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Kerala has breathed a collective sigh of relief this week as the threat of a Nipah virus outbreak in Malappuram district has subsided, with no new cases reported during the 42-day double incubation period, confirmed the state health department. However, the resurfacing of Nipah and the devastating landslides in Wayanad have overshadowed a severe Leptospirosis outbreak, which has emerged as a major public health concern across the state.
Leptospirosis, also known as “rat fever”, is caused by a type of bacteria in the urine of animal carriers, particularly rats. If a person is exposed to soil or water contaminated with an infected animal's urine, bacteria can enter their body through skin breaks, making people in flooded areas especially vulnerable. The disease is also known for a high mortality rate.
The aftermath of the 2018 floods brought the bacterial infections to the forefront and this year, the situation has escalated. A surge in Leptospirosis cases has affected almost all districts in Kerala.
The state health department has reported 121 confirmed deaths, with an additional 102 suspected cases. In August alone, the infection claimed 24 lives. Currently, 1,170 people are undergoing treatment for the disease in hospitals across the state, a number that is rapidly increasing.
Medical experts have attributed the rise in Leptospirosis cases to the excessive rainfall and resultant waterlogging during the southwest monsoon. Of the 121 deaths reported this year, more than 50 per cent have occurred in the past two months. Data from the Directorate of Health Services (DHS) showed there were 93 Leptospirosis deaths in 2022 and 103 in 2023.
Althaf A, a professor at the government medical college in Thiruvananthapuram, said he has noted an alarming increase in Leptospirosis cases and deaths since 2022.
“The Leptospira bacteria enter the body through wounds and mucous membranes. Wearing protective gear can help prevent infection. People also need to maintain personal hygiene to reduce the risk,” said Althaf.
Althaf urged the state government to launch more campaigns to raise awareness about preventive measures, particularly in waterlogged and vulnerable areas. He also advocated for a system in which the health department notifies the appropriate local authorities when a Leptospirosis death is reported, allowing the community to take preventive measures.
According to health department officials, the preventive medication doxycycline is available at health centres throughout the state. If people report any remaining symptoms on time, they can expect a simple diagnosis and treatment, the officials assured. The public, particularly those at high risk due to occupational exposure to wet soil and water, should exercise caution, the officials warned.
Fever, muscle pain (myalgia) and headaches are common symptoms of Leptospirosis; however, more serious signs such as rapid breathing (tachypnea), low blood pressure (hypotension) and jaundice should be monitored. Althaf stressed that early detection is vital in preventing fatalities and called for further studies on the disease’s spread.
Heavy rainfall and waterlogging increase the chances of Leptospirosis spreading during the monsoon season, said Dipu T S, associate professor of Infectious Diseases at Amrita School of Medicine in Kochi. He also stated that the increase in cases is due to poor waste management, which has resulted in an increase in rat population. This issue, he said, must be addressed urgently.
“Please be cautious when dealing with soil or water contaminated with animal urine. Avoid wading through or drinking floodwater or water from lakes, rivers, or swamps that may be contaminated by animal urine or flooding. If you need to drink such water, boil or chemically treat it to make it safe. If you must walk through floodwaters or other potentially contaminated water, cover any cuts or abrasions and wear protective gear, including appropriate footwear. Consult your healthcare provider to discuss the possibility of taking preventive medication against Leptospirosis,” advised Dipu.
The World Health Organization (WHO) also recommends avoiding contact with dead animals, as they may carry the bacteria.
Despite the availability of effective prevention and treatment methods, experts believe that the increasing number of cases can be attributed to insufficient grassroots prevention efforts and surveillance. In addition to rats, farm animals and dogs can also spread the disease through their faeces. Although some people may show no symptoms, Leptospirosis can lead to serious complications such as renal impairment, meningitis, liver failure and respiratory distress and can be fatal if not treated promptly.
Health experts have raised concerns about the inadequacy of pre-monsoon cleaning efforts and the limited reach of doxycycline to those most in need. Early detection is crucial, as Leptospirosis can rapidly damage internal organs if left untreated, leading to its description as a silent killer.
Alongside Leptospirosis, other vector-borne and water-borne diseases, such as hepatitis A and cholera, continue to afflict Kerala during the final phase of the South West Monsoon. Hepatitis A outbreaks have been reported in several districts, with Malappuram, Kozhikode and Ernakulam among the worst affected. This year has been particularly severe, with 4,306 confirmed cases and 41 confirmed deaths from hepatitis A as of August 21, 2024.
The state’s battle against these diseases highlights the urgent need for improved public health strategies, particularly in ensuring the provision of safe drinking water. The Kerala Water Authority and local self-governments have been criticised for their failure to adequately address water quality issues, which remain a key factor in recurring outbreaks.
Kerala has also seen a rise in dengue cases, with 13,948 confirmed and 37,735 probable cases reported this year. While heavy rainfall has mitigated the dengue outbreak to some extent, the state has still reported 54 confirmed and 40 probable dengue-related deaths.