{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:43:37Z","timestamp":1787586217544,"version":"build-2736575974"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leptospirosis is a major cause of human disease in Fiji. However, the epidemiology is poorly defined. This study was conducted to determine the epidemiology of human leptospirosis in the Central Division and to characterize the largest urban outbreak in Fiji.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study was conducted using routine leptospirosis surveillance data collected from 1 January 2012 through 30 June 2020. Descriptive analysis was performed to evaluate changes in demographic characteristics and incidence over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2248 cases were reported over the 8.5-y study period. Average annual incidence was 73.9 cases per 100\u00a0000 population, with the annual incidence ranging from 45.6 cases per 100\u00a0000 population in 2012 to 177.2 cases per 100\u00a0000 population in 2019. Overall, most cases were indigenous Fijians (82.6%) and males (53.3%). The proportion of females increased steadily from 37.8% in 2012 to 50.3% in 2020. On 28 January 2019, an outbreak of leptospirosis was declared in the Central Division. During this outbreak, the proportion of female cases (50.5%) was higher and cases among Fijians of Indian descent also increased (18.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Study findings demonstrate changes in the epidemiology of leptospirosis in the Central Division. Increasing incidence in urban settings and among population groups previously considered low risk (female and Fijians of Indian descent) indicates shifts in risk factors and transmission patterns that warrant review of existing measures and strategies for nationwide disease control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/trstmh\/traf064","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T07:51:58Z","timestamp":1749714718000},"page":"1269-1276","source":"Crossref","is-referenced-by-count":1,"title":["Human leptospirosis in the central division of Fiji: a retrospective epidemiological study"],"prefix":"10.1093","volume":"119","author":[{"given":"Sakopo'Aonga-ki-Vavau","family":"Vaka'uta","sequence":"first","affiliation":[{"name":"School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kolosa","family":"Matebalavu","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anaseini","family":"Ratu","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2126-5302","authenticated-orcid":false,"given":"Ramneek Nadan","family":"Goundar","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aalisha","family":"Sahukhan","sequence":"additional","affiliation":[{"name":"Fiji Centre for Disease Control, Ministry of Health and Medical Services , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6103-4429","authenticated-orcid":false,"given":"Simon","family":"Reid","sequence":"additional","affiliation":[{"name":"Faculty of Health, Medicine and Behavioral Sciences, School of Public Health, University of Queensland , 266 Herston Road, Herston, QLD 4006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Singh","sequence":"additional","affiliation":[{"name":"Fiji Centre for Disease Control, Ministry of Health and Medical Services , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anaseini","family":"Vesikula","sequence":"additional","affiliation":[{"name":"Fiji Centre for Disease Control, Ministry of Health and Medical Services , Princess road, Tamavua, Suva ,","place":["Fiji"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin P","family":"Howden","sequence":"additional","affiliation":[{"name":"Microbiological Diagnostic Unit, University of Melbourne at the Peter Doherty Institute for Infection and Immunity , 792 Elizabeth Street, Melbourne, VIC 3000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8425-6497","authenticated-orcid":false,"given":"Aneley","family":"Getahun Strobel","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji National University , Princess road, Tamavua, Suva ,","place":["Fiji"]},{"name":"University of Melbourne at the Peter Doherty Institute for Infection and Immunity Department of Microbiology and Immunology, , 792 Elizabeth Street, Melbourne, VIC 3000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"issue":"9","key":"2025110306000272100_bib1","doi-asserted-by":"crossref","first-page":"e0003898","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global morbidity and mortality of leptospirosis: a systematic review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"2025110306000272100_bib2","doi-asserted-by":"crossref","first-page":"e0006503","DOI":"10.1371\/journal.pntd.0006503","article-title":"A systematic review of human and animal leptospirosis in the Pacific Islands reveals pathogen and reservoir diversity","volume":"12","author":"Guernier","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"2025110306000272100_bib3","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ijid.2007.09.011","article-title":"The globalization of leptospirosis: worldwide incidence trends","volume":"12","author":"Pappas","year":"2008","journal-title":"Int J Infect Dis"},{"issue":"2","key":"2025110306000272100_bib4","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001","journal-title":"Clin Microbiol Rev"},{"issue":"7","key":"2025110306000272100_bib5","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.trstmh.2007.02.022","article-title":"Multicentre survey of incidence and public health impact of leptospirosis in the Western Pacific","volume":"101","author":"Berlioz-Arthaud","year":"2007","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"10","key":"2025110306000272100_bib6","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.trstmh.2010.07.002","article-title":"Climate change, flooding, urbanisation and leptospirosis: fuelling the