Leptospirosis: Are Children Spared?

September 12, 2012 at 1:40 pm Leave a comment

Children of all age groups are also affected by Leptospirosis.  This disease has been present in the country and was first reported in 1932. The rise in the number of leptospirosis cases and deaths has been alarming since the past 3 years, the aftermath of typhoon “Ondoy” in Luzon, and in 2011 after typhoon “Sendong” in Mindanao, and is currently affecting even more after the recent flooding in Metro Manila and Luzon brought by the southwest monsoon (habagat).

By now, we should know how to protect ourselves.  But how do we protect are kids and our teens? The Pediatric Infectious Disease Society of the Philippines (PIDSP) provided guidelines for both physicians and parents on the prevention of leptospirosis in the pediatric age group.  The succeeding paragraphs show the content of the Post Disaster Interim Advice on the Prevention of Leptospirosis in Children.

Leptospirosis is an infectious disease caused by pathogenic bacteria called leptospires. The main carriers of leptospires are animals such as rats, mice, dogs, cats and livestock. Human leptospiral infections can occur when mucus membranes and skin are contaminated by the urine of infected animals, or upon ingestion of contaminated food and water, all of which may occur when an individual is exposed to flood waters. Thus the occurrence of freshwater flooding after typhoons or increased rainfall can lead to an increased risk of leptospirosis.

Manifestations

Initial symptoms of leptospirosis may range from mild to severe, or may even be fatal.  Manifestations of the disease include:

  1. a mild influenza-like illness  (fever, cough, colds, body aches, headache)*
  2. Weil’s syndrome, characterized by jaundice (yellowing of the skin, eyes), renal failure(kidney shut down), hemorrhage (bleeding), and arrhythmias (heart beat irregularities);
  3. meningitis/meningoencephalitis (infection of the brain and meninges) ; or
  4. pulmonary hemorrhage with respiratory failure (bleeding in the lungs)

Case fatality rates range from 12-14% in the Philippines. In studies in India, case fatality rates were lower in the pediatric age group compared to adults.

Prevention

  1. Parents should instruct children not to wade or swim in flood waters.
  2. If exposure to flood waters is unavoidable, protective gear such as boots, goggles, overalls, and rubber gloves should be used.
  3. All food and drinking water should be protected against contamination. Fresh vegetables and fruit should be washed in previously boiled or clean water and then cooked or peeled.
  4. Boil drinking water for at least 10-15 minutes. Physical filtration through ceramic orcharcoal filters is not adequate for leptospirosis.
  5. Food should be protected against rodent attack or contamination.
  6. If children are exposed to flood waters, antibiotic prophylaxis may decrease occurrence of clinical disease and mortality. Prophylactic antibiotics should be given under the supervision of a physician, who can give advice regarding effects, precautions and contraindications for these medications.

Post-exposure Prophylaxis

The following antibiotics are recommended for children exposed to flood waters:

DRUG OF CHOICE

ALTERNATIVE DRUGS

If children are exposed for more than 7 days, the dose should be repeated after 1 week.  Prophylaxis is not 100% effective. Prevention of exposure is most prudent. Monitor all those exposed for the occurrence of symptoms of leptospirosis. The early signs of infection occur between 4 and 10 days after exposure, and usually begin with a fever and an influenza-like illness. Headaches, sensitivity to light, muscle and joint pains, vomiting and fatigue are also common. Seek medical attention once these symptoms are noted.

*words in italics were added  and not included in the guideline

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Entry filed under: Health Alert. Tags: , , , , , .

Health Advisories on Flood Related Diseases Essential Newborn Care in the Philippines

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