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Cuba's leptospirosis scare.

When hurricanes Gustav and Ike hit Cuba with devastating force in late August and early September, Cuban authorities rushed to prevent any epidemic outbreak in the affected areas.

A prompt response to the threat--along with efforts by Cuba's Ministry of Public Health (MINSAP)--have so far averted a major catastrophe.


Yet the hurricanes tore apart Cuba's housing infrastructure, and now tens of thousands of people live in crowded shelters. At the same time, the power grid, water-treatment and drainage systems, garbage collection and health-care services were all affected by the hurricanes--leading to the possible and rapid spread of water-borne infections.

One of the possible outbreaks the regime tried to curtail was leptospirosis, a zoonotic bacterial infection transmitted to humans when the urine of rats, pigs, dogs and other domestic or feral mammals comes into contact with the human food and water supply.'

It's also transmitted through skin lesions--not an uncommon risk for people living or working in the fields, or in shelters and warehouses, especially in soaked soils and crops.

In its acute human form, leptospirosis is known as Weil's disease and is potentially lethal though rarely so.

MINSAP is particularly concerned because of an increase in the number of leptospirosis cases last year in the provinces of Las Tunas, Holguin and Pinar del Rio--precisely those hit hardest by the hurricanes.

Cuba suffered an outbreak of leptospirosis in the darkest years of the so-called Special Period, when the sudden loss of its Soviet and Eastern European trading partners led to a chaotic drop in living standards. The number of leptospirosis cases peaked in 1994 at 2,828 (including 52 deaths), compared to an average 460 cases per year in 1985-89.

The outbreak occurred in 1991, when 1,141 people became infected--double that of the preceding year. From 1992 to 1996, Cuba reported 9,015 cases and 274 deaths, translating into a death rate of 3.04% among infected people. Males ranging from 15 to 54 years old were most commonly affected.

Despite the poor economic conditions, Cuba's government managed to halt the spread of the disease with an intense campaign spearheaded by MINSAP, including a drive to educate the population about the means of transmission. In 1996, it also embarked on a massive vaccination of 200,000 people living in high-risk areas.


In the mid to late 1990s, Havana's Carlos J. Finlay Institute developed a new vaccine (vax-Spiral) with an immunization effectiveness of 78% that was successfully tested in humans and has been in use ever since. Recently, the government of Argentina bought over 50,000 doses of vax-Spiral to curtail an outbreak in that country's northern provinces.

According to official reports, in 2007 almost one million people in Holguin province (nearly everyone) received a homeopathic product developed by the Finlay Institute to prevent both leptospirosis and hepatitis A.

In Cuba, the highest prevalence of leptospirosis consistently occurs in the eastern provinces of Holguin and Las Tunas, which in 2007 reported 256 and 383 cases respectively (169 and 27 cases in 2006).

The western province of Pinar del Rio also shows a high prevalence of the disease, with 90 cases reported in 2007.

Although Cuban health authorities don't offer any explanation for this, it so happens these provinces have a higher ratio of rural settlements due to their prominence in sugarcane, rice and tobacco production.

The prevention effort seems to be bearing fruit, as only 172 cases were reported nationwide through early October.

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Date:Nov 1, 2008
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