fire?","volume":"104","author":"Lau","year":"2010","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"5","key":"2025110306000272100_bib7","doi-asserted-by":"crossref","first-page":"e0217643","DOI":"10.1371\/journal.pone.0217643","article-title":"Risk factors for human leptospirosis following flooding: a meta-analysis of observational studies","volume":"14","author":"Naing","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"2025110306000272100_bib8","doi-asserted-by":"crossref","first-page":"e0247763","DOI":"10.1371\/journal.pone.0247763","article-title":"Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000-2015","volume":"16","author":"Galan","year":"2021","journal-title":"PLoS One"},{"issue":"9181","key":"2025110306000272100_bib9","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S0140-6736(99)80012-9","article-title":"Urban epidemic of severe leptospirosis in Brazil","volume":"354","author":"Ko","year":"1999","journal-title":"Lancet"},{"key":"2025110306000272100_bib10","volume-title":"Report of the second meeting of the Leptospirosis Burden Epidemiology Reference Group","author":"World Health Organization","year":"2011"},{"key":"2025110306000272100_bib11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/1471-2334-9-147","article-title":"Leptospirosis in the Asia Pacific region","volume":"9","author":"Victoriano","year":"2009","journal-title":"BMC Infect Dis"},{"issue":"12","key":"2025110306000272100_bib12","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.3201\/eid1812.120429","article-title":"Leptospirosis, diagnostic challenges, American Samoa","volume":"18","author":"Lau","year":"2012","journal-title":"Emerg Infect Dis"},{"issue":"3","key":"2025110306000272100_bib13","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/tmi.13965","article-title":"Global distribution of Leptospira serovar isolations and detections from animal host species: a systematic review and online database","volume":"29","author":"Hagedoorn","year":"2024","journal-title":"Trop Med Int Health"},{"key":"2025110306000272100_bib14","volume-title":"Population and housing census 2017","author":"Fiji Islands Bureau of Statistics","year":"2018"},{"key":"2025110306000272100_bib15","volume-title":"The Fiji Islands health system review","author":"Roberts","year":"2011"},{"key":"2025110306000272100_bib16","volume-title":"Communicable diseases surveillance and outbreak management guidelines","author":"Fiji Ministry of Health and Medical Services","year":"2016"},{"key":"2025110306000272100_bib17","first-page":"8","article-title":"Leptospirosis in Fiji: incidence between 2000 to 2007 and review of literature","volume":"29","author":"Ghosh","year":"2010","journal-title":"Fiji Med J"},{"issue":"1","key":"2025110306000272100_bib18","doi-asserted-by":"crossref","first-page":"e0004405","DOI":"10.1371\/journal.pntd.0004405","article-title":"Human leptospirosis infection in Fiji: an eco-epidemiological approach to identifying risk factors and environmental drivers for transmission","volume":"10","author":"Lau","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"2025110306000272100_bib19","first-page":"71","article-title":"Further observation on the epidemiology of leptospirosis in Fiji","volume":"10","author":"Ram","year":"1982","journal-title":"Fiji Med J"},{"key":"2025110306000272100_bib20","volume-title":"Republic of Fiji vital statistics report 2016\u20132021","author":"Fiji Islands Bureau of Statistics","year":"2024"},{"key":"2025110306000272100_bib21","first-page":"30","article-title":"Animal leptospirosis in the Federated States of Micronesia","volume":"5","author":"Simms","year":"1997","journal-title":"Pac Health Dialog"},{"key":"2025110306000272100_bib22","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/1471-2334-14-186","article-title":"Human leptospirosis in the Federated States of Micronesia: a hospital-based febrile illness survey","volume":"14","author":"Colt","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2025110306000272100_bib23","volume-title":"Animal & human leptospirosis in a high transmission setting in Fiji","author":"Togami","year":"2016"},{"issue":"4","key":"2025110306000272100_bib24","doi-asserted-by":"crossref","first-page":"849","DOI":"10.4269\/ajtmh.18-0335","article-title":"A large leptospirosis outbreak following successive severe floods in Fiji, 2012","volume":"99","author":"Togami","year":"2018","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"2025110306000272100_bib25","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/S1473-3099(19)30075-1","article-title":"Infection disease surveillance update","volume":"19","author":"Zwizwai","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2025110306000272100_bib26","article-title":"Leptospirosis in Fiji: a lethal bacteria poorly understood","author":"Nataro","year":"2022"},{"key":"2025110306000272100_bib27","volume-title":"Annual report, 2019\u20132020","author":"Fiji Ministry of Health and Medical Services","year":"2020"},{"issue":"2","key":"2025110306000272100_bib28","first-page":"133","article-title":"[Laboratory based human leptospirosis surveillance in New Caledonia (2001\u20132005)]","volume":"100","author":"Berlioz-Arthaud","year":"2007","journal-title":"Bull Soc Pathol Exot"},{"issue":"4","key":"2025110306000272100_bib29","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1177\/1010539516640350","article-title":"Human leptospirosis in Malaysia: reviewing the challenges after 8 decades (1925\u20132012)","volume":"28","author":"Benacer","year":"2016","journal-title":"Asia Pac J Public Health"},{"issue":"11","key":"2025110306000272100_bib30","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1086\/324084","article-title":"Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974\u20131998","volume":"33","author":"Katz","year":"2001","journal-title":"Clin Infect Dis"},{"issue":"11","key":"2025110306000272100_bib31","doi-asserted-by":"crossref","first-page":"e0242886","DOI":"10.1371\/journal.pone.0242886","article-title":"Age-specific