{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T20:57:07Z","timestamp":1781729827557,"version":"3.54.5"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Greek Governmental Authorities","award":["A\u2032 215\/22.12.2023"],"award-info":[{"award-number":["A\u2032 215\/22.12.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In September 2023, catastrophic flooding from storms Daniel and Elias struck Thessaly, Greece. We present findings from the postflood leptospirosis outbreak investigation and key lessons for future preparedness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ad hoc active surveillance was set up to complement national notifications. We used the national case definition for leptospirosis probable and confirmed cases. Diagnostic protocols involved clinical manifestation, polymerase chain reaction (PCR), targeted sequencing (blood\/urine,) and serology. Exposure history was collected via a structured questionnaire. We performed case-series analyses, logistic regression, and receiver operating characteristic curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 3-month postflood period, 285 probable and 45 confirmed leptospirosis cases were identified. The postflood notification rate was 6.5\/100 000 population. Leptospira kirschneri and Leptospira interrogans were identified in 33 (87%) and 5 (13%) of the 38 PCR-confirmed cases, respectively. Two deaths were attributed to L interrogans. Patients with L interrogans had higher odds of hospitalization (odds ratio, 16 [95% confidence interval, 1.6\u2013159.2]), elevated creatinine (P = .03) and urea (P = .03), and lower platelet counts (P = .02). Urine PCR had the highest diagnostic yield (84%). Patients with leptospirosis reported exposure to floodwater (89%), lack of strict adherence to personal protective equipment (100%), and limited awareness of protective measures (25%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 2023 Thessaly floods led to a marked rise in leptospirosis incidence, with L interrogans linked to greater clinical severity. The outbreak highlights the need for public and healthcare workers\u2019 awareness, early diagnosis, species-specific active surveillance, and One Health strategies. Strengthening multisectoral preparedness is critical as climate change increases the risk of similar events in Europe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag301","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:36:02Z","timestamp":1778826962000},"source":"Crossref","is-referenced-by-count":0,"title":["Postflood Leptospirosis Outbreak Response Due to\n                    <i>Leptospira interrogans<\/i>\n                    and\n                    <i>Leptospira kirschneri<\/i>\n                    in Central Greece, 2023: Comparison of Laboratory and Clinical Manifestations"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8908-6709","authenticated-orcid":false,"given":"Zacharoula","family":"Bogogiannidou","sequence":"first","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly , Larissa ,","place":["Greece"]},{"name":"ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC) , Stockholm ,","place":["Sweden"]},{"name":"Directorate of Epidemiological Surveillance & Prevention of Infectious Diseases, National Public Health Organization , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-0934","authenticated-orcid":false,"given":"Ioanna","family":"Voulgaridi","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly , Larissa ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tseroni","sequence":"additional","affiliation":[{"name":"Nursing Department, National and Kapod\u03b9strian, University of Athens , Athens ,","place":["Greece"]},{"name":"Scientific Council, National Public Health Organization , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-6215","authenticated-orcid":false,"given":"Georgios","family":"Dougas","sequence":"additional","affiliation":[{"name":"Zoonoses Department, National Public Health Organization , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia D","family":"Apostolidi","sequence":"additional","affiliation":[{"name":"Zoonoses Department, National Public Health Organization , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Angelouli","sequence":"additional","affiliation":[{"name":"Zoonoses Department, National Public Health Organization , Athens 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