Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 National Journal of Community Medicine│Volume 4│Issue 4│Oct – Dec 2013 Page 636 Original Article ▌ A STEP TOWARD CONTROLLING THE HAVOC OF LEPTOSPIROSIS: COMPREHENSIVE AND COMBINED EFFORTS Megha Mehta 1 , Prakash B Patel 2 , N B Patel 2 , Vaibhav Gharat 3 , R K Bansal 4 Financial Support: District Panchayat, Surat Conflict of interest: None declared Copy right: The Journal retains the copyrights of this article. However, reproduction of this article in the part or total in any form is permissible with due acknowledgement of the source. How to cite this article: Mehta M, Patel PB, Patel NB, Gha- rat V, Bansal RK. A Step toward Controlling the Havoc of Leptospi- rosis: Comprehensive and Com- bined Efforts. Natl J Community Med 2013; 4(4): 369-376. Author’s Affiliation: 1 Chief District Health officer, Surat; 2 Assistant Professor, Department of Community Medicine, SMIMER, Surat; 3 Assistant Professor, Department of Community Medicine, GMERS Medical College, Valsad; 4 Professor, Department of Community Medicine, SMIMER, Surat Correspondence: Dr Prakash Patel E mail: drpbpatel@gmail.com Date of Submission: 30-11-13 Date of Acceptance: 20-12-13 Date of Publication: 31-12-13 ABSTRACT Introduction: Leptospirosis is a globally important bacterial zoonotic disease occurring in rural areas of South Gujarat. Primary prevention of Leptospirosis is very difficult. This study was planned for early detection and timely referral of cases; increase awareness in high risk population regarding primary prevention and early treatment seeking; and establish and strengthen case suspicion and referral network in the community itself. Methodology: This intervention study was conducted in villages of Surat district with main focus on early recognition of symptoms of Leptospiro- sis and timely health care seeking. Multipronged approach including meeting with villages, local leader and local health functionaries were used as an intervention. Results: Mass campaign resulted in early health seeking behavior for suspected symptoms which is evident from gross increase in case report- ing compare to previous year. These cases were reported early in their clinical course and timely treatment resulted in decreased case fatality rate from 24% in year 2012 to 9.5% in 2013. Conclusion: The comprehensive effort involving every strata of the community from health staff to Sarpanchs/local leaders to local commu- nity under one roof has desirable and positive impact on the implemen- tation of leptospirosis control in form of early treatment seeking and timely referral. Keywords: Leptospirosis, secondary prevention, early detection INTRODUCTION Leptospirosis is a globally important bacterial zoonotic disease 1-3 , most commonly found in tropical or sub- tropical countries and prevalent in both urban and rural settings. In India Leptospirosis is endemic in many areas, where epidemic outbreaks occur after flooding caused by heavy seasonal rain fall. In South Gujarat, Surat and Tapi districts are reporting maxi- mum number of cases followed by Navsari and Val- sad. There were 611, 919, 156 suspected cases and 124, 178, 26 suspected deaths from Leptospirosis in 2010, 2011 and 2012 respectively from the above districts. Rodents and domestic mammals, such as cattle, pigs and dogs, serve as major reservoir hosts 4 , but Leptos- pira has been isolated from virtually all mammalian species. Infected animals may excrete Leptospires in- termittently or regularly for months or years, or for their lifetime. 4 Vaccinated animals may still shed infec- tious organisms in the urine. 4 Humans are accidental host and can become infected through contact with an environment contaminated with the urine of a shedder host, such as rodent. Leptospires gain entry into the blood stream via cuts, skin abrasions or mucous mem- branes. Leptospirosis has often been considered as an occupational disease, but recreational activities and traveling in endemic countries are also recognized as risk factors. 5 Significant exposure also occurs from normal daily activities, with high rates of infection during heavy rainfall and flooding. 6 Urban slum dwel- lers in areas with poor sanitation are at particularly high risk. 7 The spectrum of clinical presentations of human Leptospirosis ranges from asymptomatic to fatal. The majority of infections is subclinical or results in mild self-limiting systemic illness. 8 However, the case fatality rate in severe Leptospirosis may be as high as 20%. 8