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Influence of household rat infestation on leptospira transmission in the urban slum environment.

Costa F, Ribeiro GS, Felzemburgh RD, Santos N, Reis RB, Santos AC, Fraga DB, Araujo WN, Santana C, Childs JE, Reis MG, Ko AI - PLoS Negl Trop Dis (2014)

Bottom Line: Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71-0.84).Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households.The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.

View Article: PubMed Central - PubMed

Affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil.

ABSTRACT

Background: The Norway rat (Rattus norvegicus) is the principal reservoir for leptospirosis in many urban settings. Few studies have identified markers for rat infestation in slum environments while none have evaluated the association between household rat infestation and Leptospira infection in humans or the use of infestation markers as a predictive model to stratify risk for leptospirosis.

Methodology/principal findings: We enrolled a cohort of 2,003 urban slum residents from Salvador, Brazil in 2004, and followed the cohort during four annual serosurveys to identify serologic evidence for Leptospira infection. In 2007, we performed rodent infestation and environmental surveys of 80 case households, in which resided at least one individual with Leptospira infection, and 109 control households. In the case-control study, signs of rodent infestation were identified in 78% and 42% of the households, respectively. Regression modeling identified the presence of R. norvegicus feces (OR, 4.95; 95% CI, 2.13-11.47), rodent burrows (2.80; 1.06-7.36), access to water (2.79; 1.28-6.09), and un-plastered walls (2.71; 1.21-6.04) as independent risk factors associated with Leptospira infection in a household. We developed a predictive model for infection, based on assigning scores to each of the rodent infestation risk factors. Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71-0.84).

Conclusions/significance: Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households. We developed an easily applicable prediction score based on rat infestation markers, which identified households with highest infection risk. The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.

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Related in: MedlinePlus

Environmental variables related to source of food, water, harborage and access for rodents and rodent active signs in the study area.(A and B) Photographs of the typical environment at the community study site, which shows a valley in which households are situated and the proximity of households to open sewers, exposed garbage and bushes or shrubbery. (C and D) Rodent burrows. (D and E) Rodent runs. (F) Rattus norvegicus fecal droppings.
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pntd-0003338-g001: Environmental variables related to source of food, water, harborage and access for rodents and rodent active signs in the study area.(A and B) Photographs of the typical environment at the community study site, which shows a valley in which households are situated and the proximity of households to open sewers, exposed garbage and bushes or shrubbery. (C and D) Rodent burrows. (D and E) Rodent runs. (F) Rattus norvegicus fecal droppings.

Mentions: This study was conducted in Pau da Lima, a slum community situated in the periphery of Salvador, a city of 2.7 million inhabitants [23] in Northeast Brazil. This site was selected for epidemiological studies on leptospirosis based on the high annual incidence of severe leptospirosis (35.4 cases per 100,000 pop.) identified in this community by active surveillance during1996 to 2002. The study site is a four valley area of 0.46 km2, characterized by the absence of basic sanitation and high levels of rat infestation [10] (Figure 1A–B). In 2003, we conducted a census in the area and identified 14,122 residents living at 3,689 households. The socioeconomic profile in this site was similar to other slum populations in Brazil: subjects were squatters (85%) who did not complete primary school (77%) and had a median household per capita income of $1.30 per day.


Influence of household rat infestation on leptospira transmission in the urban slum environment.

Costa F, Ribeiro GS, Felzemburgh RD, Santos N, Reis RB, Santos AC, Fraga DB, Araujo WN, Santana C, Childs JE, Reis MG, Ko AI - PLoS Negl Trop Dis (2014)

Environmental variables related to source of food, water, harborage and access for rodents and rodent active signs in the study area.(A and B) Photographs of the typical environment at the community study site, which shows a valley in which households are situated and the proximity of households to open sewers, exposed garbage and bushes or shrubbery. (C and D) Rodent burrows. (D and E) Rodent runs. (F) Rattus norvegicus fecal droppings.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256176&req=5

pntd-0003338-g001: Environmental variables related to source of food, water, harborage and access for rodents and rodent active signs in the study area.(A and B) Photographs of the typical environment at the community study site, which shows a valley in which households are situated and the proximity of households to open sewers, exposed garbage and bushes or shrubbery. (C and D) Rodent burrows. (D and E) Rodent runs. (F) Rattus norvegicus fecal droppings.
Mentions: This study was conducted in Pau da Lima, a slum community situated in the periphery of Salvador, a city of 2.7 million inhabitants [23] in Northeast Brazil. This site was selected for epidemiological studies on leptospirosis based on the high annual incidence of severe leptospirosis (35.4 cases per 100,000 pop.) identified in this community by active surveillance during1996 to 2002. The study site is a four valley area of 0.46 km2, characterized by the absence of basic sanitation and high levels of rat infestation [10] (Figure 1A–B). In 2003, we conducted a census in the area and identified 14,122 residents living at 3,689 households. The socioeconomic profile in this site was similar to other slum populations in Brazil: subjects were squatters (85%) who did not complete primary school (77%) and had a median household per capita income of $1.30 per day.

Bottom Line: Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71-0.84).Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households.The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.

View Article: PubMed Central - PubMed

Affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil.

ABSTRACT

Background: The Norway rat (Rattus norvegicus) is the principal reservoir for leptospirosis in many urban settings. Few studies have identified markers for rat infestation in slum environments while none have evaluated the association between household rat infestation and Leptospira infection in humans or the use of infestation markers as a predictive model to stratify risk for leptospirosis.

Methodology/principal findings: We enrolled a cohort of 2,003 urban slum residents from Salvador, Brazil in 2004, and followed the cohort during four annual serosurveys to identify serologic evidence for Leptospira infection. In 2007, we performed rodent infestation and environmental surveys of 80 case households, in which resided at least one individual with Leptospira infection, and 109 control households. In the case-control study, signs of rodent infestation were identified in 78% and 42% of the households, respectively. Regression modeling identified the presence of R. norvegicus feces (OR, 4.95; 95% CI, 2.13-11.47), rodent burrows (2.80; 1.06-7.36), access to water (2.79; 1.28-6.09), and un-plastered walls (2.71; 1.21-6.04) as independent risk factors associated with Leptospira infection in a household. We developed a predictive model for infection, based on assigning scores to each of the rodent infestation risk factors. Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71-0.84).

Conclusions/significance: Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households. We developed an easily applicable prediction score based on rat infestation markers, which identified households with highest infection risk. The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.

Show MeSH
Related in: MedlinePlus