proteinuria
• jaundice
• haemorrhages (from the intestines; lung bleeding is notorious in some areas)
• cardiac arrhythmia or failure
• skin rash

and a history of exposure to infected animals or an environment contaminated with animal urine.

Other common symptoms include nausea, vomiting, abdominal pain, diarrhoea, arthralgia.

Laboratory criteria for diagnosis


• Isolation (and typing) from blood or other clinical materials through culture of pathogenic leptospires

• Positive serology, preferably Microscopic Agglutination Test (MAT), using a range of Leptospira strains for antigens that should be representative of local strains

Case classification

Suspected: A case that is compatible with the clinical description. Probable: Not applicable.

Confirmed: A suspect case that is confirmed in a competent laboratory.


Note: Leptospirosis is difficult to diagnose clinically in areas where diseases with symptoms similar to those of leptospirosis occur frequently.


Immediate case-based reporting of suspected or confirmed cases from peripheral level (hospital/general practitioner/laboratory) to intermediate level. All cases must be investigated.

Routine reporting of aggregated data of confirmed cases from intermediate to central level. Hospital-based surveillance may give information on severe cases of leptospirosis. Serosurveillance may give information on whether leptospiral infections occur or not in certain areas or populations.

International: The International Leptospirosis Society* collects worldwide data:

Royal Tropical Institute (KIT), Department of Biomedical Research, NH Swellengrebel Laboratory, Meibergdreef 39,1105 AZ Amsterdam, The Netherlands


Tel: 31 20 566 5441
Fax: 31 20 697 1841
E-mail: r.hartskeerl@kit.nl
ILS home page: http://www.med.monash.edu.au/micro/department/adler/ilspage.htm


Individual patient record for reporting and investigation


• Age, sex, geographical information, occupation
• Clinical symptoms (morbidity, mortality)
• Hospitalization (Y/N)
• History and place of exposure (animal contact, environment)
• Microbiological and serological data
• Date of diagnosis
• Rainfall, flooding

Aggregated data for reporting


• Number of cases
• Number of hospitalizations
• Number of deaths
• Number of cases by type (causative serovar/serogroup) of leptospirosis


Number of cases by: age, sex, occupation, area, date of onset, causative serovars/serogroups, (presumptive) infection source, transmission conditions (graphs, tables, maps).

Frequency distribution of signs and symptoms by case and causative serovar (tables).

Reports of outbreaks, reports of preventive measures, surveillance of the human population and populations of feral and domestic animals.



• Assess the magnitude of the problem in different areas and risk groups/areas/conditions
• Identify outbreaks
• Identify animal sources of infection
• Monitor for emergence of leptospirosis in new areas and new risk (occupational) groups
• Design rational control or prevention methods
• Identify new serovars and their distribution
• Inform on locally occurring serovars for a representative range in the MAT


Serology by Microscopic Agglutination Test (MAT) may provide presumptive information on causative serogroups. Attempts should be made to isolate leptospires, and isolates should be typed to assess locally circulating serovars.

Questioning the patient may provide clues to infection source and transmission conditions. Animal serology may give presumptive information on serogroup status of the infection Isolation followed by typing gives definite information on serovar.


Regional Offices

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Communicable Diseases Surveillance and Response (CSR)


E-mail: cosivio@who.ch / outbreak@who.ch
Tel: (41 22) 791 2531/4687/2111
Fax: (41 22) 791 4893/0746 attn CSR
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