epidemiology of human leptospirosis in New Caledonia, 2006\u20132016","volume":"15","author":"Klement-Frutos","year":"2020","journal-title":"PLoS One"},{"key":"2025110306000272100_bib32","first-page":"70","article-title":"Epidemiology of leptospirosis in Fiji","volume":"6","author":"Ram","year":"1978","journal-title":"Fiji Med J"},{"issue":"1","key":"2025110306000272100_bib33","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5365\/wpsar.2012.3.4.006","article-title":"Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji","volume":"4","author":"Greenwell","year":"2013","journal-title":"Western Pac Surveill Response J"},{"key":"2025110306000272100_bib34","doi-asserted-by":"crossref","first-page":"100915","DOI":"10.1016\/j.onehlt.2024.100915","article-title":"A review of risk factors at the human-animal-environmental interface of garbage dumps that are driving current and emerging zoonotic diseases","volume":"19","author":"Sangkachai","year":"2024","journal-title":"One Health"},{"issue":"4","key":"2025110306000272100_bib35","doi-asserted-by":"crossref","first-page":"e228","DOI":"10.1371\/journal.pntd.0000228","article-title":"Impact of environment and social gradient on Leptospira infection in urban slums","volume":"2","author":"Reis","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"2025110306000272100_bib36","doi-asserted-by":"crossref","first-page":"e0002400","DOI":"10.1371\/journal.pgph.0002400","article-title":"Quantifying the relationship between climatic indicators and leptospirosis incidence in Fiji: a modelling study","volume":"3","author":"Rees","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2025110306000272100_bib37","volume-title":"Clinical guidelines for diagnosis and management of leptospirosis in Fiji","author":"Fiji Ministry of Health and Medical Services","year":"2016"},{"issue":"16","key":"2025110306000272100_bib38","doi-asserted-by":"crossref","first-page":"9003","DOI":"10.3390\/su13169003","article-title":"Understanding traditional healing practices and the categories of practices from Fijian iTaukei's perspectives","volume":"13","author":"Orcherton","year":"2021","journal-title":"Sustainability"},{"issue":"1","key":"2025110306000272100_bib39","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/101053959000400104","article-title":"Pattern of medical care services utilization in Fiji","volume":"4","author":"Tomari","year":"1990","journal-title":"Asia Pac J Public Health"},{"issue":"1","key":"2025110306000272100_bib40","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1017\/S0950268812001951","article-title":"Enzyme-linked immunosorbent assay to diagnose human leptospirosis: a meta-analysis of the published literature","volume":"141","author":"Signorini","year":"2013","journal-title":"Epidemiol Infect"},{"issue":"8","key":"2025110306000272100_bib41","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1128\/jcm.35.8.1938-1942.1997","article-title":"Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in diagnosis of human leptospiral infection","volume":"35","author":"Winslow","year":"1997","journal-title":"J Clin Microbiol"},{"issue":"6","key":"2025110306000272100_bib42","doi-asserted-by":"crossref","first-page":"e0129236","DOI":"10.1371\/journal.pone.0129236","article-title":"Diagnosis of leptospirosis: comparison between microscopic agglutination test, IgM-ELISA and IgM rapid immunochromatography Test","volume":"10","author":"Niloofa","year":"2015","journal-title":"PLoS One"},{"key":"2025110306000272100_bib43","volume-title":"Annual report 2015","author":"Fiji Ministry of Health and Medical Services","year":"2016"},{"key":"2025110306000272100_bib44","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1186\/s12889-017-4673-1","article-title":"A process for developing multisectoral strategies for zoonoses: the case of leptospirosis in Fiji","volume":"17","author":"Reid","year":"2017","journal-title":"BMC Public Health"},{"issue":"2","key":"2025110306000272100_bib45","doi-asserted-by":"crossref","first-page":"31","DOI":"10.5365\/wpsar.2018.9.3.001","article-title":"Dengue in Fiji: epidemiology of the 2014 DENV-3 outbreak","volume":"10","author":"Getahun","year":"2019","journal-title":"Western Pac Surveill Response J"},{"issue":"12","key":"2025110306000272100_bib46","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/trstmh\/trz075","article-title":"A retrospective study of patients with blood culture-confirmed typhoid fever in Fiji during 2014\u20132015: epidemiology, clinical features, treatment and outcome","volume":"113","author":"Getahun","year":"2019","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"10","key":"2025110306000272100_bib47","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/tmi.12367","article-title":"Typhoid fever in Fiji: a reversible plague?","volume":"19","author":"Thompson","year":"2014","journal-title":"Trop Med Int Health"},{"issue":"2","key":"2025110306000272100_bib48","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4269\/ajtmh.21-0771","article-title":"Assessment of rapid diagnostic tests for typhoid diagnosis and assessment of febrile illness outbreaks in Fiji","volume":"106","author":"Getahun Strobel","year":"2021","journal-title":"Am J Trop Med Hyg"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/11\/1269\/63649864\/traf064.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/11\/1269\/63649864\/traf064.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T11:00:18Z","timestamp":1762167618000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/119\/11\/1269\/8182864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,3]]},"references-count":48,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,7,3]]},"published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/traf064","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,7,3]]}}}